Philosophiae Doctor - PhD / Pregnancy-related poor maternal health and maternal death remain major problems in most Nigerian states including Cross River State. The acute impact of these problems is borne more heavily by rural communities where the majority of births take place at home unassisted or assisted by unskilled persons. These problems are due to a mixture of problem recognition and decision-making during obstetric emergencies leading to delayed actions. Every pregnancy faces risk, and prenatal screening cannot detect which pregnancy will develop complications. If the goal of reducing maternal morbidity/mortality is to be achieved, increasing the number of women receiving care from a skilled provider (doctor/nurse/midwife) during pregnancy, delivery, and post-delivery and prompt adequate care for obstetric complications has been identified as the single most important intervention. One of the strategies identified in many countries is engaging and working with individuals, families, and communities as partners to improve the quality of maternal healthcare. This strategy is thought to remove the barriers that dissuade women from using the services that are available, empowering the community members to increase their influence and control of maternal health, promote ownership and sustenance, as well as increase access to skilled care. The aim of the study: The overall aim of this PhD study was to develop a model of community engagement to facilitate the prevention of maternal health complications in the rural areas of Cross River State, Nigeria. To develop this model, the study specifically sought to: 1. Understand the current situation in Cross River State by exploring the knowledge gap of women of child-bearing age (pregnant and new mothers) regarding obstetric danger signs, birth preparedness and complication readiness, delivery practices of women, the action of family/community members, and the role of community-based maternal health initiatives, if any, in emergencies, as well as explore participants’ opinions on actions to be taken by the community to promote the utilisation of orthodox healthcare facilities by rural women of Cross River State (Phase 1). 2. Engage community members through a participatory approach (Photovoice) to highlight problems regarding pregnancy and birth practices, identify possible solutions, and make recommendations on communities’ roles in the prevention of maternal health complications (Phase 2). The older women of the study communities were also engaged to verify and validate the findings from phases 1 & 2 analyses. 3. Develop a model of community engagement to improve maternal health literacy by increasing knowledge on early detection of obstetric complications, birth preparedness, complication readiness, and improved access to skilled birth attendance (Phase 3). Methods: The study was conducted using a qualitative descriptive research approach that combined qualitative semi-structured interviews and focus group discussions within the Photovoice participatory approach. Purposive sampling was employed to select 20 participants, 10 each from the Idundu (Community A) and Anyanganse (Community B) rural communities of Akpabuyo Local Government Area of Cross River State, Nigeria. The participants comprised pregnant women and new mothers (babies aged 12 months and younger) who met the eligibility criteria. Data collection was by means of semi-structured interviews (Phase1), focused group discussions and Photovoice (Phase 2). Trustworthiness of the data was ensured by means of applying Guba’s model of credibility, transferability, and authenticity. The ethical principles of respect for human dignity, beneficence, confidentiality, and justice were applied throughout the study. The Citizenship Healthcare and Socio-Ecological Logic models were used to direct the study. Permission was obtained from participants for all the phases of the study while approval for the study was obtained from the Senate Higher Degrees Committee of the University of the Western Cape and the Cross River State Ministry of Health Ethical Committee. Data was analysed using Tesch’s method of content analysis. Based on the findings of Phases 1 & 2 of the study, themes emerged that were then validated by the older women in the study communities. The model was then developed by means of the four steps of the theory generation process. Step one was concept development that consisted of the identification, definition, validation, classification, and verification of the main and related concepts. Step two was model development consisting of the sub-steps, namely model guidelines and definitions. The communities’ stakeholders were engaged at this phase to verify and validate the concepts, as well as contribute to the drafting of the model guidelines and the definitions. Step three was a model description whereby the structure, definition, relation statements, and the process of the model were described. A visual application of the model that depicts the main concepts, the process, and the context was shown. Step four dealt with the development of guidelines for the operation of the model. A critical reflection of the model was done using Chinn and Kramer’s five criteria for model evaluation. Results: The study revealed that Idundu and Anyanganse’s rural women have limited knowledge of obstetric danger signs and very few of them acknowledged the importance of hospital delivery. They also exhibited poor understanding of what birth preparedness and complication readiness entailed. There was a high preference for traditional birth attendant care during pregnancy and delivery with their reasons being belief and trust in traditional birth attendants, a long standing tradition to deliver with them, assumptions that orthodox healthcare is expensive, poor attitude of healthcare providers towards women, unavailability of 24-hour services in healthcare facilities, fear of hospital procedures and operations, communal living in traditional birth attendant’s homes, spirituality in traditional birth attendant services, and the consideration of proximity to service points. These factors exacerbated the delays in seeking care and in referrals for skilled care in phases of emergency. The study also revealed that in the study communities, heavy household chores carried out by pregnant women is culturally accepted and seen as exercise to ease labour, there is lack of proper information regarding maternal and child health issues, men are sole decision-makers, they are ignorant of availability of free treatment in health centres, there is an ignorance regarding care of the new-born, and a lack of community structures to support women’s health. Based on the above findings, the women made the following suggestions towards finding a solution: improving maternal health literacy, increasing spirituality in service delivery, involving of husbands in antenatal care for proper information on maternal health issues, accessing community support through the use of community structures (town announcers, women groups, churches, etc.) with the purpose of emphasising facility delivery, constitution of influential groups to monitor the activities of pregnant women to ensure utilisation of skilled attendants, access to healthcare through free services and availability of providers, trust of health services, and traditional birth attendant training/traditional birth attendant facility collaboration. A total of eight concepts were identified from the concluding statements of steps 1 & 2, and used to develop the Maternal Health-Community Engagement Model (MH-CEM). These were: maternal health literacy, spirituality in healthcare, integrated traditional birth attendants’ role (value, training, and traditional birth attendants/hospital collaboration), trust in health services (by addressing previous experiences, attitude, and fear), improving access to healthcare, culturally acceptable care, husbands’ involvement in women’s health issues, and community support. These concepts formed the core components for the Maternal Health-Community Engagement Model which was developed as the main recommendation to address the core concepts. Central to this Model was the Community Engagement Group (CEG) which was established during the process of engaging the community stakeholders in validating the concepts and drawing up of the guidelines for the Model development. Conclusions and Recommendations: It is believed that the activities of the Community Engagement Group may bring about improved maternal health literacy, a process for working with traditional birth attendants through training and re-orienting them to be promoters of facility delivery when appropriate, and a model for involving husbands, and indeed the entire community, in maternal health issues. Limitations were identified and recommendations for nursing practice, education, and research concluded the study.

M.Ed. (Education) / Please refer to full text to view abstract

In this paper we investigate how well residents of the Andaman coast in Phang Nga province, Thailand, are prepared for earthquakes and tsunami. It is hypothesized that formal education can promote disaster preparedness because education enhances individual cognitive and learning skills, as well as access to information. A survey was conducted of 557 households in the areas that received tsunami warnings following the Indian Ocean earthquakes on 11 April 2012. Interviews were carried out during the period of numerous aftershocks, which put residents in the region on high alert. The respondents were asked what emergency preparedness measures they had taken following the 11 April earthquakes. Using the partial proportional odds model, the paper investigates determinants of personal disaster preparedness measured as the number of preparedness actions taken. Controlling for village effects, we find that formal education, measured at the individual, household, and community levels, has a positive relationship with taking preparedness measures. For the survey group without past disaster experience, the education level of household members is positively related to disaster preparedness. The findings also show that disaster-related training is most effective for individuals with high educational attainment. Furthermore, living in a community with a higher proportion of women who have at least a secondary education increases the likelihood of disaster preparedness. In conclusion, we found that formal education can increase disaster preparedness and reduce vulnerability to natural hazards.

Civil infrastructure construction sites including incomplete structures and unsecured resources are among the most vulnerable environments to hurricane conditions. Hurricane driven damages cause disruption of construction sites and considerable schedule delays, and thus negatively impact the efficiency of the construction projects. This research aims to study current best practices on securing construction sites from hurricane conditions and evaluate the performance of the preparedness plan. To do that, first, an interview-survey is conducted with key project personnel from multiple construction companies. Then, the insight from the interviews serves to do a Micro and Macro Environmental Analysis. For further analysis, a Balanced Scorecard is used to suggest metrics to measure and improve the performance of the Hurricane Preparedness Plan. The findings from this research improves the organizational processes and enhances the assessment of disaster preparedness, which ultimately generates new and highly specific knowledge on disaster mitigation and preparedness guidelines for construction sites.

京都大学 / 0048 / 新制・課程博士 / 博士(地球環境学) / 甲第22710号 / 地環博第200号 / 新制||地環||39(附属図書館) / 京都大学大学院地球環境学舎地球環境学専攻 / (主査)教授 星野 敏, 教授 西前 出, 教授 寶 馨 / 学位規則第4条第1項該当 / Doctor of Global Environmental Studies / Kyoto University / DFAM

Vårt syfte med undersökningen är att granska pedagogers pågående och efter krisarbete i förskolan samt hur pedagoger stötar och möter barn i en krissituation. Vi vill bidra med kunskap om resiliens och hur pedagoger kan arbeta med resiliens för att förhindra psykiska problem i framtiden. Vi valde att skicka ut förfrågan till pedagoger i förskolan. Vår idé var att få information från olika pedagoger från olika förskolor om hur man arbetar med krissituationer. När vi samlat in material från pedagogerna kopplar vi deras svar till våra teorier och tidigare forskning. Vår undersökning ger pedagoger tillgång till hur en välutvecklad krishandlingsplan kan stödja barn i kris. Det framkom i svaren från vår undersökning att de flesta förskolor använder en krishandlingsplan och pedagoger anser att de var väl förberedda för en kris. Det fanns dock ingen krishandlingsplan i utbrottet av pandemier. Pedagogerna beskrev att de saknar information om COVID-19-pandemin och ville ha en krishandlingsplan med tydliga riktlinjer att följa för att kunna agera snabbare i ett pandemiutbrott. / Our purpose with the examination is to review pedagogues’ ongoing and post-crisis work in preschool as well as how pedagogue support and meet children in a crisis situation. We want to contribute with knowledge of resilience and how a pedagogue can work with resilience to prevent psychological problems in the future. We chose to send out inquiry to pedagogues in preschool. Our idea was to get information from different pedagogues from different preschools on how to work with crisis situations. When we collect material from the pedagogues, we link their responses to our theories and previous research. Our examination gives pedagogues access to how a well-developed crisis action plan can support children in crisis. It emerged in the responses from the inquiry that most preschools use a crisis action plan and the pedagogues consider that they were well prepared for a crisis. However, there was no crisis action plan in the outbreak of pandemics. The pedagogues described that they now lack information on the COVID-19 pandemic and wanted a crisis action plan with clear restrictions to follow in order to be able to act faster in a pandemic outbreak.

As the number of people affected by natural and man-made disasters increases, so does the need for emergency preparedness education. Previous research has indicated that education and training can have an impact on the resiliency of individuals, families, and communities. The use of Extension professionals in regional and county offices across each state is an effective means for education. In this study, family and consumer sciences (FCS) county Extension faculty in the Western Region of the United States were surveyed to determine the best practices used and perceptions of the importance and their ability to educate individuals, families, and communities on emergency preparedness. Many respondents agreed on effective strategies to recruit individuals to Extension programming. Overall, FCS county Extension faculty indicated that emergency preparedness being offered was important; however, they did not think they had adequate knowledge or ability to educate on many emergency preparedness topics.

京都大学 / 0048 / 新制・論文博士 / 博士(情報学) / 乙第12942号 / 論情博第91号 / 新制||情||102(附属図書館) / 32152 / (主査)教授 林 春男, 教授 田中 克己, 教授 牧 紀男 / 学位規則第4条第2項該当 / Doctor of Informatics / Kyoto University / DFAM

京都大学 / 0048 / 新制・課程博士 / 博士(情報学) / 甲第19115号 / 情博第561号 / 新制||情||99(附属図書館) / 32066 / 京都大学大学院情報学研究科社会情報学専攻 / (主査)教授 林 春男, 教授 田中 克己, 教授 喜多 一 / 学位規則第4条第1項該当 / Doctor of Informatics / Kyoto University / DFAM

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