The original intention of the study was to replicate Moore & Benbasat's model of information technology adoption (I990a, b,; 1991ab,) which fused two established theories, the Diffusion of Innovations (Rogers, 1962) and the Theory of Reasoned Action (Fishbcin & Ajzcn, 1975), an attitude-behaviour theory. Flaws were found in the construction and application of the model, most notably in relation to the origin of belief statements used on their instrument. Nevertheless, the overall aims of their study were thought to be worthwhile. A literature survey provided an understanding of the study context, the historical background of the Theory of Reasoned Action and the manner in which the Theory has been applied and adapted. Evidently, volitional control is a pertinent factor in organisational studies yet existing extensions of the Theory of Reasoned Action which attend to volitional control were found to be imperfect for applications in organisations. A new model was developed by the author for the purpose of predicting and explaining I.T. innovation behaviours in organisations. The model was tested on employees of the University of Central Lancashire, first by qualitatively eliciting and grouping salient beliefs and secondly through a quantitative survey of randomly selected individuals. Findings from the survey data were variable. The act-specific part of the model had predictive power, and this improved with the addition and substitution of determinants. On the other hand, problems were found with the general organisational constructs; factors contributing to the predictive weakness here have been identified. An examination of underlying belief structures provides information for implementers. Recommendations arc made for intervention communications relating to I. T. implementations. The development of organisational and control belief structures is proposed to provide a diagnostic tool for supplementary use where organisations wish to qualitatively judge the 'temperature', or alternatively to administer a quantitative study of employee satisfaction - these, without prejudice to the claims for the extended model. The author stands by the theory and recommends a course whereby the model is expected to hold.

The general aim of this study was to provide an in-depth exploration of the experiences of a group of 30 women who planned home births. This was to expand on the small amount of qualitative research in the field and suggest avenues for further research. With this general aim, I analysed the women's experiences in relation to the contexts in which they planned home births in order to provide a useful account for the women in the study, those who may plan home births in the future, as well as clinicians, managers and policy-makers involved in maternity services. I considered some of the wider political, social and historical discourses, which underpin the present situation in Scotland regarding home births. While I acknowledged that these are unstable reference points, they were useful in gaining insights into the current situation. This was particularly the case when looking at home birth as part of a complex interplay between dominant and subordinate ideologies, which were partially played out through gender relations symbolised by the male doctor and the female midwife. A postmodern reading of feminisms provided the conceptual tools to examine diverse belief systems around birth in relation to women's narratives. Suspending "truth" enabled diverse knowledges to become more visible. This validated women's experiential knowledge which could then be placed alongside other knowledge systems, and examined in terms of dominant and marginalised ideologies. The project became one of conflicts and silences, searching out and listening to, and making visible "other" voices. This raised issues of power, control, autonomy and resistance. In most cases I interviewed each woman twice before her baby's birth and twice following the birth. Interviews were usually 1 Y2 to 2 hours in length, taped and transcribed. A qualitative software program, NUD*IST was used to assist with analysis, but the conceptual framework for the analysis remained rooted in a postmodern feminist approach using a relational voice methodology. The main findings were that National Health Service (NHS) community midwifery services were based on an attenuated technocratic model of birth. This imposed a philosophy and structure of care that prevented women and midwives from developing alternative ideologies based on their own knowledges. It prevented women and midwives from forming trusting, supportive relationships, which stand at the core of holistic philosophies of birth. Women and midwives were often obliged to draw on subversive techniques to use their knowledge and skills in order to make the best of a system which by definition could not be woman-centred or holistic. The main conclusion was that birth requires to be socialised rather than medicalised, so that technology and medical practices can be developed and used to support women and babies, and midwifery practices when necessary, rather than birth being technocratised and social practices used to humanise an essentially inhumane system of care.

The Government of Malawi has entered into agreements with Christian health association of Malawi (CHAM) health care facilities in order to exempt their catchment populations from paying user fees. These agreements are called service level agreements (SLAs). Government in turn reimburses the CHAM health care facilities for the health services that they provide. The agreements started in 2006 with 28 out of 166 CHAM health care facilities and increased to 68 in 2010. The aim of the exemption policy is to guarantee universal access to a basic package of health care services. Although the agreements were designed to cover every health service in the basic health care package, only maternal and neonatal health services are included due to limited resources. The main objective of this thesis was to evaluate the impact of the health care financing change on health care utilisation and health. The specific objectives were as follows: first, to examine whether health care facility visits for maternal health care changed due to user fee exemption; second, to evaluate whether user fee exemption affected the choice of the health care provider where women living in the catchment areas of CHAM health care facilities with user fee exemption sought maternal health care; third, to analyse the effect of user fee exemption on birth weight and; fourth, to explore and apply novel methods in the evaluation of user fee exemption. The gradual uptake of service level agreements by CHAM health care facilities provided a natural experiment with treated and control health care facilities. An additional control group comprised of other demographic groups apart from pregnant women and neonates at CHAM health care facilities with service level agreements. In household survey data, individuals were assigned to treatment and control groups based on their proximity to either a CHAM health care facility with SLA or a CHAM health care facility without SLA. This proffered the unique opportunity to estimate the effect of a single treatment on multiple outcomes. The difference-in-differences (DiD) approach was used to obtain causal effects of user fee exemption. It was implemented in the context of fixed effects, switching regression and multinomial logit models across different chapters. Health care facility level panel data for utmost 146 health care facilities for a maximum of 8 years, 2003-2010, were used. The data were obtained from the Malawi health management xiii information system (HMIS). Linked survey data were also used. Malawi demographic and survey data for 2004 and 2010 were linked to health care facility data and then merged. Analyses that utilised health care facility data showed that user fee exemption had led to increases in first antenatal care visits in the first trimester, first antenatal care visits in any trimester, average antenatal care visits and deliveries at CHAM health care facilities with SLAs. Results from survey data showed that the probability of using a CHAM health care facility with user fee exemption for antenatal care increased, the probability of using home antenatal care declined and the probability of not using antenatal care also declined due to user fee exemption. The probability of delivering at a CHAM health care facility with SLA also increased while the probability of delivering at home declined. User fee exemption did not affect the choice of where to go for postpartum care. Results of the effect of user fee exemption on birth weight were not reported because of potential endogeneity bias arising from lack of instrumental variables for antenatal care. The key policy messages from this thesis are that the user fee exemption policy is an important intervention for increasing the utilisation of maternal health care and needs to be extended to as many CHAM health care facilities as necessary. User fee exemption is not enough, however. Other factors such as education of the woman and her husband/partner, wealth status and cultural factors are also important. This thesis has contributed to the body of knowledge in the following ways. First, it has generated evidence on the impact of user fee exemption on maternal health care utilisation and birth weight in Malawi. Second, with respect to maternal health care utilisation, the thesis has looked at variables that capture the whole maternal health care process from early pregnancy to postpartum care and in a policy relevant way. Third, the thesis has evaluated the effect of user fee exemption on a variable that have not been looked at before, first antenatal care visits in the first trimester. Fourth, the thesis has examined the effect of a single treatment on multiple outcomes in a methodologically unique way. Treatment effects, which were the changes in the probabilities of using different alternatives summed up to zero, thus showing where any increase in the probability of using the outcome of interest came from. Fifth, this thesis is first to use disequilibrium theory of demand and supply in health economics. Application of this theory entailed using switching regression models with unknown sample separation, a seldom used estimation method in health economics. This was an important contribution to the methods xiv of analysing aggregate health care utilisation. Sixth, the STATA program that was written for the estimation of the disequilibrium models was itself a very important contribution to the methods for estimating aggregate supply and demand.

Marine ecosystems and the ecosystem services they provide have declined dramatically over the last century. In principle, assessing ecosystem services and highlighting their value can help balancing marine conservation and socio-economic goals in environmental decision making. However, in particular for deep-sea ecosystem services many research gaps remain due to methodological challenges involved in their assessment. This thesis advances the research field by assessing economic non-market and non-use values of coastal and deep-sea biodiversity. Stated preference methods were applied along with a Delphi-based expert assessment. In the first choice experiment, participants were willing to pay between £70 and £77 annually for scenarios protecting deep-sea organisms and for medicinal products from deep-sea areas, an environment that participants were mostly unfamiliar with. The second stated preference survey with experienced marine users estimated a stewardship willingness to pay between £8.83 and £8.29 as one-off payments to protect marine sites from degradation. User-preferences were influenced by a broad range of marine habitats, accessibility and the presence of iconic species. The economic value of protected sites decreased when recreational users were excluded. In the third case study, an ecological method − the Ecosystem Principles Approach − was able to alleviate some uncertainties in submarine canyon ecosystem functioning. Ecosystem principles were developed that described spatial, temporal and causal links between processes, such as transportation processes, and important ecosystem services in submarine canyons. The stated preference case studies provide evidence for the less tangible economic trade-offs in protecting marine areas and partly answer the question of how ecosystem services can be assessed using economic tools to inform marine management priorities. The Ecosystem Principles Approach can help us to understand better how to move towards such management priorities.

Healthcare has had a storied past in the United States, and to say that the two have had a complicated relationship would be an egregious understatement. Intertwined in the narrative of our healthcare system is the narrative of United States hospitals, both how they came to be and the nature of their structures. Over time, legislation at local, state, and federal levels has shaped hospital organization and cost-structure. Here, I aim to better understand the effect of the Patient Protection and Affordable Care Act (PPACA), and more specifically Medicaid expansion, on hospitals in a handful of Southern states.

This thesis is a policy analysis of the Pharmacy In A New Age (PIANA) initiative launched by the Royal Pharmaceutical Society of Great Britain (RPSGB) in 1995. It leads to an understanding of how pharmacy services develop as a part of the Welfare State. The chosen interpretation was to explore the pharmacy policy sub-system using the Advocacy Coalition Framework (ACF), the Systems Approach and the dimensions of power associated with decision-making. The PIANA initiative identified five areas where pharmacists' input into future healthcare systems would be valued: o the management of prescribed medicines; e the management of long-term conditions; the management of common ailments; the promotion and support of healthy lifestyles; and, advice and support for other healthcare professionals. Research was conducted using both qualitative and quantitative methods to ascertain pharmacists' perceptions towards the implementation of the PIANA initiative. From the interviews it was determined that isolation, remuneration, skill mix and competitive retail environment were factors thought to impede the implementation of new pharmacy services in the community setting. Hypotheses were generated and subsequent questionnaire based research explored pharmacists' views relating to the development of the extended pharmacy services and which organisations were trusted to influence the policy process. The study group comprised 2359 pharmacists living in Great Britain who were registered With the RPSGB on March 12 th 1999. The response rate was 50.1 % (n= 1182). Statistical analysis demonstrated that the management of prescribed medicines was ranked most important role and that pharmacists employed in GP surgeries were thought best placed to carry out this role. The author suggests that clinicallytrained pharmacists based in GP surgeries would be best placed to manage prescribed medicines. Community pharmacists ranked the management of common ailments as their second most important role and were perceived to be best located by all pharmacists. Hospital ranked the advice and support of health care professionals as the second most important; community pharmacists ranked this as the fifth most important. The conclusionsd raw on the literaturea ssociatedw ith implementationT. he author considers that the methods employed, were appropriate to analyse the pharmacy policy process. The analysis identified that the RPSGB was unable to unilaterally influence the policy process and that the plethora of pharmacy organisationsm ay be detrimentatl o policy implementationT. he authorc oncludes that local leadersw ho are associatedw ith severalp harmacyo rganisationsfu rther compromise the situation. Employees of Primary Care Organisations were found to possess the triple dimensions of power associated with decision-making and are key policy brokers for emerging pharmacy services. Future policy implementation research should focus upon this group. The majority of pharmacists were unable to identify a legitimate organisation to support the local implementation of pharmacists' non-dispensing roles, this may impede the implementation process. The majority of pharmacists agreed that they would have to change the skills that they used in order to survive. Educators and trainers should ensure that pharmacists develop competencies to the expected professional standards required to develop and deliver new roles. 16

對於現代企業來說，應用系統與流程的整合並非新的需求，然而整合的複雜度與困難度卻隨著整體商業經營環境的善變日益加深，舊有的點對點應用程式整合架構已無法滿足這樣的一個環境，因此，市場上便出現了整合中介軟體(Middleware)這一類的產品來簡化複雜的傳統點對點整合架構。然而，這樣的一個做法仍然有標準以及架構不夠開放導致投資風險過高的缺點！ 相對於專屬系統，以J2EE平台為基礎的開放式架構於焉出現。他們遵循J2EE平台規格提供整合方案，以Application Server為中心，配合JCA、JMS及XML新標準，可整合新舊式系統，延展性高。而另外Web Services 是近兩年來的當紅炸子雞，為一種元件網路化的技術，透過Internet開放的標準(如Http、XML)公開讓人使用，其被視為是整合的明日之星！ J2EE架構運用在應用程式整合上是新一代的趨勢，遵循JMS以及JCA架構可讓各種不同的應用程式直接與J2EE應用程式做溝通，加上J2EE平台有著其他諸如延展性強、安全性高以及支援者眾多等優點，更使得這樣的一個整合解決方案更增無限魅力！但其也有著呼叫程式被特定協定或程式模式(如JMS、JCA)綁住而造成開發成本提高以及難度的增加等缺點。本研究擬運用Web Services之相關技術於現有之J2EE整合架構，並以一線上投保系統之內部企業應用程式整合作為範例以說明此架構之應用方式。 關鍵字：中介軟體(Middleware)、企業應用程式整合(EAI)、J2EE整合、JMS、JCA、Web Services。

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