Tyrimo tikslas – įvertinti psichikos ligomis sergančių asmenų subjektyviai vertinamo santykio su savo gydytoju psichiatru, jo nurodymų laikymosi bei pasitenkinimo sveikatos priežiūros paslaugomis sąsajas. Tyrime dalyvavo: 140 įvairiomis psichikos ligomis sergančių pacientų (66 vyrai ir 74 moterys), besigydantys VŠĮ. Pakaunės PSPC. Šio darbo naujumas bus surasti ir parodyti sociodemografinius, klinikinius veiksnius, kurie daro įtaką pozityvesniam požiūriui į vaistus ir atsakingesniam jų vartojimui. Taip pat surasti psichikos ligomis sergančių asmenų subjektyviai vertinamo santykio su gydytoju psichiatru ir gydytojo nurodymų laikymosi bei pasitenkinimo sveikatos priežiūros paslaugomis sąsajas. / The aim of the research is to evaluate the connection among the subjectively perceived relationship with one’s doctor psychiatrist, adherence to his/ her instructions and the satisfaction with the services provided by the healthcare institution from the point of view of individuals suffering from psychiatric illnesses. 140 patients (66 males and 74 females) with various psychiatric illnesses treated at Public Enterprise Pakaunė PSPC (Primary Healthcare Center) took part in the research. The novelty of this paper lies in the identification and highlighting of socio demographical and clinical factors contributing to a more positive attitude towards medication and its more responsible consumption. Besides, the discovery of the connection among the subjectively evaluated relationship with the treating doctor psychiatrist from the point of view of patients with psychiatric illnesses, adherence to his/ her instructions and satisfaction with the services provided by a healthcare institution is also innovative.

Numerous separate legal norms dealing with the individual spheres of everyday life exist in the Czech Republic at present; some acts mutually overleap and complement one another. Provision of healthcare and healthcare services is regulated by numerous international and national regulations in compliance with adherence to the basic human rights. The healthcare law issues are particularly dealt with by Act No. 372/2011 Col. on healthcare services and the conditions of their prevision, which became effective on 1 April 2012 and substituted Act No. 20/1966 Col. on people health care. Acceptance of the Healthcare Service Act completed the post-revolution changes in healthcare. The Act represents a relatively comprehensive system of rules, among others it regulates the rights and obligations of patients, healthcare providers and healthcare staff in provision of healthcare services. Recodification of the private law was completed in 2012. Act No. 89/2012 Col., the Civil Code was passed within that. It became effective on 1 January. This thesis is divided into five chapters including the conclusion. The first chapter tries to outline the development of the legal norms in healthcare and social sphere in our country. The development of the social-healthcare policy of the state from the late 19th century was later slowed down by the world economy crisis, the Second World War and the consequent normalization. The second chapter gives a brief introduction in the healthcare issues and is divided into several subchapters. It defines the basic terms health and disease. It specifies the individual models of human approach to health, the structure of the Czech healthcare; a part of the chapter deals with the physician-patient relation, particularly with its modification from the paternalistic approach of a physician to a patient to the partnership relation, in which a physician and a patient become equal partners. The third chapter introduces the international and national regulations forming a part of the current healthcare legislation. This legal norm expresses the willingness of the society not only in the Czech Republic to protect the basic values of a human being in healthcare provision. The fourth part of the thesis focuses in detail on selected spheres of provision of healthcare and healthcare services under the effectiveness of Act No. 372/2011 Col. on Healthcare Services and the newly passed Act No. 89/2012 Col., the Civil Code. The new regulation introduces a new type of contractual relation, a contract of healthcare, which should regulate the legal mode of the healthcare provision, including the position of a healthcare provider and a patient in healthcare provision. It also includes a complex regulation of intervention into natural person's integrity and the necessity of his/her agreement with such an intervention. This part of the thesis examines the relation between the Healthcare Service Act and the new Civil Code. The aim of the thesis was to map the previous and the new healthcare legislations and to specify the basic differences in the legal norms, and to assess the consequences of the changes in the regulations for a patient upon comparison of both the legal norms. This thesis is a theoretical one, based on detailed studying and on a content analysis of particularly regulations, specialized literature and further available sources. The conclusion, i.e. the fifth chapter summarizes selected problems of provision of healthcare and healthcare services. The new civil code is based on the requirements of the modern society and provides much higher improvement of patient rights. This levels the legal positions of both the involved subjects, the physician and the patient. Healthcare provision is however primarily regulated by the Act on Healthcare Service Provision and the Conditions of their Provision, namely in more detail than by the new Civil Code, which is in the subsidiarity relation to the special regulation.

In a descriptive survey, the accessibility of primary healthcare services in Molemole was explored and factors impacting on accessibility were identified. The research sample consisted of 134 community members who visited one of five clinics (one a mobile clinic) in Molemole. Questionnaires, information lists, observations and field notes were used as research instruments. Ethical principles were adhered to, and validity and reliability maintained. Findings indicated that geographical, financial and cultural accessibility were satisfactory. Functional accessibility seemed problematic. The main reasons for dissatisfaction were attitudes, shortages of staff, unavailability of treatment, dysfunctional hours and fragmented services. Recommendations included optimal utilisation of staff and resources, improvements on infrastructure and support systems, community involvement in decision-making, as well as reassessing service point locations and policies on medications, supplies and equipment. / Health Studies / M. A. (Health Studies)

Esta dissertação apresenta uma discussão sobre trabalho coletivo, gerada a partir de pesquisa realizada com profissionais que atuam na prestação de serviços de saúde em uma organização pública. O objetivo principal é abordar o trabalho em grupo considerando o contexto de serviços de saúde e investigar como os trabalhadores pertencentes às equipes de composição multiprofissional, se mobilizam para a realização do trabalho. Como referencial teórico partiu-se dos pressupostos da teoria sociotécnica para trabalho em grupo, aprofundando a discussão com premissas da ergonomia da atividade para trabalho coletivo. Realizou-se estudo de caso em uma Unidade Básica de Saúde e como método para coleta de dados e informações, foi utilizada a análise ergonômica do trabalho (AET), que incluiu a técnica de observação de atividades de trabalho na unidade, entrevistas com os profissionais envolvidos e reuniões de validação dos resultados da pesquisa. À luz dos resultados da coleta de dados em campo e revisão bibliográfica, procurou-se fazer uma reflexão sobre as hipóteses de pesquisa. Como resultado concluiu-se que o trabalho coletivo permite lidar com situações de imprevisibilidade e variabilidade, em ambientes dinâmicos como o de prestação de serviços. O trabalho coletivo permite que os trabalhadores desenvolvam estratégias para enfrentar dificuldades e constrangimentos do trabalho. Através da mobilização coletiva, os profissionais regulam suas ações e re-elaboram as demandas dos usuários, tornando os objetivos estabelecidos pela organização compatíveis com a situação real de trabalho. / This dissertation deals with the collective work on healthcare services of a public healthcare organization. The main objective is to discuss teamwork considering the healthcare services environment and to investigate how the workers of teams composed with mixed professional categories, mobilize themselves to accomplish their job. The theoretical discussion considers two main stream approaches to teamwork, the socio-technical theory to teamwork and ergonomics of the activity to collective work. Following, a case study was conducted in a public healthcare center using the ergonomic work analysis (EWA) as the main tool to data gathering. This method includes observation techniques of the work activity in the unit, interviews with the professionals and validation sessions of the researchs results. From the results of the field research and the literature review, it was analyzed the research questions previously stated. As a result, it was observed that collective work allows the workers to more properly face the situations of unpredictability and variability in a dynamic service environment. Collective work also allows the workers to develop strategies to face work difficulties and constraints. With collective mobilization, the professionals regulate their actions and re-elaborate the users demands, turning the goals established by the organization compatible with real situation of work.

Este trabalho busca responder a pergunta de pesquisa: como ocorre a gestão da inovação em uma empresa de Medicina Diagnóstica? Para isso teve como objetivo aprofundar a compreensão sobre a gestão da inovação nesta empresa, entendendo as etapas do processo de inovação (ideação, conversão e difusão), entendendo como a estratégia da inovação se insere no processo de gestão da inovação, e entendendo como que pessoas e organização se inserem na gestão da inovação. Esta pesquisa fez uso de uma abordagem de natureza teórico-prática de enfoque qualitativo e objetivos de caráter exploratório por meio deum estudo de caso único em um centro de medicina diagnóstica de grande porte, reconhecido por práticas de gestão e inovação. Foram utilizadas as técnicas de entrevistas semiestruturadas, observação direta na empresa, e análise de documentos. Para a etapa de entrevista foi elaborado um protocolo semiestruturado com questões orientadoras conforme pesquisa bibliográfica a respeito de gestão da inovação, o setor de saúde e medicina diagnóstica.Foram entrevistados 12 líderes da empresa envolvidos com a gestão da inovação. Todas as fontes de dados foram analisadas e trianguladas chegando à apresentação e discussão de resultados do caso. Como resultados, a pesquisa evidenciou a importância da inovação em medicina diagnóstica, podendo reduzir custos e aumentar a qualidade, além de gerar valor para o restante da cadeia. A estratégia da inovação é alinhada à estratégia corporativa em diversos elementos e possui um processo de definição de drivers que direcionam a companhia no processo de inovação. O processo de inovação é influenciado por atores encontrados na literatura como órgãos reguladores, médicos, pacientes, fornecedores, universidades e operadoras. Além destes, outros foram citados, como órgãos representativos e o Ministério da Ciência e Tecnologia. Dois processos estruturados de inovação foram evidenciados: de novos produtos e de novos processos. O processo de novos produtos é alinhado ao modelo destagegates, enquanto que o processo de novos processos é mais amplo seguindo o modelo hegemônico. A etapa de ideação ocorre com geração de ideias tanto por fontes internas como externas, sendo as principais fontes os médicos e técnicos assessores, e os colaboradores. Técnicas como brainstorming, observação do comportamento dos clientes, e pesquisas acadêmicas são utilizadas. Na etapa de conversão, a seleção e avaliação é feita de maneira colegiada ou individual, por meio de fóruns presenciais ou virtuais. Os critérios de seleção são o alinhamento estratégico, as análises financeiras, técnicas e comerciais. No desenvolvimento e implantação, destaca-se a aplicação de pilotos e testes antes da efetiva implantação da inovação, treinamentos e acompanhamentos da implantação. Por fim, a etapa de difusão ocorre externamente, por meio da equipe comercial junto às operadoras, e com a equipe de médicos e técnicos assessores, junto aos clientes médicos, além dos canais de divulgação como eventos e congressos. A divulgação com clientes finais se dá por meio dos sites, redes sociais, e revistas. Já internamente, a comunicação ocorre principalmente na forma de murais e portais virtuais de comunicação, na atualização de documentos técnicos, e por meio de eventos internos de divulgação do conhecimento, premiação e reconhecimento. Em pessoas e organização, a pesquisa evidenciou que a cultura influencia o processo de gestão da inovação, sendo formada historicamente sobre os pilares de geração de conhecimento e relacionamento acadêmico nas universidades. Objetiva-se gerenciar os recursos humanos capturando pessoas alinhadas ao valor da inovação desde a fase de contratação, passando por treinamentos, avaliação anual de desempenho, premiação e reconhecimento. Não somente os colaboradores internos recebem incentivos e reconhecimentos, como também há incentivos a fornecedores, médicos e universitários por meio de programas específicos. / This master thesis seeks to answer the research question: how works the management of innovation in a case of Diagnostic Medicine? The purpose of this study was to deepen the understanding of innovation management in a diagnostic medicine company, understanding the stages of the innovation process (ideation, conversion and diffusion), understanding how the innovation strategy is embedded in the process of innovation management, and understanding how people and organizations are involved in managing innovation. This research made use of a theoretical-practical approach of qualitative approach and exploratory objectives through a case study in a large diagnostic medicine center, recognized by management and innovation practices. The techniques of semi-structured interviews, direct observation in the company, and document analysis were used. For the interview stage, a semistructured protocol was developed with orienting questions according to bibliographic research regarding innovation management, the health sector and diagnostic medicine. We interviewed 12 company leaders involved in innovation management. All data sources were analyzed and triangulated, arriving at the presentation and discussion of the results of the case. The research highlighted the importance of innovation in diagnostic medicine, which can reduce costs and increase quality, and generate value for the rest of the chain. The innovation strategy is aligned with the corporate strategy in several elements and has a process of definition of drivers that guide the company in the process of innovation. The innovation process is influenced by several stakeholders found in the literature. Besides these others were cited as representative bodies, and the ministry of science and technology. Two structured innovation processes were evidenced: process of new products and new processes. The process of new products is aligned with the stage gates model, while the process of new processes is broader following the hegemonic model. The stage of ideation occurs with the generation of ideas by both internal and external sources, the main sources being the doctors and technical advisors, and collaborators. Techniques such as brainstorming, customer behavior observation, and academic research are used. In the conversion stage, the selection and evaluation can be done collegially or individually, through forums that can be even virtual. The selection criteria are strategic alignment, financial, technical and commercial analysis. In the development and implementation, we highlight the application of pilots and tests before the effective implementation of the innovation, the training and follow-up of the implementation. Finally, the diffusion stage occurs externally, through the commercial team with the operators, and with the team of medical and technical advisors, with the medical clients, in addition to the channels of dissemination such as events, congresses. Publicity with end customers is through websites, social networks, and magazines. Already internally the communication occurs mainly in the form of virtual murals and portals of communication, in the updating of technical documents, and through internal events of dissemination of knowledge, awards and recognition. In people and organization, the research evidenced that culture influences the process of innovation management, being historically formed on the pillars of knowledge generation and academic relationship in universities. It aims to manage human resources by capturing people aligned with the value of innovation from the hiring stage, through training, annual performance evaluation, awards and recognition. Not only do internal collaborators receive incentives and recognition, but there are also incentives to suppliers, doctors and university students through specific programs.

Bakgrund: Personer med substansbrukssyndrom (SUD) är en stigmatiserad och marginaliserad population i samhället som har ett stort vårdbehov. Tidigare forskning visar på att hälso- och sjukvårdspersonal har stigmatiserade fördomar och attityder gentemot denna patientgrupp. Denna studies syfte var att undersöka och belysa hur personer med SUD upplever hälso- och sjukvårdens bemötande vid vårdkontakter. Metod: Med hjälp av en deskriptiv litteraturöversikt, har material samlats in från tre databaser, PubMed, PsycInfo och CINAHL. Elva artiklar valdes ut och analyserades för att identifiera individer med SUD och deras upplevelse av bemötande inom hälso- och sjukvården. Resultat: Både positiva och negativa upplevelser rapporterades av deltagarna. Av resultatet framkom det att upplevd stigmatisering, en sämre kommunikation mellan patient och personal, en upplevd misstro och en negativ relation med personalen bidrog till ett sämre uppfattat bemötande. Det kunde bidra till att deltagarna var mindre angelägna att uppsöka vård. Ett gott bemötandet beskrevs som öppet och empatiskt, icke-dömande, en god kommunikation och en relation med vårdpersonalen som grundades på tillit. Det kunde resultera i att deltagarna var mer angelägna att uppsöka vård. Åtta teman och fyra subteman framkom när materialet studerades och resultatet presenteras utifrån dessa teman. Slutsats: Hälso- och sjukvården har en betydande roll i sitt inflytande på denna patientgrupp och har en stor möjlighet att lindra lidandet samt främja en god omvårdnad genom sitt bemötande. / Background: People with substance use disorders (SUD) are stigmatized and marginalized in society with a great need for care. Previous research shows that healthcare professionals have stigmatized prejudices and attitudes towards this patient group. This study aimed to investigate and shed light on how people with SUD experience the health service’s treatment at care contacts. Method: Using a descriptive literature review, the material has been collected from three databases, PubMed, PsycInfo and CINAHL. Eleven articles were selected and analyzed to identify individuals' with SUD experience of treatment in healthcare. Results: The results showed that perceived stigma, poorer communication between patient and staff, perceived mistrust and a negative relationship with the staff contributed to a more negative experience of the encounter. This could contribute to the participants being less likely to seek care. The better encounter was described as open and empathetic, non-judgmental, good communication and a relationship with the care staff that was based on trust. This could result in the participants being more likely to seek care. Eight themes and four sub-themes emerged when the material for this study was reviewed, and the results are presented based on these themes. Conclusion: Healthcare has a significant role in its influence on this patient group and has a great opportunity to alleviate suffering and to promote good care through its treatment.

Bakgrund Vården är i en pågående förändringsprocess mot att bli mer digital. Digitaliseringen öppnarupp nya sätt för sjuksköterskor och patienter att samspela på. Digitala vårdtjänster ökar iomfattning och vårdmiljön förändras. Sjuksköterskan bär ett ansvar över att tekniken inteäventyrar patientsäkerheten och att arbetet med personcentrerad omvårdnad bevaras. Syfte Syftet var att belysa patienters upplevelser och erfarenheter av digitala vårdtjänster. Metod Denna icke-systematiska litteraturöversikt har baserats på 15 vetenskapliga artiklar medkvalitativ, kvantitativ och mixad design. Datainsamlingen har genomförts i databasernaCINAHL och PubMed. De vetenskapliga artiklarna har kvalitetsgranskats utifrånSophiahemmets högskolas bedömningsunderlag och därefter genomgått en integreradanalys. Resultat Fyra huvudkategorier har identifierats: upplevelser av ökad tillgänglighet, upplevelser avdigitala relationer till vårdpersonal, upplevelser av ökad egenvård samt upplevelser avtekniken. Under dessa framkom åtta underkategorier: tidsaspekter och resekostnader,mindre inverkan i dagliga livet, funktionsnedsättningar, det visuella mötet, känslomässigtstöd, användarvänlighet, sekretess och privatliv, samt tekniska begränsningar. Patienternaupplevde att digitala vårdtjänster var logistiskt praktiska och ekonomiskt fördelaktigajämfört med fysiska besök. Många uppskattade fördelarna med olika informationskanaler,som ökade känslan av en individanpassad kontakt med hälso- och sjukvården och bidrogtill ökad egenvård. De flesta patienter upplevde de digitala vårdtjänsterna som lätta atthantera, med undantag för utsatta grupper i samhället som behöver särskilda insatser för attkunna tillgodogöra sig de digitala vårdtjänsternas innehåll. Slutsats Digitala vårdtjänster kan bidra till att vården blir mer jämlik. Fler patienter kan få tillgångtill samma typ av vård. Mer kunskap och utveckling krävs för att tjänsterna ska kunnanyttjas av fler människor. För att säkerställa att tjänsterna håller en likvärdig kvalitet somden konventionella hälso- och sjukvården, behöver satsningar göras för att vården skabedrivas personcentrerad och för att kvalitetssäkra tekniken. Digital kompetens krävs avsjuksköterskan som måste säkerhetsställa att den digitala vården går i linje medpersoncentrerad omvårdnad. / Background Healthcare services are moving toward digitalization. The digitalization of healthcare hasexpanded the interaction between patients and nurses. Digital healthcare is growing and thehealthcare environment is changing. Person centered care is a core factor in the nurseprofession and has to be preserved throughout the digitalization of healthcare services. Aim The purpose is to examine the patient experience of digital health care. Method This non-systematic literature review examined 15 scientific articles; quantitative,qualitative and mixed method studies were included. The scientific articles are based ondatabase search results from PubMed and CINAHL. After an examining the quality ofincluded articles regarding the Sophiahemmet university assessment basis, an integratedanalysis was implemented. Results Four main categories were identified: experiences of improved accessibility, experiences ofdigital relations to healthcare professionals, experiences of increased self-care,experiences of technology. Within these, eight subcategories emerged: time and travelexpenses, less impact in daily life, disabilities, the eye-to-eye meeting, emotional support,ease of use, secrecy and privacy, and technical limitations. Patients acknowledged practicalimplications and economical benefits compared to physical encounters with healthcareproviders. Many appreciated benefits of different types of digital information, withavailability of personalized contact with healthcare professionals and self care. Mostpatients experienced ease of use when consulting digital healthcare, with the exceptionbeing exposed groups who need specialized effort from healthcare providers to assimilatedigital healthcare. Conclusions Digital healthcare can contribute to increasing equality within the healthcare system. Morepatients can have access to corresponding healthcare. More knowledge and development isneeded for services to be used by a wider audience. Ensuring that the services matchconventional healthcare services regarding quality, investments are needed for thecontinuation of person centered care and quality assurance regarding technology. Digitalcompetence is required of the nurse, who must ensure that digital care is in line withperson-centered nursing.

Magister Economicae - MEcon / The provision of health care in South Africa is undergoing major restructuring. The aim is to achieve substantial, visible and sustainable improvements to the efficiency and accessibility of primary healthcare (PHC) services for all South Africans. One of the country's most critical problems is the weak and fragmented public sector PHC system. The most critical problems contributing to this are the maldistribution of resources (financial, physical and human) between hospitals and the primary care system, and between rural and urban areas. The health sector, therefore, faces the challenge of a complete restructuring and transformation of the national health care delivery system and related institutions. Choices need to be made about which services to cut, which to streamline and where savings can be made. Ways need to be found to use ALL of South Africa's resources optimally. This process of restructuring would be facilitated by the availability of accurate information on resource utilisation in the health sector. This study estimates the difference in the cost of primary diabetes treatment at dayhospitals and a provincial hospital in the Western Cape in 1992/93. Health economics is in its infancy in South Africa and serious data limitations exist. This study is therefore a pioneering effort in many ways. An appropriate methodological framework in which to conduct the costing had to be developed. The South African health sector, health spending arid the cost of primary diabetes treatment at day-hospitals and the provincial hospital are reviewed. Theoretical perspectives of the health care market and the methodologies of cost analysis are discussed. The cost analysis method of study is chosen, and arguments are advanced for its suitability in the South African context. A simple method of calculating the direct costs to obtain the average cost is proposed for the purpose of the study. Direct costs consist of staff costs and other related costs, such as medical supplies, non-medical supplies, building operations, equipment etc. These costs are then used to calculate the average costs per diabetic patient at the day-hospitals and the provincial hospital. The average cost per diabetic patient at day-hospitals amounted to R18.76, while at the provincial hospital the cost was R59.60.

Regeringen är skyldig att framställa och tillhandahålla allmänna tjänster till alla medborgare oberoende av åldersgrupp, etnicitet och kön. Regeringen har som ambition att digitalisera offentliga sektorer för att skapa en mer lättillgänglig och effektiv service, med målet att skapa en enklare vardag för medborgare. Den digitala vårdtjänst som används mest bland svenska pensionärer är 1177.se. Trots detta är personer på 65 år och uppåt som använder 1177.se betydligt färre procentuellt än personer i yngre åldrar. Detta utgör en motsägelse i förhållande till regeringens riktlinjer och mål. Tidigare studier av 1177.se har bland annat sammanställt användarstatistik och undersökt allmän användbarhet. Det har dock inte gjorts några kvalitativa studier av vilka faktorer som påverkar användningen och upplevelsen bland äldre som använder 1177.se:s personliga e-hälsoservice. Denna studie tillämpar en kvalitativ forskningsstrategi och använder sig av semistrukturerade intervjuer baserade på Unified Theory of Acceptance and Use of Technology (UTAUT). Därefter genomförs tematisk analys av intervjuerna, vilket resulterar i nio teman. Vi placerar in temana i UTAUT och gör två iakttagelser. Vi identifierar för det första ett samband mellan 1177:s ständiga tillgänglighet och informanternas benägenhet att använda 1177.se som ett sätt att undvika telefonköer. För det andra noterar vi att informanterna känner sig socialt tvingade av sina vårdgivare att använda 1177.se. Baserat på dessa resultat föreslår vi ändringar i UTAUT. Våra resultat indikerar ett centralt problem rörande hur vården introducerar 1177.se till nya användare, vilket tyder på att det behövs tydligare information. Vi föreslår att framtida jämförande studier av 1177.se utförs på yngre åldersgrupper, med stöd mot våra förändringar i UTAUT. Vi föreslår också att framtida studier undersöker åsikter om 1177.se hos äldre personer som inte använder 1177.se. Till sist föreslår vi att framtida studier undersöker hur interaktionsdesignen på 1177.se kan förbättras. / The Government is responsible for producing and providing services of general economic interest to all citizens, regardless of the citizens’ age group, ethnicity, and gender. The Government has an ambition of digitizing public sectors to increase service availability and efficiency, ultimately simplifying everyday life for citizens. The patient portal most widely used by Swedish pensioners is 1177.se. Despite this, people aged 65 and above who use 1177.se are significantly fewer in percentage than people of younger ages. This poses a contradiction in relation to the guidelines and goals outlined by the Government. Previous studies conducted on 1177.se have looked into usage statistics and general usability. However, no qualitative studies have been conducted on which factors influence the usage and experience among seniors using 1177.se’s personal e-services. This study takes on a qualitative research strategy, using semi-structured interviews based on Unified Theory of Acceptance and Use of Technology (UTAUT). Thematic analysis of the interviews is then conducted, resulting in nine themes. The themes are placed into UTAUT, and from this we make two observations. Firstly we identify a relationship between the constant availability of 1177.se and respondents’ propensity to use 1177.se as a means to veer off phone queues. Secondly we note that our respondents feel socially imposed by their caregivers to use 1177.se. Based on these findings we propose modifications to UTAUT. Our results indicate a central problem with how 1177.se is being introduced to patients, suggesting clearer information about 1177.se is needed. We suggest that future comparative studies of 1177.se be conducted on younger age groups, taking into account our modifications to UTAUT. We also suggest that future studies examine opinions about 1177.se among older people who are not users of 1177.se. Finally, we suggest that future studies examine how the interaction design on 1177.se can be improved.

[pt] Esta tese investiga a contribuição do design para a inovação social dos serviços públicos de atenção primária à saúde. Para tanto, a tese foi organizada em três etapas (1) pesquisa em dados secundários sobre os campos do saber do design, dos serviços e do design de serviços; (2) observação participante em um projeto de pesquisa da Lancaster University, chamado Design in Practice, no qual foi possível identificar as abordagens utilizadas pelos designers de serviços voltados à criação de novos serviços de saúde para o Sistema de Saúde Público Inglês (NHS); (3) pesquisa-ação para avaliar o potencial do método, pela criação de um novo serviço de atenção à saúde, no contexto brasileiro, voltado aos portadores de diabetes tipo II. Esta foi conduzida na Unidade Básica de Saúde (UBS) Vila Gaúcha, na cidade de Porto Alegre, a partir da aplicação da abordagem projetual centrada na experiência dos usuários. Nessa etapa, foi possível fazer uma intervenção de design de serviços, criar um novo serviço de atenção de saúde aos portadores de diabetes tipo II e avaliar os resultados alcançados pelo novo serviço. Os resultados encontrados sugerem que a competência em design pode contribuir de diferentes maneiras para criação de serviços de atenção básica à saúde, a saber: (1) pela interpretação do valor e do significado do serviço para os diferentes atores envolvidos no seu uso; (2) pela tradução desse conhecimento em uma linguagem visual compreensível a todos, possibilitando a (co)criação de uma solução; (3) pela configuração do conceito do serviço, contribuindo para a construção de um argumento persuasivo sobre como as pessoas devem agir em uma determinada situação; (4) pela inclusão das pessoas, cujo comportamento precisa ser afetado, no processo de (co)criação desse argumento, favorecendo o surgimento de uma inovação social. Por fim, a tese apresenta uma proposta de método design de serviços para aqueles que têm por foco uma inovação social. / [en] This thesis investigates the design discipline contribution on primary care health services social innovation. To this end, the thesis has been divided in three stages: (1) desk research about design, service and service design disciplines; (2) participant observational research in Design in Practice research project at Lancaster University, where it was possible to identify the service designers approaches to create new services for British National Health System (NHS); (3) an action research to evaluate the potential of service design method by creating a new primary care health service for patients with type II diabetes, in the Brazilian context. This design project was conducted at Vila Gaucha Basic Health Unit, at Porto Alegre city, by using experience based design approach. At this stage, it was possible to make a service design intervention; to create a new primary care health service for patients with diabetes type II and to evaluate the results reached by this new service. The results shows that the design competence could contribute in different ways for the creation of new primary care health services: (1) by interpreting service value and meaning for different actors involved in its use; and (2) by translating this knowledge into a visual language understandable to all, allowing the co-creation of solution; (3) by configurating services concepts, it building a persuasive argument about how people should act in a certain situation; and (4) by including these people, whose behaviour needs to be affected, in the argument co-creation process, design makes more favourable the emergence of a social innovation. As a result of this investigation, this thesis proposes a method for designing services that focus on social innovation.