Background: People with intellectual disabilities (ID) remain at high risk of developing type 2 diabetes (T2D) due to lifestyle associated risk factors such poor diets and low physical activity levels. Interventions have been adapted which target ongoing T2D self-management. However, there are no adapted programmes which prevent T2D through reducing risk factors. The present research project addresses this gap through a three-phase study on the existing literature, theoretical basis, and process evaluation of a T2D prevention programme. Methods: Phase 1: The literature reviews identified that the support needs of people with ID with T2D are currently not being met. Appropriate training needs to be delivered so that people with ID can self-manage or reduce the risk of T2D effectively. Given the early onset of T2D in people with ID and their often shorter lifespan, there is rationale for a preventative agenda in T2D education. Four potential mainstream intervention programmes were identified, and the self-efficacy model was found to be the most prevalent successfully implemented theoretical model. Phase 2: Nine sub-themes were identified following analysis of the data: 1) "Mastery through knowledge"; 2) "Mastery through tools and strategies"; 3) "Mastery through autonomy"; 4) "Influence of social setting"; 5) "Positive social comparisons"; 6) "Positive and negative self-statements"; 7) "Feedback from Caregivers"; 8) "Adjustment experiences"; 9) "Symptom awareness". These were mapped onto Bandura's (1977) Four Sources of efficacy enhancement model and were consistentwith its proposed mechanisms. The Four Sources model serves as a useful mode of enquiry for exploring people with ID's experiences and perceptions of self-managing diabetes. It also confirms the appropriateness of ssself-efficacy as a potential intervention component for this population. However, additional support may be required for people with ID to reflect meaningfully on their experiences and thus have a sense of self-efficacy. Phase3: 96% of invited students agreed to participate. The Walking Away programme was positively received, and some short-term impact was described, yet there were limitations to accessibility of the program due to the complexity of the language and materials. Suggestions for further adaptations regarding materials and content were provided, and there was perceived scope for a long-term implementation built into college curriculum. Results: Phase One: The literature reviews identified that the support needs of people with ID with T2D are currently not being met. Appropriate training needs to be delivered so that people with ID can self-manage or reduce the risk of T2D effectively. Given the early onset of T2D in people with ID and their often shorter lifespan, there is rationale for a preventative agenda in T2D education. Four potential mainstream intervention programmes were identified, and the self-efficacy model was found to be the most prevalent successfully implemented theoretical model. Phase Two: Nine sub-themes were identified following analysis of the data: 1) "Mastery through knowledge"; 2) "Mastery through tools and strategies"; 3) "Masterythrough autonomy"; 4) "Influence of social setting"; 5) "Positive social comparisons"; 6) "Positive and negative self-statements"; 7) "Feedback from Caregivers"; 8) "Adjustment experiences"; 9) "Symptom awareness". These were mapped onto Bandura's (1977) Four Sources of efficacy enhancement model and were consistent with its proposed mechanisms. The Four Sources model serves as a useful mode of enquiry for exploring people with ID's experiences and perceptions of self-managing diabetes. It also confirms the appropriateness of self-efficacy as a potential intervention component for this population. However, additional support may be required for people with ID to reflect meaningfully on their experiences and thus have a sense of self-efficacy. Phase Three: 96% of invited students agreed to participate. The Walking Away programme was positively received, and some short-term impact was described, yet there were limitations to accessibility of the program due to the complexity of the language and materials. Suggestions for further adaptations regarding materials and content were provided, and there was perceived scope for a long-term implementation built into college curriculum. Phase Three: 96% of invited students agreed to participate. The Walking Away programme was positively received, and some short-term impact was described, yet there were limitations to accessibility of the program due to the complexity of the language and materials. Suggestions for further adaptations regarding materials and content were provided, and there was perceived scope for a long-term implementation built into college curriculum. Conclusions: The findings provide basis for a further trial incorporating the suggested adaptations. A self-efficacy informed prevention programme was highly acceptability to students and teaching staff. Further education colleges provided a supportive setting and yielded a rich sample.

The thesis explored the drivers and inhibitors of change in sexual and reproductive health (SRH) policy and legislation in Kenya. The overall purpose was to contribute to the limited knowledge on national-level debates that shape how developing countries adapt the SRH agenda, which originated from international processes. The thesis explains how and why some SRH reforms have been realised in Kenya amid contention, while others have been blocked. Guided by a synthesis conceptual framework that emphasised the central role of discursive power in decision-making, the thesis adopted a qualitative case-study design enriched with various anthropological concepts. Three case-studies (two bureaucratic, i.e. adolescent RH policy and national RH policy, and one legislative, i.e. sexual offences law) were deconstructed. Data collection involved semi-structured in-depth interviews with policy actors, observations and note-taking in meetings, and document review. Findings revealed that four influential narratives of SRH – the moral narrative, cultural narrative, medical narrative (with two variations i.e. ‘moralised' versus ‘comprehensive' medical narratives), and human rights narrative – underpinned by conflicting actor interests, mediated the interplay of actor networks, knowledge, context and institutions to determine reforms. The findings revealed that the strong entrenchment of the moral and cultural narratives in the Kenyan context (mainly public structures and institutions) was a major barrier to reforms on contested SRH issues. Even then, the hegemonic narratives were in some cases unsettled to make reforms possible. The most important factors in unsettling the hegemonic narratives to facilitate reforms included: a change in the political context that brought in new political actors supportive of reforms, the presence of knowledgeable and charismatic issue champions within political and bureaucratic institutions, the availability of compelling knowledge (scientific or lay) on an issue, sustained evidence-informed advocacy by civil society/non-governmental organisations, donor pressure, and reduced political costs (for politicians and bureaucrats) for supporting reforms. The main contribution of the thesis is three-fold. First, the thesis captures the disconnect between international SRH agreements and national-level realities, showing the need for international actors to consider national-level realities that shape decision-making. Second, its findings provide lessons for informing future SRH reform efforts in Kenya and in other sub-Saharan African countries. Third, its analysis of discursive power contributes to a major theoretical gap in health systems research in developing countries identified as lack of critical analysis of power in decision-making.

Submitted by Silvana Teresinha Dornelles Studzinski (sstudzinski) on 2016-12-21T15:44:57Z No. of bitstreams: 1 Rodrigo Silva Pereira_.pdf: 951778 bytes, checksum: 90c6af826318df7c8204565678dff935 (MD5) / Made available in DSpace on 2016-12-21T15:44:57Z (GMT). No. of bitstreams: 1 Rodrigo Silva Pereira_.pdf: 951778 bytes, checksum: 90c6af826318df7c8204565678dff935 (MD5) Previous issue date: 2016-08-28 / Nenhuma / Com a emergência do crowdsourcing junto a difusão mundial de smartphones esforços recentes e pesquisas importantes sobre o uso de crowdsourcing na área da saúde ou ainda smarthealth visam auxiliar na melhoria hábitos de saúde, construção de históricos médicos pessoais de longo prazo, análise e revisão de dados médica, controle de dietas alimentares, gerenciamento do estresse, analise e comparação de informações e assistência em tempo real para catástrofes. Porém, nenhum deles usou de crowdsourcing para recomendação de centros clínicos de saúde. Segundo Chatzimilioudis crowdsourcing refere-se "a um modelo distribuído de solução de problemas em que uma multidão de tamanho indefinido é contratada para resolver um problema complexo através de um convite aberto". Neste âmbito, este trabalho apresenta um modelo de sistema de recomendação de centros clínicos de saúde, chamado CrowdHealth. A principal contribuição do modelo de sistema de recomendação de centros clínicos é possibilitar a criação de uma relação ganha-ganha entre seus usuários que podem ser cidadãos, médicos ou ainda entidades ligadas ao governo. Na literatura encontramos alguns trabalhos que carecem a abordagem do uso de crowdsourcing como fonte de dados para recomendação de centros clínicos de saúde. Nós desenvolvemos um protótipo de aplicação baseada no modelo de sistema de recomendação de centros clínicos de saúde para proporcionar uma visão do que seria uma aplicação baseada no modelo de sistema de recomendação de centros clínicos de saúde. Para avaliar o nosso modelo, apresentamos um cenário hipotético baseado numa possível aplicação para mensurar a percepção dos usuários quanto a utilidade dos centros clínicos de saúde. Os cenários descritos levavam em consideração os seguintes critérios: (1) a distância entre do usuário ao centro clinico, (2) a avaliação dos usuários em relação ao atendimento recebido nos centros clínicos e (3) o tempo de atendimento informado pelos usuários. Desta forma realizamos uma simulação de requisições de recomendações de usuários usando um dataset real contendo informações do Foursquare. O arquivo do dataset possuia 227428 check-in’s na cidade de Nova Iorque, EUA. O arquivo, foi dividido em duas partes, onde a primeira representava os check-in’s realizados pelos usuários nos centros clínicos, e a segunda representava usuários requisitando por recomendações de centros clínicos em outros locais. Assim, foram criadas funções para simular os processos de cálculo do tempo de atendimento e avaliação dos centros clínicos por parte dos usuários. Também simulou-se usuários requisitando por recomendações de centros clínicos em outros locais. Então, medimos precisão e recuperação dos centros clínicos de saúde sugeridos para cada usuário. Obtivemos valores médios de 57,5% e 61,33% para precisão e recuperação, respectivamente. Com isso, nossa avaliação retrata que centros clínicos de saúde recomendados por uma aplicação baseada no CrowdHealth poderiam aumentar beneficamente a utilidade de centros clínicos de saúde recomendados para os usuários. / With the emergence of crowdsourcing with the worldwide spread of smartphones recent efforts and important research on the use of crowdsourcing in health or smart-health are intended to assist in improving health habits, construction of historical long-term medical personnel, medical analysis and data review, control diets, stress management, analysis and comparison of information and real-time assistance for disasters. However, none of them used the crowdsourcing for recommendation clinical health centers. In this context, this paper presents a model of clinical health centers recommendation system called CrowdHealth. The main contribution of clinical health centers recommendation system model is possible to create a win-win relationship between its users that can be citizens, doctors or entities linked to the government. In the literature we find some papers that require the use of crowdsourcing as a data source for recommendation clinical health centers approach. We have developed a prototype application based on clinical health centers recommendation system model to provide a vision of what would be an application based on the clinical health centers recommendation system model. To evaluate our model, we present a hypothetical scenario based on a possible application to measure the perception of users and the utility of clinical health centers. The scenarios described took into consideration the following criteria: (1) the distance from the user to the clinical center, (2) the evaluation of other users on the service received in the clinical centers and (3) the time of service reported by users. Thus we performed a simulation of user requests recommendations using a real dataset containing information of Foursquare. The file dataset haved 227428 check in’s in New York City, USA. The file was divided into two parts, where the first represented the textit check in ’s performed by users in clinical centers, and the second represented by requesting users polyclinics recommendations elsewhere. Thus, functions were created to simulate service time calculation and evaluation processes of polyclinics by users. Also users was simulated by ordering polyclinics recommendations elsewhere. So we measure precision and recall of health clinical centers suggested for each user. Average values obtained from 57.5 % and 61.33 % for precision and recall, respectively. Thus, our assessment that portrays clinical health centers recommended by an application based on CrowdHealth could increase beneficially the usefulness of clinical health centers recommended for users.

Patient portals are web-based tools that provide patients with access to their health records and enhance communication with providers. Despite the efforts in expanding their use and patients interest in using them, patient portal usage remains low. Higher use of portals is associated with greater patient engagement and better healthcare quality and outcomes. This study investigated the impact of perceived usefulness (PU) and perceived ease of use (PEU) on patient portal usage. The conceptual framework was based on the Technology Acceptance Model, which suggests that PU and PEU of a system affect attitude and behavioral intention toward using the system, and ultimately the use of the system. The research questions focused on whether PU and PEU significantly affect portal usage. Participants included a convenience sample of 432 patients of Abington Health, located in Abington, PA, who had access to Abington's eClinicalWorks patient portal. Cross-sectional data collected from the completed online surveys included responses to Davis' PU and PEU measurement scale, self-reported portal login frequency and login duration, and some patient demographics. Data was analyzed by using chi-square test of independence and multinomial logistic regression. The study found that a significant relationship exists between PU and login frequency, PU and login duration, and PEU and login duration; however, the impact of PU and PEU on portal usage was not significant. The study could be repeated among a different population using a different patient portal. This study helps understand the relationship between PU/PEU and portal usage, something healthcare providers can capitalize upon when promoting portal use, and ultimately, encouraging greater patient engagement in their own health.

Healthcare systems have assimilated information and communication technologies in order to improve the quality of healthcare and patient's experience at reduced costs. The increasing digitalization of people's health information raises however new threats regarding information security and privacy. Accidental or deliberate data breaches of health data may lead to societal pressures, embarrassment and discrimination. Information security and privacy are paramount to achieve high quality healthcare services, and further, to not harm individuals when providing care. With that in mind, we give special attention to the category of Mobile Health (mHealth) systems. That is, the use of mobile devices (e.g., mobile phones, sensors, PDAs) to support medical and public health. Such systems, have been particularly successful in developing countries, taking advantage of the flourishing mobile market and the need to expand the coverage of primary healthcare programs. Many mHealth initiatives, however, fail to address security and privacy issues. This, coupled with the lack of specific legislation for privacy and data protection in these countries, increases the risk of harm to individuals. The overall objective of this thesis is to enhance knowledge regarding the design of security and privacy technologies for mHealth systems. In particular, we deal with mHealth Data Collection Systems (MDCSs), which consists of mobile devices for collecting and reporting health-related data, replacing paper-based approaches for health surveys and surveillance. This thesis consists of publications contributing to mHealth security and privacy in various ways: with a comprehensive literature review about mHealth in Brazil; with the design of a security framework for MDCSs (SecourHealth); with the design of a MDCS (GeoHealth); with the design of Privacy Impact Assessment template for MDCSs; and with the study of ontology-based obfuscation and anonymisation functions for health data. / Information security and privacy are paramount to achieve high quality healthcare services, and further, to not harm individuals when providing care. With that in mind, we give special attention to the category of Mobile Health (mHealth) systems. That is, the use of mobile devices (e.g., mobile phones, sensors, PDAs) to support medical and public health. Such systems, have been particularly successful in developing countries, taking advantage of the flourishing mobile market and the need to expand the coverage of primary healthcare programs. Many mHealth initiatives, however, fail to address security and privacy issues. This, coupled with the lack of specific legislation for privacy and data protection in these countries, increases the risk of harm to individuals. The overall objective of this thesis is to enhance knowledge regarding the design of security and privacy technologies for mHealth systems. In particular, we deal with mHealth Data Collection Systems (MDCSs), which consists of mobile devices for collecting and reporting health-related data, replacing paper-based approaches for health surveys and surveillance.

Ein zentrales Thema der medizinischen Informatik ist der institutionsübergreifende Austausch von Patientendaten zwischen den Akteuren des Gesundheitswesens. Die Notwendigkeit einer einheitlichen nationalen Telematikinfrastruktur für einen institutions-übergreifenden Austausch wurde auch von der Politik anerkannt. Dementsprechend wurde 2003 mit dem Gesetz zur Modernisierung der gesetzlichen Krankenversicherung (GMG) der erste Grundstein gelegt. Eine der Anwendungen, die laut Gesetzgebung (§ 291a SGB V) über die Telematikinfrastruktur umgesetzt werden sollte, ist die sogenannte elektronische Patientenakte. Diese Anwendung sollte es dem Patienten ermöglichen, seine Versorgungsdaten in einer eigenen Dokumentation zu führen und mit den Systemen seiner Behandler elektronisch zu kommunizieren. Bei der Gesetzgebung wurde der Fokus sehr eng gefasst, um aus Datenschutzgründen eine enge Zweckbindung der elektronischen Patientenakte sicher zu stellen. Wichtige Themen wie die Partizipation der Bürger und Patienten an der medizinischen Forschung wurden ausgeklammert. Werden die Prozesse der elektronischen Datenerfassung in der Versorgung und in der medizinisch-klinischen Forschung (z. B. den Universitätskliniken) betrachtet, so fällt auf, dass relevante Daten für die Versorgung und die Forschung häufig identisch sind. Da die Systeme von Forschung und Versorgung aber getrennt voneinander betrieben werden, kommt es zu Doppelerfassungen. Diese Doppelerfassungen sind für einen Anwender, der Daten in beide Systeme eintragen muss, schwer nachvollziehbar - auch die gewünschte Partizipation der Patienten an Forschungsvorhaben ist so kaum möglich. Die grundlegende Idee dieser Arbeit ist es, eine Schnittstelle zwischen einer elektronischen Patientenakte und der medizinischen Forschung gemäß den Vorgaben der nationalen Telematikinfrastruktur zu konzipieren. Damit soll dem oben geschilderten Problem der Doppelerfassung von Patientendaten entgegengewirkt werden, indem mit Hilfe dieser Schnittstelle ein Austausch von Patientendaten über eine elektronische Patientenakte zwischen den Systemen der Versorgung und Forschung ermöglicht wird. Zu diesem Zweck wurden zunächst die Systeme der Versorgung und der Forschung analysiert und ein Kommunikationsmodell sowie Datenschutzanforderungen für die Kommunikation zwischen einer elektronischen Patientenakte und den Systemen der Forschung formuliert. Auf Grundlage des Kommunikationsmodells und der Datenschutzanforderungen wurden sowohl eine Fach- als auch eine Sicherheitsarchitektur für die Schnittstelle zwischen einer elektronischen Patientenakte und den Systemen der Forschung beschrieben. Als Ergebnis konnte herausgestellt werden, dass die Anbindung der IT-Systeme der medizinischen Forschung über eine elektronische Patientenakte sicher und datenschutzkonform umgesetzt werden kann. Abschließend wird der entstandene Ansatz mit bisherigen Lösungen zur Nutzung von Versorgungsdaten für die medizinische Forschung kritisch verglichen und die Stärken einer in der nationalen Telematikinfrastruktur integrierte Löschung gegenüber alleinstehenden Insellösungen hervorgehoben. Es wird herausgestellt, dass die grundlegenden Konzepte stehen, aber noch erheblicher Aufwand erbracht werden muss, um ein auf nationaler Ebene verfügbares System bereitzustellen. Vorschläge für die weiteren Arbeiten zu einem funktionierenden System sowie weitere Potentiale der Ergebnisse dieser Arbeit werden in einem Ausblick aufgezeigt.

Darbo tikslas – įvertinti pacientų nuomonę ir požiūrį apie atliekamų paslaugų saugą PSP grandyje. Uždaviniai: Išanalizuoti pacientų nuomonę apie atliekamų medicininių paslaugų saugą PSP įstaigoje. Įvertinti paciento požiūrį apie gydymo vaistais saugumą. Išanalizuoti, paciento ir gydytojo tarpusavio pasitikėjimo aspektus, siekiant efektyvaus ir saugaus gydymo. Ištirti pacientų požiūrį į nepageidaujamų įvykių priežastis ir jų registravimo sistemą. Tyrimo metodika. Kiekybinis momentinis tyrimas. Tyrimo laikas: 2013 m. sausio - balandžio mėn. Tyrimo vieta - UAB „Šilainių šeimos sveikatos centras“. Tiriamoji imtis 378 respondentai. Atsako dažnis - 94,5 proc. Rezultatai. Respondentams svarbus sveikatos priežiūros paslaugų prieinamumas ir jų savalaikiškumas (22,49 proc. ir 20,37 proc., atitinkamai). 63,49 proc. pacientų žino, kas yra pacientų sauga, todėl vertina komunikavimą su gydytoju, teiraujasi apie paskirtus vaistus, jų pašalines reakcijas, domisi paskirtu gydymu. 38,89 proc. respondentų nuomonė apie antibiotikų skyrimo pagrįstumą yra teigiama, o juos vartoja pagal gydytojo rekomendacijas. Bendravimo tarp personalo ir paciento analizė, parodė, kad visais analizuotais atvejais tarpusavio bendravimas tarp personalo ir paciento yra vertinamas pakankamai gerai. Jaunesni respondentai žymiai dažniau nei vyresni linkę reikšti savo nuomonę, dažniau teiraujasi apie savo sveikatą, dalyvauja jiems svarbių sprendimų priėmime. Respondentai mano, kad dažniausia... [toliau žr. visą tekstą] / Objective of the work – to assess the patients’ opinion and attitude to the safety in the primary health care. Tasks: To analyze the patients’ opinion about the safety of medical services provided in the primary health care facilities. To evaluate the patient’s attitude to the safety of conservative treatment. To analyze the aspects of mutual trust of doctor and patient in order to achieve effective and safe treatment. To examine the patients’ attitude to the reasons of undesirable events and their registration system. Research methodology. Quantitative survey. Study time: January-April 2013. Place of research – Silainiai Family Health Center Ltd. Analyzed sample – 378 respondents. Response frequency – 94,5 percent. Results. The respondents find the accessability and timeliness of the health care services important (22,49 percent and 20,37 percent accordingly). 63,49 percent of the patients are familiar with the safety of patients, thus they appreciate communication with the doctor, inquire about the prescribed medicine, their side effects, and show interest in the prescribed treatment. 38,89 –percent of respondents think that prescription of antibiotics is reasonable and they use antibiotics according to the recommendations of the doctor. The analysis of the communication of the patient and the doctor revealed that in all the analyzed cases the interrelations between the staff and the patient are evaluated quite well. The younger respondents tend to... [to full text]

Thesis (doctoral)--Swinburne University of Technology, 2006. / Title from PDF title page (viewed on Nov. 30, 2006). Includes bibliographical references (p. 177-188).

The thesis deals with a nurse and the care of her own health. The theoretical part mainly deals with mental health, proper regimen and physical as well as mental load on nurses in relation to the health care job. The main aim of the thesis was to identify the factors affecting the regimen of nurses and their care about their own health, and to try to find how the work load and department character is related to possible occurrence of health problems. Partial goals and working hypotheses were set for this purpose. Variables like age, gender, education and type of department were included among the assumed factors affecting care about health and health problems.

Health is related to the growth of life quality and longevity, helping people to have equilibrium in all personal life areas. In this context, the actual study consists in to develop a Personal Health Strategic Planning Model, to establish or to improve individual health. The study was based on the Strategic Planning and the Planning Model of Estrada (2006); Personal Strategic Planning and Models of Personal Strategic Planning, which tells about the changeable variables of Health. The adopted work methodology was the qualitative research, with exploratory objective and exploratory character. The procedure design adopted for to collect data, from the technical point of view, was the biographic research. The theoretical analysis let to establish the main elements for the composition of the Personal Health Strategic Planning Model purposed. To improve the understanding of this study, the purposed model is composed on two types: biological and psychosocial. The first one is composed by three elements: clinical control, nutrition and fitness, and the second one is composed by the resilient concept (stress adaptive answer), which is divided on three types: academic, emotional and social. It was possible to see that the Personal Health Planning can contribute for the Health promotion and the sickness prevention, because it systematizes the elements of Health and its scientific technical recommendations, guiding people to have healthy habits. / A saúde está relacionada ao aumento da qualidade de vida e longevidade, contribuindo para que o indivíduo tenha equilíbrio em todas as áreas da sua vida pessoal. Neste contexto, o presente estudo consiste em desenvolver um Modelo de Planejamento Estratégico Pessoal da Saúde, para manter ou melhorar a saúde individual. O estudo tomou como base o Planejamento Estratégico e o Modelo de Planejamento Estratégico de Estrada (2006); Planejamento Estratégico Pessoal e Modelos de Planejamento Estratégico Pessoal, que mencionam os aspectos determinantes modificáveis da saúde. A metodologia constituiu-se de pesquisa de natureza qualitativa, com objetivo e caráter exploratório. O delineamento dos procedimentos, para a coleta de dados, do ponto de vista técnico, foi a pesquisa bibliográfica. A análise da fundamentação teórica permitiu estabelecer os elementos essenciais para a composição do Modelo de Planejamento Estratégico Pessoal da Saúde proposto. Para facilitar a compreensão, o modelo proposto foi dividido em duas categorias: biológica e psicossocial. A primeira composta por três elementos: controle clínico, nutrição e condicionamento físico, e a segunda envolvendo o conceito de resiliência (resposta adaptativa ao estresse), dividindose em três tipos: acadêmica, emocional e social. Percebeu-se que o Modelo de Planejamento Estratégico Pessoal da Saúde proposto, pode contribuir para promoção da saúde e prevenção de doenças, pois sistematiza os elementos da saúde e as suas respectivas recomendações técnico científicas, orientando as pessoas à prática de hábitos saudáveis.