Thesis (MBA) --University of Limpopo, 2007 / If medical doctors are expected to function effectively and efficiently to provide the highest quality of care to the largest number of patients in rural hospitals, it is imperative that they derive job satisfaction from their work and thus perform well. The present study aimed to investigate whether the doctors in the target population have job satisfaction. The doctors were selected from the rural hospitals of the Waterberg District of the Limpopo Province. An exploratory qualitative research design was used, which included a self administered questionnaire enquiring about the demographic and work situation variables. Content analysis was used to analyse qualitative data. The main findings that emerged from the study were that the respondents were dissatisfied with their work environment. The most common theme that emerged was related to the bad working conditions, lack of support from management, lack of proper equipment, and the salary or incentives in proportion to the workload. These findings highlighted the issues that can be addressed by the employing organisation.

Doctor of Philosophy (PhD) / Understanding factors that enhance or diminish performance levels of individuals is instrumental for achieving individual (low level) and organisational (high level) goals. In this study, the effect of social network structure, position, ties and information and communication technologies (ICT) use on performance attitudes of knowledge intensive workers in dispersed occupational communities is investigated. Based on social network theories of strength of weak ties and structural holes, and the social influence model of technology use, a theoretical framework is developed. In conjunction with qualitative interviews conducted with subject matter experts, the framework is used to further develop and refine a valid and reliable survey instrument. Secondly, network measures of degree centrality, density, structural holes (constraint and efficiency), tie strength and tie diversity are applied for exploring the association with ICT use and performance from a sample of 110 rural general practitioners. Empirical results suggest that network structure, position and ties of knowledge workers play a crucial role in individual performance and ICT use. In particular, degree centrality and task-level ICT use was found to be positively associated with performance while ego-network constraint was found to be negatively correlated with performance. In terms of ICT use, functional diversity and degree centrality were positively associated with task-level ICT use whereas ego-network efficiency was found to be negatively correlated with ICT use at the communication-structure level. Among the variables that showed significance, degree centrality best explained overall variance for performance, and functional diversity best explained overall variance for task-level ICT use, although professional accreditations remains a potent indicator also. The results from this study resonate with findings from past literature and extend traditional theory of social networks and performance within the micro level to include geographically dispersed individuals involved in knowledge intensive work. For individuals in such non-competitive settings, traditional network theories such as structural holes theory still apply. However, a key finding is that network structure is a much more potent predictor of performance although network position is important. The second key finding addresses a major gap in the literature concerning understanding social processes that influence ICT use. As the technology acceptance and the social influence models lack empirical evidence from a social networks perspective, this research shows that rather than the strength of ties which functions as a conduit of novel ideas and information, it is the functional tie diversity within individual professionals networks that increase ICT use at the task-level. Methodologically, the study contributes towards a triangulation approach that utilises both qualitative and quantitative methods for operationalising the study. The quantitative method includes a non-traditional “networks” method of data collection and analysis to serve as a fine complement to traditional research methods in behavioural studies. The outcome is a valid and reliable survey instrument that allows collection of both individual attribute and social network data. The instrument is theoretically driven, practically feasible to implement, time-efficient and easily replicable for other similar studies. At the domain level, key findings from this study contradict previous literature which suggests that professionals in occupational communities such as general practitioners decline in performance as they age. In fact, findings from this study suggest that age and experience do not affect for performance; rather, there is a negative relationship between experience and task-level ICT use, and that task-level ICT use is positively associated with performance in terms of attitudes to interpersonal care. Furthermore, degree centrality is also positively associated with professional accreditations, such as fellowship of the Royal Australian College of General Practitioners, which is conducive to performance in terms of attitudes to interpersonal and technical care. The contextual implication from the quantitative and qualitative evidence of this study is that while contemplating strategies for optimising ICT use or for improving attitudes to quality of care at the technical and interpersonal level, the importance of social structure, position and relations in the practitioner’s professional network needs to be considered carefully as part of the overall individual and organisation-level goals.

This qualitative modified participatory study underpinned by social critical theory explored the experiences of immigrant medical practitioners seeking registration in New Zealand. The occupational science notions of occupation, occupational deprivation and occupational apartheid were used to understand the experiences of the participants. The objective of the study was to understand the experiences of the participants and facilitate their self-empowerment through facilitated dialogue, affording them opportunities for collective action. Data was obtained through in-depth interviews and focus group discussions with eighteen immigrant medical practitioners who were doctors and dentists as well as two physiotherapists. The two physiotherapists were sampled out of necessity to explore diversity in findings. Transcripts were analysed using thematic analysis. This method included the processes of coding data into themes and then collapsing themes into major themes which were organised under categories. Four categories were created in the findings describing the experiences of immigrant practitioners and suggesting solutions. Firstly; findings revealed that immigrant medical practitioners had a potential worth being utilised in New Zealand. Secondly; it was found that these participants faced negative and disabling experiences in the process of being registered. Thirdly; the emotional consequences of the negative experiences were described in the study. Fourthly; there were collectively suggested solutions where the participants felt that their problems could be alleviated by support systems modelled in other Western English speaking countries that have hosted high numbers of immigrant medical practitioners from non-English speaking countries. This collective action was consistent with the emancipatory intent of participatory research informed by social critical theory. This study resulted in drawing conclusions about the implications of the participants’ experiences to well-being, occupational satisfaction as well as diverse workforce development initiatives. This study is also significant in policy making as it spelt out the specific problems faced by participants and made recommendations on what can be done to effectively utilise and benefit from the skills of immigrant medical practitioners. A multi-agency approach involving key stakeholders from the government departments, regulatory authorities, medical schools and immigrant practitioners themselves is suggested as a possible approach to solving the problems faced by these practitioners.

<p>Objective: To explore views of medical doctors, veterinarians and drug sellers on use of antibiotics on humans and nonhumans and on factors that influences the development of resistance to antibacterial agents. Further, to look at the bi-directional relationship between antibiotic use and environment. </p><p>Methods: The study was a qualitative explorative interview study, analysed using conventional content analysis. It was conducted in Orissa, India. Data were collected by face to face semi structured interview. The interviews were tape recorded and transcribed into Oriya, then translated in to English. Each paragraph or sentence was coded. Similar codes were clustered together and collapsed into sub categories and categories. The main themes were allowed to emerge, based on the relationship between categories.</p><p>Findings: The main finding of the study was mishandling and abuse of antibiotics in patients as well as at professional level due to weak implementation of legislation, which appears to be the major cause of antibacterial agent resistance. Incomplete course or dose due to poverty in rural area and self medication in urban area are more common. The study also showed that climatic factors, pollution and population density are the major ecological factors which influence antibiotic prescriptions. Another major finding of this study was that, due to improper disposal system of pharmaceuticals; antibiotics are contaminating air, water and terrains which can cause major risk to aquatic and grazing animals. </p><p>Conclusion: This study emphasises the need for comprehensive actions including information, training, legislation and education at all levels of drug delivery system to rationalize antibiotic use by improving prescribing pattern and creating awareness among consumers. Proper disposal of pharmaceutical wastes is required to prevent the contamination of environment from pharmaceutical pollutants. Further study is essential concerning environmental impact of antibiotics.</p><p>Key words: Antibiotic use; antibiotic resistance; environment; qualitative; conventional; content analysis; veterinarians; medical doctors; drug sellers; Orissa; India.</p>

The main aims were to: explore whether there is a relation between doctors’ ability to identify patients’ worry and wish for information and self-efficacy with regard to communicating with patients about difficult matters; describe which cues doctors consider when estimating patients’ worry and wish for information, and investigate whether there is a relation between patients’ satisfaction with doctors’ care and patients’ psychosocial function. Eleven doctors and 69 patients (of which 36 patients participated in the longitudinal study) with carcinoid tumours participated. Doctors’ self-efficacy, and ability to identify patients’ worry/wish for information were investigated at patients’ first admission. Doctors were interviewed about which cues they considered when estimating patients worry/wish for information. Patients’ satisfaction with care (CASC SF 4.0) and psychosocial function (EORTC QLQ-C30, HADS) were measured longitudinally, during the first year after diagnosis. Doctors reported higher self-efficacy when showing good ability to identify patients’ wish for information, than when showing less good ability, overestimated patients’ worry and underestimated patients’ wish for information. Doctors considered patients’ verbal behaviour and body language together with knowledge and experience when estimating patients worry and wish for information. Patients who met doctors showing good ability to identify their wish for information, reported a higher cognitive function than patients who met doctors showing less good ability. At all assessments patients expressed high satisfaction with doctor’ care and patients’ satisfaction did not change over time. Patients’ satisfaction with doctors’ care were related to their psychosocial function shortly after the first three admissions to specialist care. Patients with carcinoid tumours in some respects reported a worse HRQoL than the general Swedish population. Fatigue, diarrhoea, limited possibilities to work/pursue daily activities, and worry that the illness will get worse were among the most prevalent, and worst, aspects of disease- and treatment related distress.

The Internet’s popularity as a health resource (also referred to as e-health) for patients is impacting the doctor-patient relationship and health care overall. Many patients now tend to look on the Internet for the information they seek in order to avoid the hassle of going to the doctor. It is important to investigate how the doctors themselves feel about this impact and see what factors influence their behaviors toward patients with regards to e-health. This study used mediation behavior theory and the theory of reasoned action to assess the relationship between doctors’ beliefs/attitudes and their subjective norms about e-health and their mediation behavior toward patients. Results revealed that many factors, including perceived benefits of the effects of e-health, perceived concerns about possible negative effects, evaluations, positive experiences with patients and social norms indeed affect the type of mediation behavior doctors perform with patients when discussing e-health.

Ett ämne som är återkommande i medier är användningen av stafettläkare. Ämnet är aktuellt och enligt oss outforskat. Denna studie har genomförts för att ge en inblick av vårdcentralens ledning och sätt att arbeta för att vara en attraktiv arbetsplats. Vi har genom en intervjustudie skapat en bild av stafettläkarnas syn av att arbeta på en vårdcentral och om varför de väljer denna form av anställning. För att få fram data har vi utgått från en teoretisk referensram som har omfattat hur ett samspel kan uppstå mellan fördelningen av arbetsuppgifterna, sätt att leda och sätt att skapa motivation. Detta har legat till grund för vårt val av semistrukturerade intervjuer. Den tydligaste faktorn som varit avgörande för att välja en anställning som stafettläkare istället för en fast anställning visa sig vara friheten. Denna frihet har lett till att läkaren själv kan styra över sin arbetande tid och val av semester såväl när som varaktighet. Något som tydligt framkommer i denna studie är tidsbristen som ofta nämns i flertalet sammanhang. Verksamhetschefer anser sig ha för lite tid för utveckling och läkare anser sig ha för lite tid för patienterna och det administrativa arbetet. Tidigare forskning berör ledning och organisering inom sjukvård främst inom storsjukhus, medan forskningen på mindre enheter saknas i stor utsträckning. Vidare öppnar denna undersökning upp för vidare forskning inom primärvården då denna studie påvisar att det finns tydliga brister gällande resurser och arbetsbelastning. / A subject that is recurrent in media is the use of relay doctors. The topic is current and according to us unexplored. This study was conducted to provide insight of health center's management and ways of working to be an attractive workplace. We have through interviews created a picture of the relay doctors' views of working in a health center and about why they choose this form of employment. To obtain data, we have assumed a theoretical framework that has covered how an interaction can occur between the allocation of functions, ways to lead and ways to create motivation. This has been the basis for our choice of semi-structured interviews. The most obvious factor has been crucial to select a position as a relay doctor instead of a permanent employment proves to be freedom. This freedom has given the doctors has more control over their working time and choice of holiday in terms of both duration and when. Something that clearly emerges from this study is the lack of time that is often mentioned in most contexts. Health care managers feel that they do not have enough time for development and doctors consider themselves have too little time for patients and administrative work. Previous research involves management and organization in healthcare mainly in large hospitals, while research on smaller units is largely lacking. Furthermore, this study opens up for further research in primary care as this study demonstrates that there are clear gaps existing resources and workload. The language of this paper is Swedish.

Objective: To explore views of medical doctors, veterinarians and drug sellers on use of antibiotics on humans and nonhumans and on factors that influences the development of resistance to antibacterial agents. Further, to look at the bi-directional relationship between antibiotic use and environment. Methods: The study was a qualitative explorative interview study, analysed using conventional content analysis. It was conducted in Orissa, India. Data were collected by face to face semi structured interview. The interviews were tape recorded and transcribed into Oriya, then translated in to English. Each paragraph or sentence was coded. Similar codes were clustered together and collapsed into sub categories and categories. The main themes were allowed to emerge, based on the relationship between categories. Findings: The main finding of the study was mishandling and abuse of antibiotics in patients as well as at professional level due to weak implementation of legislation, which appears to be the major cause of antibacterial agent resistance. Incomplete course or dose due to poverty in rural area and self medication in urban area are more common. The study also showed that climatic factors, pollution and population density are the major ecological factors which influence antibiotic prescriptions. Another major finding of this study was that, due to improper disposal system of pharmaceuticals; antibiotics are contaminating air, water and terrains which can cause major risk to aquatic and grazing animals. Conclusion: This study emphasises the need for comprehensive actions including information, training, legislation and education at all levels of drug delivery system to rationalize antibiotic use by improving prescribing pattern and creating awareness among consumers. Proper disposal of pharmaceutical wastes is required to prevent the contamination of environment from pharmaceutical pollutants. Further study is essential concerning environmental impact of antibiotics. Key words: Antibiotic use; antibiotic resistance; environment; qualitative; conventional; content analysis; veterinarians; medical doctors; drug sellers; Orissa; India.

Canadian doctors have historically been an extremely powerful interest group. While there are many variables that account for their political influence, it is widely accepted that much of their power is due to their control over specialized knowledge. To determine whether or not physicians’ control over knowledge is changing, I examine doctors’ position relative to the state, the public and other health professionals. This research finds that, in all three relationships, physicians’ control over knowledge is weakening. Moreover, organized medicine’s response to these developments has largely been a strategy of co-optation, demonstrating that doctors are aware that these changes often cannot be openly fought. This strategy signals that the medical profession recognizes that some changes in its control over knowledge are bound to occur. This study concludes that these changes could contribute to a ‘critical juncture’ signalling the potential for significant change in the physician-state relationship.

There are notable differences between the dominant Western medical model of health and the model of CAM, and looking at these differences may provide a greater understanding around doctors’ views towards CAM and its place in the wider health system. The purpose of this dissertation is to provide a systematic literature review into how doctors view complementary and alternative medicine, and to see if this has changed since the 1970s through to 2009. A systematic review of the literature was conducted, mainly using online original research Journal articles from medical databases. The internet was the main tool used in locating data, and literature was included or excluded based on relevance. This was evaluated on the relevance of time period, such as 1970, subject, such as chiropractic, or theme, such as attitudes of doctors to CAM. Literature from the 1970s was scarce on this research question, but this review noted a significant increase in literature on this topic since the 1990s, identifying this research area as a relatively new field of study, with much potential for further exploration into beliefs and attitudes of doctors towards CAM. Scientific research papers that were published highlighted a strong emphasis towards doctors’ requirement for further scientific research on the efficacy of CAM. Randomised controlled trials (RCTs) were the preferred method of testing; however this review also discusses appropriate methodology to test both CAM and doctors’ views and beliefs. The difference between the Western medical model and the CAM model highlights the differences between both concepts; from which this author provides a possible interpretation of doctors’ indifferent views towards CAM using the psychological theory of cognitive dissonance (Festinger, 1957). This theory suggests that a person cannot hold two conflicting beliefs simultaneously, without the presence of cognitive ‘dissonance.’ “The existence of dissonance, being psychologically uncomfortable, will motivate the person to try to reduce the dissonance and achieve consonance” (Festinger, 3: 1957). This systematic review then provides a discussion around how this could explain doctors’ views towards CAM. . This then leads to the question of whether ‘successful integration of Western medicine and CAM is therefore possible’? The systematic review concludes with the highlighting of important issues in regard to the study design and methodology on effectively testing CAM, and on effectively testing doctors’ beliefs: also, the issues around integration and further scientific literature on CAM in a bid to potentially reduce the ‘moderate tone of answering’ that is reported in the literature in regard to doctors’ views towards CAM.