Key institutions and services are suggested to contribute to remote communities in ways that extend beyond their primary function.  For example, schools and health services are suggested to have important, social, symbolic or economic roles in small remote communities.  There is little empirical evidence identifying the nature and extent of such roles.  Consequently, service reconfiguration driven by economic, political, technological and demographic change may have wider, but currently inadequately understood, impact on remote communities.  This is important for policy. This study explored the nature and extent of added-value contributions, using remote health services as an exemplar (Part 1).  A method for measuring the impact, on remote communities, of added-value contributions from any sector was then constructed (Part 2). Part 1: Eight remote community case studies in Scotland and South Australia explored the added-value roles of the health sector.  Cross-case findings present evidence of health professionals’ behaviour and residents’ perceptions of the social, economic and symbolic importance of remote health service to communities.  Findings revealed a distinction between health service institutions’ contributions (built environment, employer role, health professional status and competencies and symbolic aspects) and those attributable to health professionals as individuals. Part 2:  Institutional and personal added-value contributions were conceptualised as contributing to stocks of different categories of capital insofar as they constitute tangible and intangible resources available for use by individuals and communities.  This conceptual framework provided the basis for developing a prototype generic quantitative instrument (C-CAT) capable of measuring the added-value contributions of institutions and individuals to community stocks of human, social, economic, symbolic and institutional capital. Uniquely, study outputs provide a potential method of quantifying complex and intangible aspects of remote community life that  underpin an innate sense of community ownership, but which have hitherto not been explicitly conceptualised or been capable of measurement.

A disabling farm injury affects both the farmer and the farmers spouse. In Canada, injuries rank third as a leading cause of death and second as a leading cause of medical spending. There have been studies of agriculture-related injury and death, including research on the prevalence, incidence, and causes of farm injuries. There is a lack of empirical data on the impact of agricultural injuries on farm families. This qualitative study explored the lived experiences of wives of Saskatchewan farmers who experienced a disabling farm injury and returned to farming. Potential study participants were contacted and invited to participate in the study with the assistance of the extension division of the Institute of Agriculture, Rural, and Environmental Health (IAREH) and the Farmers with Disabilities Program of the Saskatchewan Abilities Council of Saskatoon. Between October 2002 and October 2004 seven Saskatchewan farm women volunteered to participate and were interviewed. Participants who contacted the researcher to indicate their interest in the study were sent cameras and information inviting them to take photographs depicting their lives since the occurrence of the disabling farm injury. They were contacted later to set up the interviews. The grounded theory method of constant comparison was used for the thematic analysis of the interviews. Seven common themes emerged from the analysis: My world just crashed, Superwoman, Somethings got to give, Survival tactics, Definitely impacted them, Support, and Advice for others. The experiences of the seven Saskatchewan farm women have been heard. Their successes and the hardships they experienced with the injury event and the farmers return to farming have been recorded. Implications for health practice, the development of an Internet based support program, education of health care providers on the needs of people who have experienced a disabling farm injury, and future research are considered.

A disabling farm injury affects both the farmer and the farmers spouse. In Canada, injuries rank third as a leading cause of death and second as a leading cause of medical spending. There have been studies of agriculture-related injury and death, including research on the prevalence, incidence, and causes of farm injuries. There is a lack of empirical data on the impact of agricultural injuries on farm families. This qualitative study explored the lived experiences of wives of Saskatchewan farmers who experienced a disabling farm injury and returned to farming. Potential study participants were contacted and invited to participate in the study with the assistance of the extension division of the Institute of Agriculture, Rural, and Environmental Health (IAREH) and the Farmers with Disabilities Program of the Saskatchewan Abilities Council of Saskatoon. Between October 2002 and October 2004 seven Saskatchewan farm women volunteered to participate and were interviewed. Participants who contacted the researcher to indicate their interest in the study were sent cameras and information inviting them to take photographs depicting their lives since the occurrence of the disabling farm injury. They were contacted later to set up the interviews. The grounded theory method of constant comparison was used for the thematic analysis of the interviews. Seven common themes emerged from the analysis: My world just crashed, Superwoman, Somethings got to give, Survival tactics, Definitely impacted them, Support, and Advice for others. The experiences of the seven Saskatchewan farm women have been heard. Their successes and the hardships they experienced with the injury event and the farmers return to farming have been recorded. Implications for health practice, the development of an Internet based support program, education of health care providers on the needs of people who have experienced a disabling farm injury, and future research are considered.

Thesis PlanB (M.S.)--University of Wisconsin--Stout, 2009. / Includes bibliographical references.

published_or_final_version / Public Health / Master / Master of Public Health

Aims To investigate the impact of organisational change on the delivery of health services in remote and rural Scotland using, as an example, changes in the organisation of out of hours primary care, and to identify the attributes of successful innovation in remote and rural health provision. Methods The thesis comprised a thematic literature review; in depth interviews with key stakeholders, and case studies based in remote communities. Results The literature review identified recurring attributes of successful innovation. Interviews with remote and rural GPs showed that working out of hours had been, or still was, an integral part of life as a GP. Most agreed there had been an impact on family life. Advantages and challenges of remote and rural working were identified; many GPs could not envisage a better way of delivering services. This was contested by managers. There were divergent views of the 2004 GMS contract. The GPs who opted out of 24 hour responsibility experienced a transformational change in working life. All in all, there was a lack of understanding, and trust, between organisations. NHS 24 and Scottish Ambulance Service were criticised. There had been little change in out of hours service delivery since 2005, and the present configuration was seen as expensive and unsustainable. Despite these acknowledged difficulties, the view was that difficult decisions had been avoided, and a long-term solution that fits the area was required. The case studies added detail and contextual understanding of delivery of services. This could vary even within a practice area. Service delivery on islands was different, with a stronger tie between community and practice, governed by transport logistics, and difficult to understand from an outside perspective. Conclusions. The delivery of out of hours services in remote and rural Scotland has been a difficult and contested issue. Context can have different impacts, even within a very small area. Failure to innovate was associated with lack of collaboration, lack of strategy, lack of understanding of local context, and avoidance of difficult decisions. The organisational change literature demonstrated that receptive contexts for change were not present.

Thesis (MAppSc)--University of South Australia, 1998

Thesis (MAppSc)--University of South Australia, 1998

Thesis (M.S.P.)--University of Michigan, 1944.

Thesis (M.S.P.)--University of Michigan, 1944.