Faculty of Humanities School of Human and Comminity Development 9611126v gs_mckenzie@hotmail.com / The primary aim of this study was to identify and assess the type of, and level of emotional and psychological support offered by home-based caregivers within a Home Community-Based Care Programme, and to explore the type of issues that home-based caregivers are dealing with on a day-to-day basis. A secondary aim of this study was to evaluate and determine the level of emotional and psychological support that is being offered and received by home-based caregivers themselves, as well as the type of training that they receive. Data was collected using the semi-structured interview method of data collection from a sample of 16 participants. The data was analysed using both quantitative and qualitative techniques. The main findings were that the emotional and psychological services being offered by the participating home-based caregivers to the beneficiaries/clients of the Tapologo HIV/AIDS Programme were adequate, and included the following services: providing emotional support, spiritual support, basic counselling skills such as active listening and empathy, providing pre and post-test counselling, and psychoeducation. These services are offered primarily on an individual basis, although evidence for group support being used was also indicated. Issues that the participating home-based caregivers are having to deal with on a day-to-day basis included addressing both the physical and emotional needs of clients, and helping patients to accept their illness and disease as well as dealing with the subsequent loss/losses. The type of emotional and psychological support received by the participating home-based caregivers themselves was suggested to be provided from both within and outside of the programme. The provision of support provided from within the programme was provided by the social worker/s, the sister/s in charge, the church, counsellors at Lifeline, supervisors, and colleagues. The types of emotional and psychological support received by these service providers included general counselling and emotional support, debriefing, supervision, psychoeducation, and spiritual support. Emotional support provided outside of the programme included support from family members and friends. Finally, a holistic approach to training was indicated from the data. The types of emotional and psychological training received include the provision of basic counselling skill, psychoeducational skills, and training in self-care.

Diabetes mellitus is a common chronic disease that affects approximately 382.8 million people worldwide. Globally, the Kingdom of Saudi Arabia (KSA) has the seventh highest prevalence of diabetes, with over one-fifth of the Saudi population diagnosed with diabetes. Poor understanding and low health awareness, in parallel with lifestyle choices are considered the main components behind the increase of diabetes and diabetes-related complications in KSA. There is also a lack of diabetes speciality centres, especially in remote areas of KAS. Moreover, diabetes management becomes more complicated during the Ramadan month because people observe fasting throughout the month. The month long fasting process complicates the disease status of Saudi diabetic patients with potential complications post the fasting period. In this thesis, we present the design and development of a novel and intelligent mobile diabetes management system tailored for type 2 diabetic (T2D) patients in Saudi Arabia with the focus on the integration of educational and compliance issues, which we name as the SAED system. The system was validated in two preliminary pilots in the Kingdom, one pilot being specifically dsigned to evaluate the system for diabetic patient during Ramadan fasting month. The outcomes of the clinical pilot indicated the clear effectiveness of the SAED system in lowering the HbA1c levels. The system was tested for its performance through a randomized control trial on 20 diabetic patients for a period of six months in Kingdom of Saudi Arabia. The outcomes of the pilot study showed improvements in the HbA1c levels of patients and also significant improvements in diabetes knowledge amongst the patients. The HbA1c levels of the diabetic patients in the SAED intervention group decreased from 8.76% to 7.85%. The diabetic knowledge test outcomes of the diabetic patients in the SAED intervention group significantly improved from 46.20% to 61.10%. Further, our study also tested the SAED system on diabetic patients during the Ramadan period. This is important because fasting is observed during the Ramadan month which can significantly affect the diabetes management and diagnosis amongst the patients. The study for the Ramadan period was conducted on another 20 patients using the similar approach described above. The results from the clinical trial indicated significant reductions in the number of hypoglycaemic and hyperglycaemic events during the month of Ramadan in patients who used the SAED system. The diabetes knowledge test outcomes also significantly rose from 44.60% to 64.10%. The SAED system for diabetes management using mobile technologies in KSA has been proven to be successful in improving the diagnosis and management of diabetes amongst the patients. The SAED system offers an inexpensive, practically feasible solution for diabetes self-management in KSA. Considering the social, economic, and political conditions in KSA, the SAED system can enhance the quality of healthcare provided to patients, lead to better utilization of resources, provide timely interventions, and improve the overall quality of life of diabetic patients and their family and friends.

The number of patients diagnosed with long term conditions in the UK is increasing with an expected number of 18 million patients by 2018, responsible for 69% of all spending on health and social care in England. These challenges cannot be solved solely by conventional approaches and other alternatives, such as cost-effective technological solutions, must be considered to increase patient's independence and quality of life, and produce cost savings for the authorities. This practice-based research explored the potential role of technologies in the care of patients with long term conditions, and aimed to evaluate the acceptance and effectiveness of a telehealth service provided to patients' with chronic obstructive pulomary disease and heart failure; to map and compare chronic obstructive pulmonary disease care pathways between different EU countries to better understand how technologies fit within the standard forms of care; to explore how m-health interventions can be developed and designed to support the care of cancer patients and survivors; and to provide data on UK cancer patients' ownership of and interest in m-health technologies. Mixed-mthod research approach was used in this study with a mixture of face-to-face and email semi-structured interviews, postal and online questionnaires, and data extraction from available databases. This approach was selected to harness the strengths of, both quantitative and qualitative methodologies. Seven nurses, working on telehealth for an average of 15 months were interviewed. Lack of resources and organisational support, patient selection criteria, and technological support were identified as barriers for effective implementation of telehealth. Telehealth reduced the number of both A&E and hospital admissions by 36% (P=0.03) and 28% (P=0.02), respectively. 27 patients responded to the postal questionnaire and were very satisfied with the service. They agreed that telehealth had improved their health, was a convenient form of healthcare delivery for them, and that it made them more involved in the decisions about their care or treatment. Five COPD-specialised HCPs were interviewed, and the COPD care pathway was compared between 5 EU countries including Germany, Greece, Ireland, Netherlands and England. Lack of communication among different healthcare providers managing COPD and co-morbities is a common feature of the studies care pathways. In all countries, the lifestyle management services provided were similar with no specific tools used to enhance patients' adherance, and no specified role/training existing for informal carers (partners, family & friends). Telehealth can play a role int he integrated care of long tem conditions by providing means communication allowing better communications between different healthcare providers managing LTCs and co-morbidities. Next, the role of m-health in cancer care was explored. A need for m-health platforms to support cancer patients and survivors was identified, and two m-health platforms were developed and designed using patient's centred approach and Waterfall system development model. MyAppPal and CanAdvice+ were designed to support colorectal cnacer srvivors set up on follow-up care plans and cancer patients receiving oral chemotheraphy at home, respectively. 12 colorectal cancer patients were interviewed and 69 patients responded to the postal questionnaire. Patients expereince with the support provided during follow up plan varied based on appointment type and location. They had problems remembering or accessing information as they moved away from their treatment, and reported needs for more specific and personalised information, more information on how to handle financial difficulties and social care, and more control over their hospital appointments. The usability scores of the developed apps were very positive, and they were seen as simple and attractive to use, and had very positive learnability and usability scores. Finally, 529 cancer patients completed surveys to assess their ownership of smart-technologies and interest in m-health apps. 90.5% of the patients had access to smartphone, tablet or both, and only patients' age significantly affected this ownership. Almost half of the patients showed an interest in the use of m-health apps, and two out of five were willing to download apps in were made available from the hospital. Five factors were found to significantly predict patients' willingness to use and download health applications, including age, health literacy, previous use of apps in general and health apps in particular, and previous use of smartphones/tablets to access related health information in the past six months. Ownership of smart-technologies and interest in m-health apps was independent from all other socio-economic factors. Technologies seem to be acceptable to patients with long term conditions, and can play an important role in improving their clinical outcomes if well designed, introduced, implemented and managed. Patients' perceptions of the usefulness and ease of use of these technologies seem to be a crucial factor in their acceptance of such interventions.

Ecotourism emerged as an alternative form of tourism in the 1990s to mitigate the faults of conventional (mass) tourism in meeting the needs of sustainable development. It has since become widespread in Thailand and is adopted not only in natural areas but also in rural communities. Key elements of ecotourism include a focus on ecological resources, sustainable management, environmental education, and community participation. Community participation receives a high degree of consideration among developers in Thailand. Ecotourism (ET) is seen to support this concept and is increasingly geared in the direction of social development. These trends form the backdrop to this study on community participation in ecotourism development. The study applies a triangulation methodology to collect data by combining both qualitative and quantitative methods, combining theory and empirical study to analyse the context of how local people have participated in ecotourism development. The study pays particular attention to the practices and opinions of local people in recognition of communities' rights and responsibilities in controlling their own development. The empirical study was carried out at two levels, including a general survey by postal questionnaire (thirty-one respondents) and in-depth study in four areas (Umphang, Khiriwong, Sasom and Tha Madua). The research merges theory and practice into an analysis and empirical presentation throughout the study. Theoretically, the thesis is informed by political economy and political ecology approaches, together with the concept of participation in community development and tourism development models. The research found that many communities achieve a degree of self-management in offering tourism services such as homestays, guided tours, cultural performances and cultural products. Community ecotourism organisations have been established in most communities in order to serve these new activities and to create a collective management process. Similarities in pattern and differentiation in practices among many communities were supported by different outside initiatives, developed according to similar aims and involving similar processes, but there is no uniformity or single model that is effectively applied to all communities. One significant barrier for local communities to take a major role in ecotourism is the access to ecotourism resources, which are mostly located in protected areas and are controlled by state agencies. This has led them to promote primarily their own cultural resources. Consequently, these practical changes have led to a transformation of the dominant development concept from Ecotourism (ET) to Community-based Ecotourism (CBET). Results also show that most practices involve a level of cooperation in decision-making and action with other stakeholders who are in a better position to run tourism businesses. It is difficult for local communities to be empowered to control the whole situation, which is sometimes claimed to be the ultimate goal level of local participation. The demands of marketing and conflict in management among local people, together with the limitations in accessing natural resources, are the weakest points of and constraints on the communities. To deal with these limitations, communities try to create relationships with outsiders. To develop better management of community tourism, many communities rely on help and support from outside, especially from government agencies. This, however, impels the community to become dependent on outsiders. It is also hard for communities to generate a high level of income offering basic services, since there are many levels of demand from different types of ecotourists. In summary, the main contributions of this study are: an understanding of community tourism in Thailand; the experiences of ecotourism development in the community from the leading case studies; directions, roles and responsibilities of actors and community organisations in particular; a range of options for community action in support of a more participatory process in ecotourism development. Last but not least is a set of recommendations for community-based ecotourism development from the level of policy application to practical improvement at the community level.

The thesis contends that holistic, community-based treatment is preferable to carceral options for offenders with fetal alcohol conditions, presents emerging support for this contention, identifies barriers to the implementation of community-based treatment, and culminates with analyses of ways of influencing policy reform or of legally mandating non-carceral treatment options. Potential avenues that will be examined include:<P> &bull;&#x00A0;&#x00A0; Charter of Rights and Freedoms, s. 15, including an analysis from Eldridge, Law, and Auton, based on the duty to accommodate disabilities;<BR> &bull;&#x00A0;&#x00A0; Constitution Act, 1982, s. 35 and its recognition and affirmation of such relevant treaty right as the alcohol ban, particularly as the ban operates as a contextual factor in a s. 15 Charter analysis as applied to affected treaty beneficiaries; and<BR> &bull;&#x00A0;&#x00A0; Articles 23, 24 and 40 of the Convention on the Rights of the Child, and Article 12(1) of the International Covenant on Economic, Social and Cultural Rights, particularly as they influence the s. 1 analysis under the Charter. <P> A remedy mandating a positive state obligation to provide community-based treatment likely would require favourable cost-benefit analyses, as well as evidence of effectiveness of the treatment (the latter to be studied in a subsequent interdisciplinary Ph.D. program using qualitative research techniques). The implications of a finding of disability and mental disorder related to fetal alcohol conditions will be examined. The present research topic is at the interface of health and justice, and indeed is multidisciplinary in nature as fetal alcohol influences every aspect of affected individuals' lives. Moreover, the problem is situated in its historical, ideological, global, and trans-disciplinary context.

The thesis contends that holistic, community-based treatment is preferable to carceral options for offenders with fetal alcohol conditions, presents emerging support for this contention, identifies barriers to the implementation of community-based treatment, and culminates with analyses of ways of influencing policy reform or of legally mandating non-carceral treatment options. Potential avenues that will be examined include:<P> &bull;&#x00A0;&#x00A0; Charter of Rights and Freedoms, s. 15, including an analysis from Eldridge, Law, and Auton, based on the duty to accommodate disabilities;<BR> &bull;&#x00A0;&#x00A0; Constitution Act, 1982, s. 35 and its recognition and affirmation of such relevant treaty right as the alcohol ban, particularly as the ban operates as a contextual factor in a s. 15 Charter analysis as applied to affected treaty beneficiaries; and<BR> &bull;&#x00A0;&#x00A0; Articles 23, 24 and 40 of the Convention on the Rights of the Child, and Article 12(1) of the International Covenant on Economic, Social and Cultural Rights, particularly as they influence the s. 1 analysis under the Charter. <P> A remedy mandating a positive state obligation to provide community-based treatment likely would require favourable cost-benefit analyses, as well as evidence of effectiveness of the treatment (the latter to be studied in a subsequent interdisciplinary Ph.D. program using qualitative research techniques). The implications of a finding of disability and mental disorder related to fetal alcohol conditions will be examined. The present research topic is at the interface of health and justice, and indeed is multidisciplinary in nature as fetal alcohol influences every aspect of affected individuals' lives. Moreover, the problem is situated in its historical, ideological, global, and trans-disciplinary context.

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Thesis (Ph. D.)--University of Oregon, 2000. / Typescript. Includes vita and abstract. Includes bibliographical references (leaves 241-252). Also available for download via the World Wide Web; free to University of Oregon users.

Diss.--Rand. / Title from first screen of PDF (viewed Oct. 22, 2003). Includes bibliographical references (p. 140-146).