Universiẗat, Diss.--Kassel, 2007.

Texte remanié de: Th. doct.--Géogr.--Rouen, 1998. / Bibliogr. p. 273-280.

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Das Dissertationsvorhaben greift zu Beginn einen Praxisfall im Krankenhaus auf und verdeutlicht exemplarisch, dass der Krankenhausarzt in einen Konflikt zwischen ökonomischen und ethischen Anforderungen gerät. Um die Frage beantworten zu können, wie die soziale Praxis der Krankenhausärzte gelingen kann, wird das Problem im ersten Schritt rekonstruiert. Nach der Diskussion verschiedener Lösungsansätze für das Problem im zweiten Schritt, werden im dritten Schritt Anregungen für die Praxis abgeleitet.

Background: Radical cystectomy (RC) still poses a significant risk for mortality and morbidity. Objectives: We compared in-hospital outcomes after RC in the United States and Germany using population-based data. Methods: We compared data from the US Nationwide Inpatient Sample to the German hospital billing database. Mortality and transfusion during hospital stay and length of stay (LOS) were evaluated. Results: In all, 17,711 (the United States) and 60,447 (Germany) cases were included. The share of robot-assisted RC increased to 20.5% in the United States vs. 2.3% in Germany (p < 0.001). In-hospital mortality was 1.9% (the United States) vs. 4.6% (Germany), transfusion rates were 34.2% (the United States) vs. 58.7% (Germany), and LOS was 10.7 (the United States) vs. 25.1 days (Germany; all p < 0.001). On multivariate analysis, higher patient age and lower annual hospital caseload were associated with increased mortality and longer LOS. Minimalinvasive surgery was associated with less blood transfusion and shorter LOS in the United States vs. hospital caseload and choice of urinary diversion in Germany. Conclusions: Healthcare systems might exert a relevant impact on outcomes of oncologic surgery. Increased in-hospital mortality rates in Germany seem to be partly explained by much longer LOS compared to those in the United States. Annual caseload seems to be influential on in-hospital outcomes raising the question of centralization of RC.

Introduction Multimodal pain therapy (MPT) has been established accounting for biopsychosocial consideration in diagnostic and therapy. MPT seems to be effective, but comparability of studies is limited due to diversity of study designs and outcome measurements. The presented study aims to develop a core outcome set consisting of a minimum of outcome measures deemed necessary for medical and therapeutic decision-making, which must be measured in all clinical trials and non-randomised intervention studies.

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The research questioned the efficacy of standard biomedical information sharing and communication processes in ensuring rapid and reliable behavioural changes in the control of epidemics, especially in high-context cultures. Information processing arousals and behaviour change motivations are subject to the level of interactions in the extrinsic and intrinsic elements of an information. Following, epidemic control can only be successful if relevant elements of a system’s values, norms, beliefs and practices for information processing are superimposed on scientific communication to create shared meanings. An empirical research approach in grounded theory underscore the data collection of this research with the data analogy utilising the MAXQDA Analytics Pro software. Ebola behavioural changes were identified to be enabled by the functional properties of community mobilisation as a structure and process for meaning making and behavioural motivation. A contextual health communication model dubbed the ecological collegial communication model has been modelled for epidemiological control as the output of the research. Specific to the methodology, a systematic qualitative and data analysis process in grounded theory was adopted for conducting the research and the dissertation writing. Commencing the process was the identification and analysis of the problem from the perspectives of the challenges to the Ebola communication management. This was comprehensively identified from the fundamentals of the process of communication to the communication itself and was assessed from the motivational factors underlying the behaviours within which the rationality of the behaviours could be understood for their inflexibility to change or their insensitivity to the Ebola messages. The mediations of the behavioural motivators in the cognitive processes to information processing were considered for their intrinsic and extrinsic values to arouse information processing and persuade change. To explore the interface between communication and culture in cognitive processes of information processing and decision making, literatures on behavioural theories, including anthropological theories from which the processes and determinants of behavioural enactment are predicted were reviewed in chapters two to four. Intention (also used interchangeably in this dissertation as motivation) was unanimously construed as proximal in determining behaviours in the literatures. However, intention was also construed to have linkages with other factors in the determination of behaviours.:Dedication ii Declaration iii Acknowledgements iv Table of contents v List of figures vi List of photos vii List of matrices vii List of tables vii List of appendices viii Abbreviations ix 1 Communication and culture of the 2014/2015 West Africa Ebola outbreak 1 1.1 Introduction 1 1.2 Conceptualisation of the research problem – the key factors of the Ebola outbreak 4 1.2.1 Structural violence 7 1.2.2 Communication deficiency 10 1.2.3 Cultural models (values and practices 20 1.2.3a Death and funerals 21 1.2.3b Caregiving 26 1.2.3c Reliance on traditional healers 31 1.3 Research objectives 37 1.4 Definitions 38 1.5 Questions formulation and research questions 42 1.6 Justification 52 1.7 Conclusion 58 2 Theoretical frameworks consistent with the 2014/2015 Ebola outbreak health communication approaches – A discourse 59 2.1 Introduction 59 2.2 Psychological/behaviour science models 60 2.2.1 Health belief model 61 2.2.2 Protection motivation theory 64 2.2.3 Theory of planned behavior /reasoned action 71 2.2.4 Social cognitive theory / social learning theory 76 2.3 Summary 79 3 Information processing/communication theories 81 3.1Introduction 81 3.2 Elaboration likelihood model 81 3.3 Activation model 86 3.4 Narrative theory and entertainment education 88 3.5 Summary 95 4 Ecological theories / framework 97 4.1 Introduction 97 4.2 The PEN-3 Model 98 4.2.1 Health education (cultural identity)100 4.2.2 Cultural appropriateness of health behavior (cultural empowerment) 101 4.3 Bioecological theory 103 4.4 Developmental process of Bronfenbrenner’s model in the framework of the 2014/2015 Ebola outbreak 108 4.5 Theoretical framework of this dissertation 119 5 Research process and methodologies 125 5.1 Introduction 125 5.2 Justification of the research methodology 128 5.3 Overview of Monteserrado County 134 5.4 Techniques/procedures 137 5.4.1 Archival materials/documents 138 5.4.2 Ethnographic/observations 139 5.4.3 Key informants/in-depth interviews 142 5.4.4 Focus group discussions 143 5.5 Data analysis 146 5.5.1 Codes 147 5.5.2 Qualitative analysis employed in the research 152 5.6 Role of the researcher 153 5.6.1 Origins of the project 153 5.6.2 The discourse - philosophical worldview 156 5.6.3 Concluding thoughts 157 6 Data analysis: cultural practices, health and communication in the Liberian context 160 6.1 Introduction 160 6.2 Ethnicity and religion 162 6.3 Social organization 171 6.4 Aspects of death and burial practices 179 6.5 Concept of health and health care 186 6.6 Communication and information sharing approach in Liberia 193 6.6.1Traditional communication and the town crier in Liberia 195 6.6.2 Contribution of Crusaders for Peace 201 6.6.3 Development of overarching Ebola communication messages 206 6.7 Conclusion 210 7 Data analysis: Socio-cultural patterns in Ebola perceptions, content of messages and behavioural outcomes 212 7.1 Introduction 212 7.2 Parent codes – summative description and discussions 214 7.3 Understanding the socio-cultural patterns in Ebola knowledge and behaviours: Perceptions of Ebola transmissions 226 7.4 Content and nature of Ebola messages in perceptions and behaviours 237 7.5 Conclusion 276 8 Data analysis: Understanding the motivators of Ebola behaviours – an analytical interrelationships model perspective 278 8.1 Introduction 278 8.2 Patterns of Ebola behaviours 279 8.3 Conclusion 317 9 Decoding: the interface between culture and communication in the Ebola communication management 319 9.1 Introduction 319 9.2 Contextual elements of effective communication – the interface 321 9.3 Cognitive heuristics to “…protect yourself…” 336 9.4 Processes of moderations of “protect yourself” in cognitions 339 9.5 Conclusion 343 10 Theoretical and conceptual inferences from empirical data and framework for a culturally appropriate communication 344 10.1 Introduction 344 10.2 Research questions 344 10.3 Epidemic control: The cultural model framework to persuasive communication for epidemic management 359 10.3.1 The composite conceptual analytical elements of the model 364 10.3.1a Model definition and assumptions 365 10.3.1b The ECCM – the interactive elements of a system 367 10.3.1c Pattern of communication in the ECCM 371 10.3.2 Summary 374 10.4 Processes of how to apply the ECCM 375 10.5 Limitations of the model 382 10.6 Conclusion 383 11 Conclusions and recommendations 385 11.1 Introduction 385 11.2 Key conclusions 385 11.3 Implications 387 11.3.1 Policy framework implications 387 11.3.2 Theoretical implications 390 11.4 Further research 393 11.4.1 Approach to communication 393 11.4.2 Cultural dynamics 396 11.4.3 Health perceptions 398 11.4.4 Ebola orphans and victims 398 11. 5 Research limitations 399 References 401

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