Submitted in full compliance with the requirements for a Master’s degree in Technology: Dental Technology at the Durban University of Technology, 2009. / The Dental Technology profession in South Africa is currently undergoing a possible role transformation. In the past, Dental Technicians were restricted to laboratory work only and were not permitted to have direct contact with patients. Due to a demand for oral care, and a gap that is perceived to exist in service delivery, Clinical Dental Technology has emerged as a possible new profession in South Africa. The 1997 amendment to the Dental Technicians Act allows Dental Technicians to broaden their scope of practice through further education into the clinical aspects of the profession. South Africa is one of few countries that have an enabling legislation in terms of the recognition of Clinical Dental Technology. However, there is to date no training programme or curriculum for people who would like to practise as Clinical Dental Technicians. The three institutions in South Africa that provide training for Dental Technicians do not provide training to those technicians who would like to pursue a clinical career path. Internationally, Dentists have argued that Dental Technicians have insufficient clinical capabilities. They feel that technicians do not have sufficient knowledge and experience in dealing directly with patients, and consequently have identified a need for further training of Dental Technicians before they are recognised as Clinical Dental Technicians. The aim of this study was to evaluate educational institutions’ readiness in terms of the role transformation of Dental Technicians and to establish perceptions about the introduction of this new profession by Dentists, Dental Technicians and Dental Technology lecturers. The views of these three stakeholders have implications not only in terms of the development of a new curriculum, but were also found to raise serious concerns about the implementation of this profession in South Africa. Data was collected by means of questionnaires and personal interviews with Dentists, Dental Technicians and Dental Technology lecturers in South Africa. The responses were transcribed and then coded according to pertinent themes for interpretation purposes. The data revealed major differences in the perceptions of the proposed profession by the three sectors. This has important implications for the likely success of Clinical Dental Technology, given the need for these sectors to work together as members of the dental team. The data also reveals concerns about the type of training that would need to be incorporated into the curriculum and who would be able to provide such training. By using an overview of curriculum theory, this study also raises concerns that clinical aspects might be infused into the curriculum as simply the acquisition of additional technical skills, rather than as a significant shift in professional identity to incorporate patient care.

This thesis is about ethics in the dentist-patient relationships. Using cultural-historical activity theory and discourse analysis as theoretical and methodological frameworks, I investigate (a) how ethics emerges in dentists' discourse when they talk about dental-patient relationships; (b) how dentists deal with conflicts that emerge in their interaction with the patients; and (c) how a dental clinic is organized and works on a daily basis. I also discuss the implications of a theory of unknowability of actions for dentistry practice. My database is composed of dentists' narratives during videotaped interviews, and an ethnographic study in a private dental clinic in Canada. I conclude that ethics is embodied in the dentists' actions; that the development of phronesis helps dentists to solve conflicts in the workplace: and that the trajectory of the dental treatment is conducted in states through a complex division of labor and often in more than one activity system.

Darbo tikslas. Ištirti Lietuvos sveikatos mokslų universiteto, Kauno technologijos universiteto bei Vytauto Didžiojo universiteto studentų nuomonę apie odontologinių paslaugų prieinamumą. Tyrimo metodika. Tyrime dalyvavo trijų Kauno aukštųjų mokyklų atsitiktinai atrinkti bakalauro nuolatinių studijų studentai. Išdalinta 360 anketų, gauti 347 atsakymai (96,4%). Po 33% atsakytų studentų anketų buvo iš Lietuvos sveikatos mokslų bei Vytauto Didžiojo universitetų, o 34% anketų buvo iš Kauno technologijos universiteto. Vertinta, kaip atsakymai priklausė nuo skirtingų universitetų studentų, jų lyties, odontologinio kabineto rūšies. Skirtumas laikytas reikšmingas, kai p<0,05. Rezultatai. Odontologinių paslaugų prieinamumas, studentų nuomone, organizaciniu, finansiniu bei komunikaciniu požiūriu yra geras. Studentams atvykti pas gydytoją labiausiai trukdo jų pačių laiko trūkumas (72,9%). Žvelgiant iš finansinės pusės: retai (40%) arba dažnai (38%) finansinių problemų turi beveik vienoda dalis studentų. Organizacinį prieinamumą respondentai taip pat įvertino neblogai. Beveik pusė apklaustųjų (47,3%) dantis gydosi privačioje praktikoje ir dažniausiai lankosi dėl dantų gydymo (52,2%). Telefonu registruojasi dauguma (73,2%) apklaustųjų. Vizito pas odontologą 48,4% tenka laukti 1 – 2 savaites ir dauguma (49%) dažniausiai patenka laiku, nebent reikia palaukti iki 15 min. (74,9%). Vizitas pas odontologą trunka 31 – 60 min. (49,6%). Daugumos respondentų nuomone (70,3%), odontologų... [toliau žr. visą tekstą] / Aim of the Study. Surveying Lithuanian University of Health Sciences, Kaunas Technology University and Vytautas Magnus University students’ opinion on dental service accessibility. Survey methods. The selected at random B.A. students of three Kaunas universities took part in the survey. 360 questionnaire forms were given out to the students and 347 answers were received (96. 4%). Lithuanian University of Health Sciences students as well as Vytautas Magnus University students presented 33% of the answers and Kaunas Technology University – 34%. It was estimated how the answers depended on different university students, their sex and the type of dental surgery. The difference was considered important when p<0,05. Results. In students’ opinion the dental service accessibility is good from organizational, financial and communicative point of view. 72.9 % of the students say they can not get to the doctor mainly due to their lack of time. Financial problems arise to almost the same number of students: rarely – 40%, often – 38%. The respondents estimated organizational accessibility quite well. Nearly a half of the surveyed (47.3%) go to private dental surgeries to have their teeth treated (52.2% in most cases). 73.2% of the respondents make appointments by telephone. 48.4% of the surveyed have to wait for 1-2 weeks to get an appointment and the majority (49%) are accepted at the appointed time, unless it is necessary to wait for up to 15 min. (74.9%). The visit at the dentist... [to full text]

Ubiquitous computing aims to make human-computer interaction as naturalistic and functionally invisible as possible through embedding computing potential within a particular context to support human activity. However, much of ubiquitous computing research is focussed on technical innovation due to the challenges involved with deploying embedded computing, thereby reducing the commitment to the philosophical ideals of ubiquitous computing in research. This dissertation describes the investigation of a participatory approach to technically-complex research in order to understand how our view of the engineering and human challenges changes when the two are approached hand-in-hand. The domain chosen for this system was a dental surgery. Dentistry involves a complex workspace with computer interaction constrained by surgery hygiene. Ubiquitous computing offers a compelling interaction alternative to the keyboard and mouse paradigm in such an environment. A multi-method approach that employed ethnographic research and design prototyping was undertaken with dentists from several different private practices. A series of field studies used ethnographic methods such as observation and interview. Design events explored prototypes with activities such as design games, contextual interviews, role-playing and contextual prototyping. Activities were devised with the aim of providing a level playing field, whereby both designers and participants feel they can contribute equally, with their respective disciplinary knowledge. It was found that methods needed to be carefully chosen, devised and managed, in order to communicate complex concepts with participants and to constrain the design to technically feasible options. The thesis examines the design problem from the perspectives of a variety of different stakeholders within a participatory design framework, reflected upon by means of human-centred action research. Data was gathered through design speculations and observation, and explored using methods such as the Video Card Game and Video Interaction Analysis. Fieldwork was analysed using a multi-stage qualitative analysis process which informed further design collaboration with participants. The analysis of data gathered during design studies with dentists also contributed to the development of a prototype system to validate methodological contributions. The resulting prototype utilised off-the-shelf hardware and software which allowed for innovative customisation and development. In-situ prototyping (defined by the author as “participatory bootstrapping”) and a comprehensive knowledge of the domain afforded the creative application of technology. In addition to contributing to the prototype design, the interpretive understandings drawn from analysis identified how technical ideas were presented and utilised by participants of the studies, and how best to engage busy professionals. The final outcomes of the research were a multimodal ubiquitous computing system for interacting within a dental surgery; the development and implementation of a variety of methods aimed at communicating technical concepts and eliciting user motivations, practices and concerns; and a set of design principles for engineers engaging in design of systems for human use. The research presented within this thesis is primarily part of the field of human-computer interaction, but provides evidence of how engineering development can be influenced by a user-centred participatory approach. The benefits that derive from inclusive methods of design are demonstrated by the evaluation of a prototype that employed such methods. The contribution of this thesis is to demonstrate and delineate methods for developing ubiquitous computing technologies for the context of human use. This led to a set of design principles for the engineering of systems for human use: 1. Technology needs to be robust and simple to appropriate. This allows users to give insights on technology developments and also to allow users to discover for themselves how they would use the technology. 2. An evolving and carefully considered set of methods are needed to elicit communication between practitioners and across disciplines. The gaps in understandings and the different representations that arise across the disciplines provide essential clues to next steps in design. These gaps and differences form tensions that can be exploited productively. 3. Context is important for determining which design steps to take. Rather than abstracting a problem in order to solve it, as is usual in engineering design, the problem should remain grounded in the context of use. It reveals what the real problems are that need to be solved rather than the imagined ones. This requires an appreciation of the situated nature of action and of the variability of work. In turn it also requires an appreciation of what the human can and does do and what the machine should support. 4. Accountability in design is required. There is a fundamental tension between trying to make something work and seeing what really does work; specifically it is necessary to understand when automation is worth it in human machine systems. While engaged in the design process, engineers should ask how much technology should reconfigure human practices because of a useful outcome, rather than attempting to automate and converge devices for its own sake. A clear understanding of the constraints and workings of the work space needs to be balanced with the understandings of the limitations of the technology in order to design a system that improves work practice and empowers the practitioner.

Doctor of Philosophy / This work was digitised and made available on open access by the University of Sydney, Faculty of Dentistry and Sydney eScholarship . It may only be used for the purposes of research and study. Where possible, the Faculty will try to notify the author of this work. If you have any inquiries or issues regarding this work being made available please contact the Sydney eScholarship Repository Coordinator - ses@library.usyd.edu.au

Thesis (M.A. (Health Social Sciences))--Mahidol University, 2000.

Thesis (Ph. D.)--University of North Carolina at Chapel Hill, 1996. / eContent provider-neutral record in process. Description based on print version record. Includes bibliographical references.

Thesis--University of Washington. / Photocopy. Vita. Bibliography: leaves [116]-122.

Thesis (Ph. D.)--University of North Carolina at Chapel Hill, 1996. / eContent provider-neutral record in process. Description based on print version record. Includes bibliographical references.

Thesis (MSc)--Stellenbosch University, 2002. / ENGLISH ABSTRACT: It can safely be assumed that work is a central part of people's daily activities in modem times, and dentists and other health workers are no exception to this rule. The following benefits have been ascribed to having a job, namely that of being a source of money, activity, variety, temporal structure, social contacts, status and identity in society. To what extent does the job as dentist in the civil service provide fulfilment of these basic requirements of having a satisfying job? Considering the number of resignations in recent years of state employed dentists and the well known and often reported "brain drain" of South African professionals, it is important to assess the status of job satisfaction amongst our health professionals, especially those within the state employ. These dentists are responsible for the health care delivery to the impoverished masses who make up a large proportion of the South African population. This study set out to determine the level of job satisfaction among state dentists and how this is perceived by them and reflected in their work performance. It was the aim of the researcher to provide some insight into the working lives of a very important sector of the primary health care providers employed by the Department of Health of the Western Cape Provincial Government. The outcome of the study could be used as a basis for further research in this area. A survey was conducted among all state employed dentists in the Western Cape, excluding dentists attached to the military or academic institutions. The survey instrument consisted of a structured, quantitative questionnaire as well as an open-ended section for comment on specific issues. Furthermore, an indepth semi-structured interview was conducted with one dentist in order to write a case report on the work experience of a state employed dentist.The major fmdings of this study are the following: i) The main determinants of job satisfaction revolve around the work environment, and dentists in state employ enjoy staff support, feel good about what they do for patients, and the standard of work done, but are unhappy about income, lack of respect by patients, senior management and colleagues in private practice. Limited treatment options, poor procurement systems and frequent breakdown of equipment affect their sense of job satisfaction negatively. ii) The level of dissatisfaction is not of such a proportion to persuade them to leave the service, as most dentists would like to remain in their posts. However, most dentists agree that there are no incentives for improving work performance. iii) Dentists responded to their sense of job satisfaction in different ways. While some admitted that their performance is directly linked to how well it is going at work, a large percentage of respondents reported that they do not allow their work performance to be influenced by their perceived job dissatisfaction. iv) Ifwe look at the case study, it is evident that perceived satisfaction or dissatisfaction depends on the individual and how he or she views the world. In this particular case the dentist was very realistic about his ambitions as a person and as a dentist, and set goals for himself within these boundaries. The result is that he remains motivated and satisfied. / AFRIKAANSE OPSOMMING: Dit kan geredelik aanvaar word dat werk die kern uitmaak van mense se daaglikse aktiwiteite, en tandartse en ander gesondheidswerkers is geen uitsondering nie. Die volgende voordele word aan werk toegeskryf: bron van inkomste, aktiwiteit, afwisseling, tydsindeling, sosiale omgang, status en posisie in die gemeenskap. Tot watter mate voldoen die werk van 'n tandarts in die staatsdiens aan die basiese vereistes van 'n bevredigende werk? As mens die getal bedankings van tandartse uit die staatsdiens oor die afgelope jare in ag neem, asook die welbekende en gereeld vermelde "brein trein" van professionele mense in Suid-Afrika, voel mens dis belangrik om vas te stel watter werksbevrediging heers onder gesondheidspersoneel, veral diegene in die staatsdiens. Tandartse in die staatsdiens is verantwoordelik vir gesondheidsdienslewering aan die arm massas, wat die oorgrote meerderheid uitmaak van die Suid-Afrikaanse bevolking. Hierdie studie was daarop gemik om die werksbevredigingsvlak van staatstandartse vas te stel, asook hoe hulle dit ervaar en demonstreer in hul werkverrigting. Die navorser het dit ten doel gehad om insig te bring in die werksbestaan van 'n baie belangrike komponent van gesondheidswerkers in diens van die Departement van Gesondheid in die Wes-Kaapse Provinsiale Regering. Die bevindinge van die studie kan dien as basis vir verdere navorsing op hierdie gebied. 'n Meningspeiling is onderneem onder staatstandartse in die Wes-Kaap, met tandartse verbonde aan die weermag en akademiese instellings uitgesluit. Die opname-instrument het bestaan uit 'n gestruktureerde kwantitatiewe vraelys saam met 'n afdeling vir kommentaar oor spesifieke knelpunte. Verder was daar 'n semi-gestruktureerde diepte-onderhoud gevoer met een tandarts om verslag te doen oor 'n gevallestudie rakende die werksondervinding van 'n staatstandarts. Die kembevindinge van die studie was: i) Die belangrikste determinante van werksbevrediging betrek die werksomstandighede. Terwyl tandartse ondersteuning geniet van hul mede-personeel, goed voeloor hul diens aan pasiente, en die standaard van hul werk, voel hulle ongelukkig oor inkomste, gebrek aan respek van pasiente, senior bestuur en kollegas in die privaat sektor. Beperkte behandelingskeuses, swak voorsieningsisteme en knaende gebrek aan toerusting affekteer hul werksbevrediging negatief. ii) Die mate van werksbevrediging is nie van so 'n aard dat dit hulle motiveer om die diens te verlaat nie, want die meeste tandartse wil hul poste behou. Die meeste tandartse voel egter dat daar nie enige aanmoediging bestaan vir verbeterde werkverrigting nie. iii) Tandartse reageer verskillend op hul menmg omtrent werksbevrediging. Terwyl sommige erken dat hul werkverrigting direk gekoppel is aan hoe goed dit by die werk gaan, het 'n groot persentasie van deelnemers aan die opname aangedui dat hulle nie toelaat dat hul werkverrigting deur hulonbevredigende werksomstandighede geaffekteer word nie iv) As ons die gevallestudie beskou, is dit duidelik dat of bevrediging ondervind word, al dan nie, van die individu afhang, en sy of haar lewensbeskouing. In hierdie spesifieke geval, was die tandarts baie realisties omtrent sy ambisie as persoon en as tandarts, en het sy doelwitte binne hierdie perke gestel. Die uitslag is dat hy gemotiveerd en bevredig bly.