<p>This study focuses on the changing practices of South African residents’ associations and their relationship with political parties and local government from 1990 to 2006, with the aim to examine how associations in Cape Town respond when they are confronted with a new democratic institutional and political context.</p><p>Two empirical questions guide the analysis: How do residents’ associations perceive that the changing political context has affected them in their attempts to influence agenda-setting and decision-making? And how can we understand the process in which they decide to act, or not act, in response to important changes in their political environment? </p><p>Drawing on social movement theory, most importantly the notions of political opportunity structures and framing processes, an analysis is made of the most significant changes in Cape Town’s post-apartheid institutional and political context. The empirical findings – based on questionnaires, interviews and an in-depth study of the township of Imizamo Yethu in Hout Bay – show that associations in socio-economically distinct areas have different perceptions of their prospects of affecting agenda-setting and decision-making. Because of the close links with political parties, many associations interpret the political and institutional changes as either threats or opportunities depending on which party controls the City Council. In predominantly white affluent areas associations generally seem to underestimate their chances of being influential, whereas those in black poor areas tend to overestimate their ability to influence decision-making when the ANC is in a government position. </p><p>The study contributes to the development of social movement theory by its systematic application of the framework of political opportunity structures in a local urban context outside the US and Western Europe. The pattern suggested by theory, that movements choose their action repertoire according to the rule “as moderate as possible, as radical as necessary”, is largely confirmed by the findings.</p>

Det overordnede målet med denne avhandling var å få en oversikt over ulike forstyrrelser i de nedre urinveier hos gamle. Dernest var målet å beskrive oppfatninger og barrierer som influerte på personalets muligheter for å gi riktig inkontinenspleie til beboere i sykehjem. Avhandlingen består av en kvantitativ studie (artikkel I, II, III), og en kvalitativ studie (artikkel IV). Artikkel I var en tverrsnittstudie. Artikkel II og III var en prospektiv tidsdesignstudie med en oppfølgingsperiode på ett år. 183 beboere fra seks sykehjem deltok i den kvantitative studien. I artikkel I ble prevalensen av urininkontinens hos norske sykehjembeboere evaluert. I tillegg ble det forsøkt å identifisere faktorer som var assosiert med urininkontinens i denne populasjonen. I artikkel II ble det undersøkt om residualurin var en risiko for å utvikle urinveisinfeksjon hos gamle på sykehjem. I artikkel III ble det undersøkt om bleiebruk per døgn er en pålitelig metode for å kvantifisere urininkontinens hos sykehjemsbeboere. Det ble også studert om det var sammenheng mellom urinveisinfeksjon, bleiebruk per døgn og væskeinntak. I den kvalitative studien var målet å identifisere oppfatninger og barrierer som influerte på pleiernes muligheter for å gi riktig inkontinenspleie. Fem avdelingsledere, fem sykepleiere og fem hjelpepleiere ble intervjuet i til sammen tre fokusgruppeintervjuer.Analysen i artikkel I viste at 122 beboere (69 %) var inkontinent for urin og 144 (83 %) brukte bleier. 14 % brukte bleier for sikkerhets skyld. Lav ADL-skår, demens og urinveisinfeksjon var assosiert med urininkontinens (P = &lt;0.01). I artikkel II hadde 98 beboere (63.3 %) residualurin mindre enn 100 ml, og 52 (34.7 %) hadde residualurin på 100 ml eller større. I løpet av oppfølgingsperioden hadde 51 beboere (34 %) utviklet en eller flere urinveisinfeksjoner. Forekomsten av urinveisinfeksjon var høyere hos kvinnene enn hos mennene (40.4 % versus 19.6 %; P = 0.02). Det ble ikke funnet noen signifikant forskjell i gjennomsnittlig residualurin mellom beboere som utviklet og som ikke utviklet urinveisinfeksjon (79 versus 97 ml, P = 0.26). Residualurin på 100 ml eller større var ikke assosiert med større risiko for utvikling av urinveisinfeksjon.I artikkel III brukte 118 (77 %) av beboerne bleier. Bleiebruk per døgn er et upålitelig mål på urininkontinens hos beboere i sykehjem. Beboere som brukte bleier hadde en økende risiko for å utvikle urinveisinfeksjon sammenlignet medvibeboere som ikke brukte bleier (41 versus 11 %; P = 0.001). Daglig væskeinntak var ikke assosiert med urinveisinfeksjoner (P = 0.46). Antall bleieskift viste ingen korrelasjon med risikoen for utvikling av urinveisinfeksjon (P = 0.62). Bleiene som beboerne brukte per døgn, viste stor variasjon i inkontinensvolum. I den kvalitative studien ledet innholdsanalysen fram til tre emner og åtte kategorier. Det første emnet, Oppfatninger og barrierer assosiert med beboerne, inneholdt en kategori ”fysiske og kognitive problemer”. Det andre emnet, Oppfatninger og barrierer assosiert med personalet, inneholdt tre kategorier: ”manglende kunnskaper”, ”holdninger og tro” og ”manglende tilgjengelighet”. Det tredje emnet, Oppfatninger og barrierer assosiert med den organisatoriske kulturen, inneholdt fire kategorier: ”rigide rutiner”, manglende ressurser”, ”manglede dokumentasjon” og ”svakt lederskap”. Resultatene i denne avhandlingen viser at forekomsten av urininkontinens i sykehjem er høy. Absorberende produkter er hyppig brukt uten en kjent historie av urininkontinens. Fysisk svekkelse, demens og urinveisinfeksjon er assosiert med urininkontinens. Residualurin er vanlig hos beboere i sykehjem. Det ble ikke funnet noen sammenheng mellom residualurin og urinveisinfeksjon. Bruk av absorberende bleier er assosiert med økt risiko for utvikling av urinveisinfeksjon. Bleiebruk per døgn og væskeinntak var ikke korrelert med økt risiko for utvikling av urinveisinfeksjon. Bleiebruk per døgn er et upålitelig mål på urininkontinens hos beboere i sykehjem. Funnene fra den kvalitative studien viser at det er mange barrierer som influerer på personalets evne til å gi riktig inkontinenspleie til beboere i sykehjem. Det kan likevel se ut som om personalets oppfatninger og holdninger, samt manglende kunnskaper om urininkontinens, er de viktigste barrierene for å gi riktig inkontinenspleie. / The overall aim of this thesis was to get an overview over different dysfunction in the lower urinary tract in the elderly. Also, we wanted to describe the perceptions and barriers that influence the nursing staff`’s ability to provide appropriate incontinence care in nursing home residents. The thesis includes one quantitative study (paper I, II, III), and one qualitative study (paper IV). Paper I was a cross-sectional study. Paper II and III were a prospective surveillance with a follow-up period of 1 year. 183 residents from six Norwegian nursing homes participated. In paper I, the prevalence of urinary incontinence in Norwegian nursing home residents was evaluated. The factors possibly associated with urinary incontinence were also studied. In paper II, we investigated whether residual urine was a risk factor for developing urinary tract infections in the elderly in nursing homes. In paper III, the objective was to determine whether pads per day usage is a reliable measure of urinary incontinence in nursing home residents. Furthermore, we wanted to study the association between urinary tract infections, pads per day usage and fluid intake. In the qualitative study, the aim was to identify perceptions and barriers that influence the ability of nursing staff to provide appropriate incontinence care. Five charge nurses, five registered nurses and five certified nursing assistants participated in the focus group interviews.The analysis in paper I, showed that 122 (69 %) of the resident were incontinent for urine and 144 used absorbent pads (83 %). 14 % of residents used absorbent pads ‘just to make sure’. They did not have a history of urinary incontinence. Low ADL score, dementia and urinary tract infection were significantly associated with incontinence for urine (P = &lt;0.01). In paper II, 93 of the residents (65.3 %) had postvoid residual urine (PVR) &lt; 100 mL and 52 residents (34.7 %) had a PVR 100 mL. During the follow-up period, 51 residents (34.0 %) had one or more urinary tract infections (UTI). The prevalence of UTI among females was higher than among men (40.4 % versus. 19.6 %; P = 0.015). There was no significant difference in mean PVR among residents that did or did not develop UTI (79 mL versus 97mL; P = 0.26). A PVR 100 mL was not associated with an increased risk of developing UTI`s (P = 0.59).In paper III, 118 (77 %) used absorbent pads. Residents that used absorbent pads were at increased risk of developing UTIs compared to residents that did notviiiuse pads (41 % versus 11 %; P = 0.001). Daily fluid intake was not associated with UTIs (P = 0.46). The number of pad shifts had no relation with the risk of developing UTIs (P = 0.62). Residents with a given pad per day (PPD) presented a wide range of incontinence volumes.In paper IV, three topics and eight categories were identified. The first topic, Perceptions and barriers associated with residents, consisted of one category: ‘physical and cognitive problems’. The second topic, Perceptions and barriers associated with nursing staff, consisted of three categories: ‘lack of knowledge’, ‘attitudes and beliefs’ and ‘lack of accessibility’. The third topic, Perceptions and barriers associated with organizational culture, consisted of four categories: ‘rigid routines’, ‘lack of resource’, ‘lack of documentation’ and ‘lack of leadership’.The results of the thesis show that the prevalence of urinary incontinence in nursing homes is high. Absorbent products are frequently used without a history of urinary incontinence. Physical impairment, dementia and urinary tract infections are associated with urinary incontinence. is common in nursing home residents. No association between PVR and UTI was found. The use of absorbent pads is associated with an increased risk of developing UTIs. PPD and daily fluid intake are not correlated with the risk of developing UTIs. PPD is an unreliable measure of urinary incontinence in nursing home residents. The findings from the qualitative study shows that there are many barriers that might influence the possibilities of nursing staff to provide appropriate incontinence care to residents in nursing homes. However, it can nevertheless seem like opinions and the attitude of nursing staff, together with a lack of knowledge about urinary incontince, are the most important barriers to provide appropriate incontinence care.

This study focuses on the changing practices of South African residents’ associations and their relationship with political parties and local government from 1990 to 2006, with the aim to examine how associations in Cape Town respond when they are confronted with a new democratic institutional and political context. Two empirical questions guide the analysis: How do residents’ associations perceive that the changing political context has affected them in their attempts to influence agenda-setting and decision-making? And how can we understand the process in which they decide to act, or not act, in response to important changes in their political environment? Drawing on social movement theory, most importantly the notions of political opportunity structures and framing processes, an analysis is made of the most significant changes in Cape Town’s post-apartheid institutional and political context. The empirical findings – based on questionnaires, interviews and an in-depth study of the township of Imizamo Yethu in Hout Bay – show that associations in socio-economically distinct areas have different perceptions of their prospects of affecting agenda-setting and decision-making. Because of the close links with political parties, many associations interpret the political and institutional changes as either threats or opportunities depending on which party controls the City Council. In predominantly white affluent areas associations generally seem to underestimate their chances of being influential, whereas those in black poor areas tend to overestimate their ability to influence decision-making when the ANC is in a government position. The study contributes to the development of social movement theory by its systematic application of the framework of political opportunity structures in a local urban context outside the US and Western Europe. The pattern suggested by theory, that movements choose their action repertoire according to the rule “as moderate as possible, as radical as necessary”, is largely confirmed by the findings.

This essay examines resident experiences and notions of the Gotland countryside and their ideas about the future. In particular the countryside is studied as both space and place. In space and place people interacting. People are therefore important components in the study of the landscape. One can say that the landscape and the interaction between people affect resident experiences and notions of the countryside, as well as people certainly affect the landscape. From that point of view is the landscape seen as a social construction. Moreover, the study examines the residents’ attitudes to tourism in the countryside, tourists being a group of importance for Gotland’s regional development. The study also identifies reasons behind experiences and attitudes. The study is based on questionnaires and interviews with residents’ and three different groups are studied; the general public, farmers, and public servants, who in one way or another work with regional development. The study shows residents’ positive and negative opinions as well as similarities and differences among the three studied groups. One important finding is that public servants tend to think that other people are more positive towards the future than they really are. Nevertheless, positive and negative perspectives are important to be aware of to understand residents’ situation, likewise to be able to have an influence on people, their attitudes and situations. Eventually, it is clear that sense of place and experience of space affect residents’ ideas about the future and vice versa. Therefore these aspects need to be taken into consideration in physical planning and regional development. / Denna studie om Gotlands landsbygd och invånarnas framtidstro är ett examensarbete i geografi, inriktning kulturgeografi, vid Södertörns högskola. Syftet är att beskriva hur invånarna upplever landsbygden och vad de har för tro på framtiden, vilket sker genom studier av tre grupper; allmänheten, tjänstemän och lantbrukare. Vidare är syftet att analysera vilka attityder och inställningar som finns till landsbygden samt identifiera påverkansfaktorer. Studien baseras på en enkätundersökning och åtta intervjuer. Geografiska teorier har sedan använts, framförallt teorier om ”sense of place” (medvetenheten om känslan till en plats). Hänsyn tas till samhällsutvecklingen som gett flertalet konsekvenser för landsbygden och dess befolkning samt turistnäringen som har blivit en allt viktigare näring för Gotland, när påverkansfaktorer samt människors upplevelser, inställningar och attityder undersöks. Studien har tillkommit utifrån en förförståelse om att Gotlands landsbygd sedan några decennier genomgått åtskilliga utmaningar, särskilt inom jordbruksnäringen (inom jordbruksnäringen avses både jord- och lantbruk) som är en betydelsefull näring för hela ön. Sedan något år tillbaka har landsbygden på ön dessutom stått inför särskilda prövningar i och med att industrier och andra verksamheter lagts ned eller flyttats. Skolor och övrig samhällsservice samlas allt mer i Visby, som är Gotlands enda stad. Den bild som skildras av landsbygden skiljer sig åt mellan allmänheten, tjänstemännen och lantbrukarna. Allmänheten och tjänstemännen upplever landsbygden och turismen på landsbygden positivt. När det däremot gäller samhällsutvecklingen ser tjänstemännen odelat positivt på hur den påverkar livsvillkoren på landsbygden, medan allmänheten tydligt visar en oro för dess konsekvenser för landsbygden. För de enskilda lantbrukarna spelar egen intressen och specialisering inom jordbruksnäringen stor roll för deras syn på landsbygden. Därtill är odlingsförutsättningar på olika delar av ön samt avstånd till samhällsservice (dvs. geologi och geografi) påverkande faktorer på deras upplevelse av landsbygden och är tillsammans med egenintressen också avgörande för lantbrukarnas framtidstro. I undersökningen framträder såväl den enskilde personens grundinställning som individuella och situationsberoende attityder. Både mer eller mindre positiva och negativa attityder kommer till uttryck vad gäller människors upplevelser och framtidstro. Sammantaget bidrar människors olika attityder till en mer sammansatt helhetsbild, vilken är av vikt att klargöra och beakta i en utvecklingsprocess. Studien visar också att allmänhetens syn på samhällsutvecklingen och landsbygdens befolkningsminskning, inte nödvändigtvis hör samman med den verklighet som råder idag. Bland annat skildras en upplevelse av avfolkning vilket egentligen speglar situationen på landsbygden för tio år sedan. En annan skillnad är att tjänstemännen tror att landsbygds-befolkningens framtidstro är positiv i större utsträckning än den faktiskt tycks vara. Samtliga undersökningsgrupper visar vidare en öppen attityd till turistnäringen. Det finns dock reservationer; att vissa platser överexploateras, att områden står outnyttjade större delen av året och att material, byggnadsstil och utformning stör den lokala miljön. I fysisk samhälls-planering och regional utveckling är det viktigt att ta hänsyn till landsbygdsbefolkningens känsla till platsen, upplevelse av rummet och framtidstro – eftersom det i studien framkommit att dessa aspekter understödjer en framgångsrik och hållbar regional utveckling.

Mémoire numérisé par la Division de la gestion de documents et des archives de l'Université de Montréal

為因應社會結構變遷、失能老人對長期照護需求的增加，衛生署近年來增修法案使的台灣地區護理之家的家數大幅增加。護理之家在面對護理之家的家數激增與相關制度的雙重考驗下，藉著提昇服務品質而達到永續經營是每一護理之家所必須面臨的重要課題。但目前評估護理之家服務品質的問卷，大多是從主管或護理人員的眼光來觀察且問項繁多，而非從住民的眼光來設計的精簡化問卷。故，無法得知住民的真正觀感，了解護理之家服務品質的缺口。而護理之家對於住民制式化忽略住民個人屬性的管理方法，也是本研究欲探討的層面。根據上述研究動機，本研究主要有四個目的：1. 利用深度訪談佐以文獻探討，建立從住民眼光評估護理之家服務品質的精簡化問卷。2. 利用本研究所設計之問卷，針對單一護理之家中『高度重視、低度滿意』之項目，探討顯著差異之服務品質缺口，提供明確而立即的改善方向，以提升住民的服務品質。3. 探討影響護理之家服務品質變項之個人屬性變項。4. 探討影響護理之家住民整體滿意度之個人屬性變項。本研究利用自行設計出來的問卷，佐以從P、Z、B所提出之服務品質觀念性模式修改而成的研究架構，將問卷發放於某中區護理之家，藉此知道問卷的信度並了解護理之家真實的服務品質缺口。並利用統計分析工具探討住民個人屬性對於整體滿意度的影響。經統計分析後，問卷信度皆有0.9以上，而所發放問卷的護理之家其醫療團隊目前有人力不足，住民覺得工作人員態度需更加溫和、親切的服務品質缺口。至於，住民的個人屬性對於整體滿意度而言，並無顯著性影響。 / Because elder who losing limbs’ functions are increasing and most of them are sent to long-term care facilities, The Department of Health additions and deletions law for increasing N.H.（nursing home）numbers to contain them in recent years. Because of N.M. numbers increase, it is an important issue to increase N.H. service quality for sustainable operation. Most of current N.H. service quality questionnaires have a lot of items, and these questionnaires come from managers and nurses’ view. If managers use these questionnaires, they may not know residents’ need. In this research, researcher also wants to discuss N.M. uniform management because it may not appropriate to residents. According to this background, this research has four purposes：1.Developing a subtle questionnaire which comes from residents’ view. 2. For increasing residents’ satisfaction, this research will use this questionnaire to detect N.M. service quality gaps and to tell managers improvement directions. 3. Discussion residents’ attributions variables that affect service quality variables. 4. Discussion residents’ attributions variables that affect total satisfaction degree. The research’s framework modifies from PZB conceptual model of service quality. After retrieving and analyzing questionnaires, the questionnaire’s reliability is over 0.9. That N.M. service quality gaps are shortage of staff and lacking good attitude to residents. There is no significant relationship between residents’ attributes variables and total satisfaction degree. / 中文摘要 -------------------------------------------------------------------------- i 英文摘要 -------------------------------------------------------------------------- ii 序言 --------------------------------------------------------------------------- iii 目錄 -------------------------------------------------------------------------- iv 表目錄 -------------------------------------------------------------------------- vi 圖目錄 -------------------------------------------------------------------------- viii 一、 緒論--------------------------------------------------------------------- 1 1.1 研究動機--------------------------------------------------------------- 1 1.2 研究目的------------------------------------------ 2 1.3 研究流程------------------------------------------ 3 二、 文獻探討--------------------------------------------------------------- 4 2.1 機構服務品質的發展------------------------------------------------ 4 2.2 機構品質的意涵與量測--------------------------------------------- 7 2.3 重視度-滿意度模式與改善係數--------------------------------- 16 2.4 病患滿意度與醫療服務品質的關係------------------------------ 18 2.5 機構品質指標--------------------------------------------------------- 19 2.6 影響服務品質的因素------------------------------------------------ 21 2.6.1 護理之家服務品質指標------------------------------------------ 21 2.6.2 住民個人屬性變項-------------------------------- 26 三、 研究方法--------------------------------------------------------------- 28 3.1 研究架構--------------------------------------------------------------- 28 3.2 研究假設-------------------------------------------------------------- 30 3.3 研究對象------------------------------------------ 31 3.3.1 研究機構---------------------------------------- 31 3.3.2 研究對象---------------------------------------- 31 3.4 研究工具------------------------------------------ 31 3.4.1 問卷設計---------------------------------------- 31 3.4.2 信效度測試-------------------------------------- 32 3.5 資料收集方法-------------------------------------- 33 3.6 研究變項之操作型定義------------------------------ 34 3.6.1 個人屬性變項------------------------------------ 34 3.6.2 服務品質量測變項-------------------------------- 35 3.6.3 整體服務品質滿意-------------------------------- 35 3.7 資料分析方法-------------------------------------- 36 四、 研究結果--------------------------------------------------------------- 37 4.1 住民個人屬性變項之敘述性統計-------------------------------- 37 4.2 住民服務品質問卷之敘述性統計---------------------- 38 4.3 住民服務品質滿意度問卷之因素分析------------------ 40 4.4 照護服務品質缺口之假設檢定------------------------ 45 4.4.1 假設檢定---------------------------------------- 45 4.4.2 討論-------------------------------------------- 55 4.5 住民個人屬性之統計變量假設檢定-------------------- 59 4.5.1 個人屬性對服務品質變項之差異性分析-------------- 59 4.5.2 個人屬性變項對整體服務品質滿意度之差異性分析---- 60 五、 結論--------------------------------------------------------------------- 63 5.1 重要結果討論--------------------------------------------------------- 63 5.1.1 研究對象特性------------------------------------ 63 5.1.2 因素分析之結果---------------------------------- 63 5.1.3 服務品質缺口之分析結果-------------------------- 65 5.1.4 個人屬性對服務品質變項之分析結果---------------- 66 5.1.5 個人屬性對整體服務品質滿意度之分析結果---------- 66 5.2 研究限制------------------------------------------ 67 5.2.1 問卷問項之限制---------------------------------- 67 5.2.2 機構住民之限制--------------------------------------------------- 67 5.3 後續研究建議-------------------------------------------------------- 68 5.4 研究應用--------------------------------------------------------------- 69 中文參考文獻 -------------------------------------------------------------------------- 70 英文參考文獻 --------------------------------------------------------------------------- 72 附錄一 住民認知服務品質問卷--------------------------------------------- 78 附錄二 醫療團隊認知服務品質問卷--------------------------------------- 81 附錄三 單位主管認知服務品質問卷--------------------------------------- 85 表 目 錄 表1 服務品質概念----------------------------------------------------------------- 7 表2 服務品質量測---------------------------------------------------------------- 8 表3 SERVQUAL量表構面與認知項目------------------------------------------- 15 表4 服務品質指標----------------------------------------------------------------- 20 表5 各問卷的Cronbach’s α係數表------------------------------------------ 33 表6 資料分析目的與統計方法-------------------------------------------------- 36 表7 有效樣本住民個人屬性變數資料統計表-------------------------------- 37 表8 住民服務品質問卷之敘述性統計表-------------------------------------- 39 表9 各問卷類別之MSA值-------------------------------------------------------- 40 表10 住民服務品質滿意度問卷之轉軸結果----------------------- 41 表11 住民服務品質滿意度問卷之因素分析----------------------- 41 表12 「服務品質變項」敘述統計分析表-------------------------- 44 表13 「住民對護理之家服務品質之重視度」與「主管認知住民對護理之家服務品質之重視度」之檢定結果表--------------------- 46 表14 「主管認知住民對護理之家服務品質之重視度」與「主管認知護理之家服務品質之執行度」之檢定結果表------------------- 47 表15 「主管認知醫療團隊對護理之家服務品質之執行度」與「醫療團隊認知照護服務傳遞之執行度」之檢定結果表--------------- 48 表16 「住民對護理之家服務品質之滿意度」與「醫療團隊照護服務傳遞之執行度」之檢定結果表------------------------------- 49 表17 「住民對護理之家服務品質的重視度」與「住民對護理之家服務品質的滿意度」之檢定結果表------------------------------ 50 表18 「主管認知住民對護理之家服務品質之重視度」與「醫療團隊認知住民對護理之家服務品質之重視度」之檢定結果表--------- 51 表19 「醫療團隊認知照護服務傳遞之執行度」與「醫療團隊認知住民對護理之家服務品質之重視度」之檢定結果表--------------- 52 表20 「住民對護理之家服務品質之重視度」與「醫療團隊認知住民對護理之家服務品質之重視度」之檢定結果表----------------- 53 表21 照護服務品質缺口之假設檢定結果表----------------------- 54 表22 醫療團隊之5個因素的SERVQUAL點數----------------------- 56 表23 住民之5個因素的SERVQUAL點數-------------------------- 57 表24 服務品質指標改善順序表-------------------------------------------------- 58 表25 個人屬性對於服務品質變項之變異數分析------------------- 59 表26 個人屬性對於整體服務品質滿意度之變異數分析------------- 60 表27 個人屬性之統計變量假設檢定結果表----------------------- 62 表28 SERVQUAL問卷、醫療服務品質及滿意度問卷與機構服務品質問卷之異同表----------------------------------------------- 64 圖 目 錄 圖1 研究流程圖------------------------------------------------------------------ 3 圖2 10個決定因素濃縮為5個決定因素示意圖----------------------------- 10 圖3 服務品質的觀念性模式圖-------------------------------------------------- 11 圖4 重視度-滿意度分析模式--------------------------------------------------- 17 圖5 研究架構圖-------------------------------------------------------------------- 29 圖6 護理之家服務品質之重視度-滿意度分析模式------------------------ 57

Worldwide tourism has become one of the largest and fastest growing industries. Specifically in the South African context, this growth has been confirmed in recent statistics. However, the growth in the tourism industry does not occur without challenges. It brings both benefits and costs to the residents of a host community, consequently generating both positive and negative tourism impacts. Further, it is recognised that once a community becomes a tourism destination, the lives of the residents are influenced by that particular development; thus effecting their Quality of Life (QoL). Only minimal research has, however, been conducted to determine the influence of the perceived impacts of tourism on residents’ QoL, especially in the South African context. A number of theoretical frameworks have been developed in tourism to signify how the perception of or reactions towards tourism of residents in a host community are influenced at any particular stage of development. Pertaining to QoL, various theoretical models have also been created to describe the functioning of the construct. Although theoretical frameworks have been developed that are distinct to tourism and QoL; to date an integrated approach does not exist that explores the influence of tourism on residents’ QoL. In addition to the lack of an integrated approach in literature, the permanency of tourism products too have not yet been examined in literature. Further, permanency has not been examined in order to determine the influence of tourism impacts on residents’ QoL in selected towns, one being a permanent tourism product (PTP) and the other a nonpermanent tourism product (N-PTP). From the above, it can be seen that three theoretical and practical issues exist: (1) only a modest amount of research has been done to determine the influence of tourism impacts on residents’ QoL; (2) an integrated approach does not exist signifying the relationship between tourism impacts and QoL and; (3) permanency as a differentiation factor has not been investigated in host communities. By addressing these issues, a significant contribution will be made to literature, together with the ensuing practical contributions. Therefore, the main goal of the study was to develop a model to indicate the influence of perceived impacts of tourism on residents’ QoL in selected towns; these having specific differentiation made between a PTP and N-PTP. In order to achieve the goal of the study, five objectives were formulated: The first objective was to analyse theoretical frameworks of tourism and QoL and to identify a particular theoretical framework for the study. Specifically, the Social Exchange Theory (SET) was selected from the theoretical frameworks of tourism, while the Bottom-up Spillover theory was designated as it is peculiar to QoL frameworks. Therefore, the derived theoretical framework indicated that an ‘exchange’ process occurs between tourism development and the residents of the host community. More specifically, social exchange arises between the perceived impacts of tourism and life domains in order to establish the QoL of residents in host communities. The second objective was to analyse tourism both as an industry and product in a host community through a review of existing literature. From the literature review, it can be seen that tourism is a growing industry and product, not only internationally but also in the South African context. Permanency as a characteristic was explored comprehensively to define a tourism product while maintaining the differentiation between a PTP and N-PTP. Residents of a host community are noted as important roleplayers in the tourism industry as tourism impacts affect them in PTP and in N-PTP. This importance is emphasised as residents of a host community: (1) influence the tourism experience; (2) determine the attractiveness of a destination and; (3) control the sustainability of tourism in a host community. The third objective was to analyse QoL and its relation to the residents of a host community, once more, through a literature review. From the review, it was observed that QoL has different definitions and views, some more intricate than others. For the purpose of the study, it was determined that QoL can be described appropriately through the Bottom-up Spillover theory. Therefore, QoL is determined through the collaboration of various life domains that, further, may be either objective or subjective in nature. When examining the relationship between tourism development and QoL, it was established that tourism, through tourism products, produces effects that will influence various life domains, consequently determining the QoL of residents in a host community. As with tourism impacts, the QoL of the host community’s residents will subsequently: (1) influence the tourism experience; (2) determine the attractiveness of a destination and; (3) ensure the sustainability of tourism in a community. The fourth objective was to analyse the influence of the economic, environmental, social and cultural impacts of tourism on residents’ QoL and to differentiate between a PTP and N-PTP by using an empirical study. Having in mind that the main goal of the study was to develop a model, Confirmatory Factor Analysis (CFA) and Structural Equation Modelling were conducted on the data. The models, constructed separately for tourism impacts and QoL, were subsequently integrated to determine the influence of the perceived impacts of tourism on residents’ QoL. The model with good model fit statistics and supportive of underlying theory was thereafter accepted for further analysis in order to attain comprehensively the main goal of the study. Thereafter, model development tested permanency of tourism products by specifically determining the influence of perceived impacts of tourism on residents’ QoL in selected towns (PTP and N-PTP). From the latter exercise, no practically significant differences were found between a PTP and N-PTP. Therefore, the model constructed as Stage 3 was accepted as the final model of the study and was given the title of Root’s model of Community TourQoL (CTQ). Specifically, the model signified that positive economic, environmental, social and cultural impacts influence residents’ QoL, while negative environmental and social impacts do not influence residents’ QoL in host community. Furthermore, the model showed that no differences were found between a PTP and N-PTP regarding the influence of perceived impacts of tourism on residents’ QoL. The fifth and final objective was to draw conclusions, indicate contributions, formulate recommendations and present limitations peculiar to the study. The greatest significance of the study is seen in the practical contributions of the study, specifically, the development of Root’s model of Community TourQoL (CTQ). Community and tourism planners and/management can implement the model in both PTP and N-PTP to enhance the positive impacts of tourism; while minimising negative impacts, in order to improve residents’ QoL. / Thesis (PhD (Tourism Management))--North-West University, Potchefstroom Campus, 2013.

Worldwide tourism has become one of the largest and fastest growing industries. Specifically in the South African context, this growth has been confirmed in recent statistics. However, the growth in the tourism industry does not occur without challenges. It brings both benefits and costs to the residents of a host community, consequently generating both positive and negative tourism impacts. Further, it is recognised that once a community becomes a tourism destination, the lives of the residents are influenced by that particular development; thus effecting their Quality of Life (QoL). Only minimal research has, however, been conducted to determine the influence of the perceived impacts of tourism on residents’ QoL, especially in the South African context. A number of theoretical frameworks have been developed in tourism to signify how the perception of or reactions towards tourism of residents in a host community are influenced at any particular stage of development. Pertaining to QoL, various theoretical models have also been created to describe the functioning of the construct. Although theoretical frameworks have been developed that are distinct to tourism and QoL; to date an integrated approach does not exist that explores the influence of tourism on residents’ QoL. In addition to the lack of an integrated approach in literature, the permanency of tourism products too have not yet been examined in literature. Further, permanency has not been examined in order to determine the influence of tourism impacts on residents’ QoL in selected towns, one being a permanent tourism product (PTP) and the other a nonpermanent tourism product (N-PTP). From the above, it can be seen that three theoretical and practical issues exist: (1) only a modest amount of research has been done to determine the influence of tourism impacts on residents’ QoL; (2) an integrated approach does not exist signifying the relationship between tourism impacts and QoL and; (3) permanency as a differentiation factor has not been investigated in host communities. By addressing these issues, a significant contribution will be made to literature, together with the ensuing practical contributions. Therefore, the main goal of the study was to develop a model to indicate the influence of perceived impacts of tourism on residents’ QoL in selected towns; these having specific differentiation made between a PTP and N-PTP. In order to achieve the goal of the study, five objectives were formulated: The first objective was to analyse theoretical frameworks of tourism and QoL and to identify a particular theoretical framework for the study. Specifically, the Social Exchange Theory (SET) was selected from the theoretical frameworks of tourism, while the Bottom-up Spillover theory was designated as it is peculiar to QoL frameworks. Therefore, the derived theoretical framework indicated that an ‘exchange’ process occurs between tourism development and the residents of the host community. More specifically, social exchange arises between the perceived impacts of tourism and life domains in order to establish the QoL of residents in host communities. The second objective was to analyse tourism both as an industry and product in a host community through a review of existing literature. From the literature review, it can be seen that tourism is a growing industry and product, not only internationally but also in the South African context. Permanency as a characteristic was explored comprehensively to define a tourism product while maintaining the differentiation between a PTP and N-PTP. Residents of a host community are noted as important roleplayers in the tourism industry as tourism impacts affect them in PTP and in N-PTP. This importance is emphasised as residents of a host community: (1) influence the tourism experience; (2) determine the attractiveness of a destination and; (3) control the sustainability of tourism in a host community. The third objective was to analyse QoL and its relation to the residents of a host community, once more, through a literature review. From the review, it was observed that QoL has different definitions and views, some more intricate than others. For the purpose of the study, it was determined that QoL can be described appropriately through the Bottom-up Spillover theory. Therefore, QoL is determined through the collaboration of various life domains that, further, may be either objective or subjective in nature. When examining the relationship between tourism development and QoL, it was established that tourism, through tourism products, produces effects that will influence various life domains, consequently determining the QoL of residents in a host community. As with tourism impacts, the QoL of the host community’s residents will subsequently: (1) influence the tourism experience; (2) determine the attractiveness of a destination and; (3) ensure the sustainability of tourism in a community. The fourth objective was to analyse the influence of the economic, environmental, social and cultural impacts of tourism on residents’ QoL and to differentiate between a PTP and N-PTP by using an empirical study. Having in mind that the main goal of the study was to develop a model, Confirmatory Factor Analysis (CFA) and Structural Equation Modelling were conducted on the data. The models, constructed separately for tourism impacts and QoL, were subsequently integrated to determine the influence of the perceived impacts of tourism on residents’ QoL. The model with good model fit statistics and supportive of underlying theory was thereafter accepted for further analysis in order to attain comprehensively the main goal of the study. Thereafter, model development tested permanency of tourism products by specifically determining the influence of perceived impacts of tourism on residents’ QoL in selected towns (PTP and N-PTP). From the latter exercise, no practically significant differences were found between a PTP and N-PTP. Therefore, the model constructed as Stage 3 was accepted as the final model of the study and was given the title of Root’s model of Community TourQoL (CTQ). Specifically, the model signified that positive economic, environmental, social and cultural impacts influence residents’ QoL, while negative environmental and social impacts do not influence residents’ QoL in host community. Furthermore, the model showed that no differences were found between a PTP and N-PTP regarding the influence of perceived impacts of tourism on residents’ QoL. The fifth and final objective was to draw conclusions, indicate contributions, formulate recommendations and present limitations peculiar to the study. The greatest significance of the study is seen in the practical contributions of the study, specifically, the development of Root’s model of Community TourQoL (CTQ). Community and tourism planners and/management can implement the model in both PTP and N-PTP to enhance the positive impacts of tourism; while minimising negative impacts, in order to improve residents’ QoL. / Thesis (PhD (Tourism Management))--North-West University, Potchefstroom Campus, 2013.

No description available.

Syfte: Mot bakgrund kring en ökad turism i europeiska storstäder (Statista, u.å.) har syftet med studien varit att studera Barcelona som exempel för att bidra med en djupare förståelse kring hur turister och lokalbefolkning uppfattar varandra i stadsmiljöer med högt turistantal. Samt undersöka hur turismen har förändrat stadens stadskärna och miljö (Duran, 2005). Metod: I studien har ett kvalitativt tillvägagångssätt applicerats i form av semistrukturerade intervjuer och insamling av vetenskapliga artiklar till empirin. Tolv personer som har intervjuats som har koppling till Barcelona och det sammanfattas i empirin, tillsammans med de vetenskapliga artiklarna. Slutsatser: Den här studie har undersökt Barcelona som exempel för att belysa massturism som är ett omfattande problem som även går att finna i andra europeiska storstäder. Genom de insamlade intervjuerna och de vetenskapliga artiklar påvisades det att Barcelona har fått både positiva och negativa effekter av den massiva turism som finns i staden. Utifrån de insamlade intervjusvaren kunde slutsatsen dras att den sociala aspekten har störst negativ inverkan på lokalbefolkningen i staden. / Purpose: Against the background of increased tourism in European metropolitan areas (Statista, u.o.), the purpose of the study has been to study Barcelona as an example to contribute a deeper understanding of how tourists and locals perceive each other in urban environments with a high tourist number. As well as investigating how tourism has changed the city's city center and environment (Duran, 2005). Methodology: In this study, a qualitative approach has been applied in the form of semi-structured interviews and the gathering of scientific articles of empirical data. Twelve people interviewed who are connected to Barcelona and this is summarized in empirical section, along with the scientific articles. Conclusions: This study has explored Barcelona as an example to illustrate mass tourism, which is a major problem that can be found in other European cities. Through the collected interviews and the scientific articles, it was demonstrated that Barcelona has had both positive and negative effects of the massive tourism that exists in the city. Based on the collected interview answers, it could be concluded that the social aspect has the most negative impact on local people in the city.