Text in Afrikaans / Summaries in Afrikaans and English / Vigs is 'n "sluipende moordenaar "_ Dit toon geen respek vir kultuur, status,ouderdom of geslag nie. Vigs veroorsaak 'n onnnatuurlike dood wat vriende en familie bedreig en vervreem, lank na die dood van die vigsslagoffer. Die navorsingsdoel van hierdie studie was om riglyne daar te stel vir die psigoterapeutiese hantering van die vigslyer en sy gesin. Die navorsing het getoon dat 'n stigma en skuldgevoelens rondom die vigslyer en sy gesin ontstaan het, en dat hulle direk verantwoordelik gehou word vir die siekte bloot omdat hulle betrokke is by mekaar. 'n Vraelys wat aspekte (soos dit uit die literatuurstudie geblyk het) inkorporeer, is opgestel en aan die vigslyer en sy gesin gegee om te voltooi. Van die belangrikste elemente wat na vore gekom het, is die vrees vir die onbekende, die stigma verbonde aan die siekte en die pad wat die siekte loop ten opsigte van naiwiteit en valse gerugte ten opsigte van die siekte. 'n Verdere hoofstuk fokus op die literatuur om die hoofaspekte van die probleem vas le stel, en sodoende riglyne vir 'n terapieprogram daar te stel om die vrese te onderskep en die familie te help om die siekte beter te begryp_ Die doel is om die samelewing te laat begryp dat vigs nie 'n kulturele of "klas" siekte is nie, maar dat dit alle lae van die samelewing kan tref. 'n Afdeling is gewy aan 'n wye verskeidenheid terapeutiese tegnieke wat geimplimenteer kan word tydens hulpverlening aan die vigslyer en sy gesinslede. Verder verskaf hierdie studie ook riglyne om ondersteuning en hulp aan die vigslyer en sy gesin te bied, om sodoende hulle selfkonsep te verbeter. / Aids is a "stalking killer''. It has no respect for culture, breeding, age or sex. It is an unnatural death which offends and alienates many friends and family, even after the victim has died. A questionnaire incorporating important aspects of the cause and effect of aids was compiled and given to the aids sufferers and family to complete. From the responses it was clearly evident that the fears of the unknown, the stigma attached to the victim's close associates and family, was a problem, and the route course of incredible naive and false rumours. A chapter of the research focused on literature to establish what was the major aspects of the problem expressed by the media. Guidelines were provided whereby therapy could address and allay these fears to assist the family to better understand the illness and it's effects. This chapter has in mind to provide the Psychologist with guidelines to provide therapy to both the victim and the family in this regard. This study confirms that the survivors are the actual victims. / Educational studies / M.Ed. (Voorligting)

The present study explored the interaction between paediatric asthma and family functioning, within the context of family systems theory. Eight families, each with an asthmatic child between the ages of 8 and 15, were included in this study. In each case, the parents were interviewed and completed a quantitative measure, the Family Assessment Device, The results indicated that each family has a unique way of functioning and of integrating the child's asthma into its lifestyle. Factors found to be involved in the mutual impact of paediatric asthma and family functioning were the size of the family, the severity of the child's condition, the ways in which the family copes with the stress of asthma, communication patterns between parents, compliance with family rules and boundaries, and the affective responsiveness and involvement of family members. / Psychology / M.A. (Psychology)

This study aimed at exploring chronic illness from both the perspectives of the patient, living with the illness and the professional, treating the illness. The epistemological framework is social constructionism. Qualitative research was selected as the research approach. Three in-depth interviews with three patients, suffering with a chronic illness were conducted, as well as three interviews with professionals, who had experience with patients diagnosed with chronic illnesses. Thematic analysis was the method used for the analysis of data. The stories of the participants were reconstructed in terms of themes. A comparative analysis for both participants groups was done, and linked to the relevant literature This study created an understanding of the complexity of chronic illness. The themes identified, highlighted the importance of the patient-professional relationship, specifically in the context of chronic illness. / Psychology / M.A. (Clinical Psychology)

Les systèmes de santé accordent une attention croissante au point de vue des usagers dans l’organisation de l’offre de soins. L’instauration d’une offre de soins sensible aux besoins et préférences des patients constitue un enjeu majeur de qualité et d’efficacité des soins. Ce travail analyse le point de vue des patients pour l’offre de soins de médecine générale en utilisant différentes méthodes permettant d’obtenir des informations complémentaires en termes d’expérience de soins, de satisfaction, d’importance ou encore de préférences. Il s’agit des méthodes Delphi, de classement du meilleur au pire et de révélation des préférences par les choix discrets. Ces méthodes sont appliquées sur deux échantillons : en population générale pour la première et chez des patients poly-pathologiques pour les 2 autres afin d’identifier les principaux enjeux actuels et à venir de la réorganisation de l’offre de soins de médecine générale du point de vue des patients. Les résultats montrent le rôle central de la relation médecin-patient et plus particulièrement de l’échange d‘informations entre le médecin et le patient. Cependant une relation médecin-patient de qualité ne doit pas pour autant être réalisée au détriment de la qualité technique du soin et de la coordination de la prise en charge du patient. Ce travail montre également l’importance de prendre en compte l’expérience de soins des patients lors de l’analyse de leur point de vue, et plus particulièrement de leur disposition au changement. L’évaluation systématique et régulière des préférences des patients en pratique quotidienne peut permettre d’améliorer la communication médecin-patient ainsi que le contenu de l’offre de soins du point de vue des patients. / The healthcare systems are paying a great interest to the patients’ perspective for the organization of health care provision. Healthcare system which is accountable and responsive of patients’ needs and preferences is a major issue for the quality and efficiency of care. In this thesis, we analyze the views of patients for the supply of GP care in using different complementary methods about patients’ experience, satisfaction, importance or preferences. These methods are applied to a sample of patients in GP and to a sample of chronically ill patients in order to identify current and future major issues for the reorganization of GP care from the patients’ perspective. The results show the main role of the doctor-patient relationship and especially of the information exchange between doctor and patient and between patient and doctor. However the quality of the doctor-patient relationship is not enough. The technical quality of care (i.e. thoroughness) and the coordination are of high importance for patients. This work highlights that it is necessary to take into account the patients’ experiences in the analysis of their perspective (e.g. preferences) to fully and appropriately understand the results, especially in terms of willingness to change. The systematic and regular screening of patient preferences in daily GP practice can improve the doctor-patient communication and the content of the provision of care from the perspective of patients.

The present study explored the interaction between paediatric asthma and family functioning, within the context of family systems theory. Eight families, each with an asthmatic child between the ages of 8 and 15, were included in this study. In each case, the parents were interviewed and completed a quantitative measure, the Family Assessment Device, The results indicated that each family has a unique way of functioning and of integrating the child's asthma into its lifestyle. Factors found to be involved in the mutual impact of paediatric asthma and family functioning were the size of the family, the severity of the child's condition, the ways in which the family copes with the stress of asthma, communication patterns between parents, compliance with family rules and boundaries, and the affective responsiveness and involvement of family members. / Psychology / M.A. (Psychology)

This study aimed at exploring chronic illness from both the perspectives of the patient, living with the illness and the professional, treating the illness. The epistemological framework is social constructionism. Qualitative research was selected as the research approach. Three in-depth interviews with three patients, suffering with a chronic illness were conducted, as well as three interviews with professionals, who had experience with patients diagnosed with chronic illnesses. Thematic analysis was the method used for the analysis of data. The stories of the participants were reconstructed in terms of themes. A comparative analysis for both participants groups was done, and linked to the relevant literature This study created an understanding of the complexity of chronic illness. The themes identified, highlighted the importance of the patient-professional relationship, specifically in the context of chronic illness. / Psychology / M.A. (Clinical Psychology)

Indiana University-Purdue University Indianapolis (IUPUI) / The presence of a chronic pain condition can have a profound impact on one’s self-concept. Some individuals may have had to make major lifestyle changes. As a result, some people may start to define themselves in terms of their pain, such that their self-schema and pain-schemas become intertwined in a process termed schema-enmeshment. It is thought that schema-enmeshment is related to psychological distress making it a prime target for intervention. Little research has been conducted on interventions to reduce schema-enmeshment. Acceptance-based interventions may be especially appropriate in reducing schema-enmeshment or the connection between self and illness symptoms as these interventions tend to emphasize learning to live with pain and other symptoms and to work toward important life goals rather than continually fighting against the condition and allowing it to control their life. This study is a randomized trial comparing Acceptance and Commitment Therapy (ACT) to education about pain management in a sample of women with Fibromyalgia Syndrome (FMS). The primary aim of this study was to assess the efficacy of ACT in reducing schema-enmeshment between self and pain, as well as enmeshment between self and other symptoms and FMS as a whole. In addition, this study also explored the role of pain acceptance, specifically activity engagement as a mediator of the relationship between treatment group membership and changes in schema-enmeshment. The data was analyzed as an intent-to-treat analysis using the “last measure carried forward” method. Results indicated that the ACT group reported statistically significant differences in self schema-enmeshment with FMS, fatigue, and cognitive symptoms, but not with pain, following the intervention, compared to the educational control group. In each of these cases, the ACT group experienced greater reductions in schema-enmeshment compared to the education group. Interestingly, no statistically significant differences were observed for schema-enmeshment with pain. Statistically significant group differences were also observed for acceptance of pain following the intervention. Finally, a mediational model in which changes in activity engagement (a form of pain acceptance) served as the mediator of the relationship between treatment group and changes in schema-enmeshment with FMS was tested. The model was tested using a bootstrapping method, and results revealed a trend toward a significant indirect effect of changes in activity engagement leading to changes in schema-enmeshment with FMS. Taken together, the results of this study indicate that ACT may be a promising intervention for targeting maladaptive beliefs about the self in relation to illness, especially schema-enmeshment of self with illness and illness symptoms. Additionally, there is evidence that ACT may target key constructs such as activity engagement, which may be related to other cognitive and behavioral changes. Future directions for research and clinical practice related to ACT as an intervention for FMS are discussed in depth.

Indiana University-Purdue University Indianapolis (IUPUI) / Stroke is the main cause of disability in the United States. Individuals with stroke commonly report sensory impairment affects their recovery. Motor recovery and sensory impairment are related and impact individuals’ ability to perform valued occupations. Despite the prevalence of sensation impairment after stroke, many occupational therapists fail to include sensation assessment and intervention in treatment planning. The exclusion of sensation in occupational therapy interventions during stroke rehabilitation may be due to the lack of literature supporting the association between sensation and occupational performance. The current study aimed to determine the relationship between touch sensation of the affected hand and occupational performance and satisfaction in individuals with chronic stroke. Using a cross-sectional study design, this study associated factors related to hand sensation and function in individuals with chronic stroke. Fifty individuals with chronic stroke participated in a one-time testing session in which assessments related to sensation, movement of the hand and engagement in daily activities were administered. Correlation analyses were utilized to determine relationships between touch sensation of the affected hand with individuals’ abilities to engage in valued daily activities, arm and hand disability, and manual abilities. The main finding of the study was that individuals with intact sensation reported greater ability to perform valued occupations and satisfaction with their performance, as compared with individuals with touch sensation impairment. For individuals with impaired touch sensation of the affected hand, impairment of touch sensation of the hand did not correlate with individuals’ performance or satisfaction with valued occupations, arm or hand movement, or manual abilities. Collectively, the results of this study reflect the complex interaction between touch sensation, occupational performance, motor functioning, and manual abilities of the affected hand for individuals’ who have experienced a stroke. This study informs therapists, rehabilitation scientists, and other healthcare professionals that client-centered, individualized approaches, including a wide array of clinical assessments and intervention, including assessment of occupational performance and sensation, remain important components in stroke rehabilitation.

Managed care plans purport to improve the health of their members with chronic diseases. How has the growing adoption of Medicare Advantage (MA), the managed care program for Medicare beneficiaries, affected the progression of chronic disease? The literature is rich with articles focusing on managed care organizations' impacts on quality of care, access, patient satisfaction, and costs. However, few studies have analyzed these impacts with respect to market penetration of Medicare managed care. The objective of this research has been to analyze the relationships between the market penetration of MA plans and the progression of chronic diseases among Medicare beneficiaries. The Chronic Disease Severity Index scale (CDSI) was constructed to represent beneficiaries' overall chronic disease states for survey or claims-based data, when more direct clinical measures of disease progression are not available. Using the CDSI on the MEPS survey dataset from AHRQ, we sought to assess the impacts of MA market penetration and other covariates on the overall chronic disease state of Medicare beneficiaries from 2004 through 2008. Though the model explains much of the variation in CDSI change, the author expected the multilevel model would show that MA penetration explains a significant level of variation in CDSI change. However, this hypothesis was not substantiated, and the findings suggest that unmeasured factors may be contributing to additional unexplained heterogeneity. Policymakers should explore opportunities to refine the current MA program. The MA program costs the federal government more than the Traditional Fee-for-Service Medicare program, and there is no definitive evidence that outcomes differ. Within both programs, there is opportunity to experiment with different models of payment, healthcare service delivery and care coordination. The Patient Protection and Affordable Care Act (ACA) contains provisions for innovative demonstration projects in delivery and payment. The effectiveness of these ACA initiatives must be monitored, both for impacts on health outcomes and for economic effects. This research can inform future approaches to outcomes assessment using the CDSI, and multilevel modeling methodologies similar to those employed here. Firms offering MA health plans would be prudent to proactively demonstrate their value to beneficiaries and taxpayers. They should explore means of better monitoring and reporting the longitudinal outcomes of their enrolled beneficiaries. Demonstrating that they can bring value in terms of improved health outcomes will help insure their long-term survival, both in the marketplace and in the political arena. / Graduation date: 2012