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The relationship between the Swedish government and the Swedish Association of Local Authorities and Regions (SALAR) has sparked debates, particularly regarding the agreements established in the healthcare sector. These agreements strive to ensure national equivalence while allowing municipal influence in governance. However, the agreements entail closed negotiations and bestow decision-making authority upon SALAR – a non-public employers' and interest organization funded by tax money – representing the municipalities. Despite their significance, limited research has explored the utilization and repercussions of these agreements, especially concerning their democratic implications. This knowledge gap is striking given the regional authorities' substantial management of tax revenues and primary responsibility for healthcare, as regional democracy has received scant attention in political science research and society. Therefore, this thesis aims to bridge this gap by mapping and evaluating the democratic legitimacy of the agreement development process between the government and SALAR. The focus of analysis is on the 2023 agreement relating to maternity care and women's health. The empirical material includes accessible documents, as well as interviews with individuals knowledgeable about the decision-making process and those anticipated to have gained insights. Through reconstructing the decision-making process and employing two contrasting democratic ideals – the traditional representative model and the network-based multi-actor model – this study uncovers the challenges encountered in upholding these ideals during the agreement development. Notably, the democratic values of accountability, openness, and transparency were significantly compromised. Therefore, the decision-making process can be assessed as lacking full democratic legitimacy.

Preliminary investigation at the beginning of this research showed that informatics on point-of-care (POC) devices was limited to basic data generation and processing. This thesis is based on publications of several studies during the course of the research. The aim of the research is to model and analyse information generation and exchange in telehealth systems and to identify and analyse the capabilities of these systems in managing chronic diseases which utilise point-of-care devices. The objectives to meet the aim are as follows: (i) to review the state-of-the-art in informatics and decision support on point-of-care devices. (ii) to assess the current level of servitization of POC devices used within the home environment. (iii) to identify current models of information generation and exchange for POC devices using a telehealth perspective. (iv) to identify the capabilities of telehealth systems. (v) to evaluate key components of telehealth systems (i.e. POC devices and intermediate devices). (vi) to analyse the capabilities of telehealth systems as enablers to a healthcare policy. The literature review showed that data transfer from devices is an important part of generating information. The implication of this is that future designs of devices should have efficient ways of transferring data to minimise the errors that may be introduced through manual data entry/transfer. The full impact of a servitized model for point-of-care devices is possible within a telehealth system, since capabilities of interpreting data for the patient will be offered as a service (c.f. NHS Direct). This research helped to deduce components of telehealth systems which are important in supporting informatics and decision making for actors of the system. These included actors and devices. Telehealth systems also help facilitate the exchange of data to help decision making to be faster for all actors concerned. This research has shown that a large number of capability categories existed for the patients and health professionals. There were no capabilities related to the caregiver that had a direct impact on the patient and health professional. This was not surprising since the numbers of caregivers in current telehealth systems was low. Two types of intermediate devices were identified in telehealth systems: generic and proprietary. Patients and caregivers used both types, while health professionals only used generic devices. However, there was a higher incidence of proprietary devices used by patients. Proprietary devices possess features to support patients better thus promoting their independence in managing their chronic condition. This research developed a six-step methodology for working from government objectives to appropriate telehealth capability categories. This helped to determine objectives for which a telehealth system is suitable.

This study sought to examine linguistic and discursive strategies used to construct messages reflective of the implementation of the HIV and AIDS policy for Zimbabwe of 1999 by government and private newspapers. Such analysis was perceived to be important since media content has a bearing on Zimbabweans‘ perception and attitudes regarding HIV and AIDS prevention, treatment and control. The study was aimed at comparing messages from newspapers with views by the people of Zimbabwe regarding the implementation of the policy. Findings reveal that empowerment programmes particularly those targeting women and children are lagging behind as Zimbabweans, literature and newspaper data sources testify. In addition, information sources concur that cultural (For example, stigmatisation, polygamy, religious practices, spouse inheritance) and structural (For example, patriarchy, masculinity, bureaucracy, politics) are stumbling blocks that negatively affect the implementation of the policy. Further, even though private and government newspapers do not fully agree on the portrayal of human agents, there is a general consensus between newspaper reports and Zimbabweans that people still face socio-economic and econo-political challenges that militate against the smooth implementation of the HIV and AIDS policy. Government newspapers tend to downplay aspects which reveal inadequacies of government activities. The study notes this as betrayal of use of ideological squares both by government and private newspapers whereby certain aspects regarding the implementation of the policy are either downplayed or highlighted to influence perception. The study reveals that newspaper reports used nominalisation, quantification, positive politeness, thematisation, rhematisation, intertextuality, euphemism, proverbs, idioms, action verbs, metaphors and citation of experts as linguistic and discursive strategies both for agenda setting and building purposes regarding the implementation of the HIV and AIDS policy. Other devices used particularly in the encoding of Operation Murambatsvina are, claptraps, deictic referencing, personal pronouns, adjectives and direct speech. The study attributes problems regarding the Zimbabwean HIV and AIDS intervention model to the top – down approach inherent in the policy. Hence, the call for an adoption of an unhu/hunhu/ubuntu inspired bottom – up HIV and AIDS intervention model in Zimbabwe. This would inculcate pro-family, pro-village, pro-nation/people and ―servant leadership‖ (Mangena and Chitando, 2011) values in the fight against the pandemic through the embracing of Indigenous Knowledge Systems (IKS). Unfortunately, such values largely continue to elude the radar of the current top – down HIV and AIDS intervention model cuurently in use in Zimbabwe. / African Languages / D. Litt et Phil. (African Languages)

Despite the availability of numerous models for knowledge translation into practice and policy, research uptake remains low in resource-limited countries. This study was aimed at developing a model to facilitate research uptake in healthcare practice and policy development. The study used a two-phase exploratory sequential approach (QUAL→QUAN). Qualitative data were collected through semi-structured interviews with a total of 21 participants, categorised as researchers (6), frontline workers/practitioners (7), programme/policy managers (4), and directors/senior managers (4) from government, private sector and academic institutions of higher learning (universities and colleges). Quantitative data were collected through an online cross-sectional survey, administered to 212 respondents who conducted research studies in the Mpumalanga Province between 2014 to 2019. The most significant findings seem to be lack of awareness of research findings and champions to lead engagements among research stakeholders on research uptake. In addition, the research has established a failure by researchers to align public health research projects to existing local contexts and available resources. Conversely, there is a growing propensity of using informal research without consideration of data quality issues. It was further observed that establishing and sustaining beneficial collaboration between all research stakeholders is required to promote effective research uptake for practice and policy development. The survey results established a total of 13 components: four individual factors (support, experience, motivation & time factor); four organisational factors (research agenda, funding, resources & partnerships), and five research characteristics factors (gatekeeping, local research committees, accessibility of evidence, quality of evidence & critical appraisal skills). However, the Spearman’s correlation coefficient revealed that of the 13 factors, only six factors had a significant positive correlation with research uptake, namely: support, experience, motivation, time factor, resources, and critical appraisal skills. Consequently, a model for institutionalising research uptake is proposed. The roles of local research committees have been clarified, and a logical framework has been incorporated with pathways and channels of engagements to enable successful implementation of the research uptake model. / Health Studies / Ph. D. (Public Health)

Die Forschungsarbeit „Ich sehe nur, wie sich die Menschen plagen“: Gesundheitsvorstellungen, -risiken und -verhalten von Berufspolitikern – Eine empirische Analyse befasst sich aus medizinsoziologischer Perspektive mit potentiellen Gesundheitsvorstellungen, -risiken sowie gesundheitsförderlichen bzw. -riskanten Verhaltensweisen deutscher Berufspolitiker. Der Einfluss gesundheitsrelevanter persönlicher Erfahrungen auf gesundheitspolitische Entscheidungen auf Bundesebene stellt einen ergänzenden Fokus dar. Grundlage der Forschungsarbeit ist die subjektiv zunehmende krankheits- und krisenbedingte (medial vermittelte) Belastung der Mandatsträger in der Öffentlichkeit. Die Arbeit stützt sich u.a. auf die Modelle der Salutogenese nach Antonovsky, der Gratifikationskrise nach Siegrist, auf das Anforderungs-Kontroll-Modell nach Karasek sowie die kognitiv-transaktionale Stresstheorie nach Lazarus. Weitere Basis ist das biopsychosoziale Krankheitsmodell. Das empirische Vorgehen der qualitativ angelegten Studie wurde an die Grounded Theory angelehnt. Eine teilnehmende Beobachtung, die Durchführung und Auswertung von 21 Interviews samt sich anschließender Typenbildung wurde angestrebt und vollzogen. Das Interviewsample setzte sich aus Berufspolitikern aller in der 17. Wahlperiode des deutschen Bundestages vertretenen Parteien (CDU/CSU, SPD, FDP, Bündnis 90/die Grünen, Die Linke) zusammen. In der Ergebnisdarstellung werden besonderer Wert auf die individuellen Gesundheitsvorstellungen der einzelnen Politiker gelegt, zudem gesundheitsförderliche Verhaltensweisen eruiert. So scheint Gesundheit durch persönliche Prioritätensetzung und zurückliegende Erfahrungen geprägt. Es können hierzu 14 Themenbereiche und drei zentrale Phänomene ermittelt werden. Krankheitsbilder und Krisenerfahrungen des Interviewsamples werden samt ihrer Einbettung in den sozialen Kontext dargestellt. So werden offensichtliche und allgemeingehaltene Krankheitsbilder durch die Mandatsträger oft am eigenen Beispiel geschildert, lebensbedrohliche im Gegenzug fast ausnahmslos an Kollegen illustriert. Deutlich werden krisen- und krankheitsbedingte Auswirkungen auf politische Akzente. Es können sechs klar voneinander abgrenzbare Typen der Berufspolitiker bezüglich ihres Gesundheitsverhaltens im beruflichen Alltag eruiert werden (Extrempole: Das Opfer vs. Der Abgesicherte). Weiterhin werden besondere Risikofaktoren des arbeitsreichen Mandats illustriert, im Gegenzug Optimierungsmöglichkeiten aufgezeigt. Es zeigt sich ein berufsbedingtes Ungleichgewicht zwischen Risiko- und Schutzfaktoren zulasten der Ressourcen. Hier sind Ansätze zur (Verhaltens-/Verhältnis)Prävention und Gesundheitsförderung zu finden. Der Link zwischen Gesundheitspolitik im Allgemeinen sowie Gesundheitsverhalten im Speziellen wird geschaffen. Abschließend erfolgt eine Kategorisierung der zentralen Themen der Studie. Hierbei werden der Grounded Theory und dem offenen, axialen und selektiven Kodieren folgend Kategorien, Subkategorien sowie eine Kernkategorie ermittelt. Es zeigt sich eine Schwerpunktverlagerung bezüglich In- und Output der Leitfadenthemen (Stigmatisierbarkeit, Tabuisierung). Abschließend werden weiterführende Forschungsperspektiven aufgezeigt.