Thesis (Ph. D.)--University of Washington, 2006. / Includes bibliographical references (leaves 131-148).

Theses (Ph. D.)--Marshall University, 2007. / Title from document title page. Includes abstract. Document formatted into pages: contains vi, 108 pages Bibliography: p. 100-108.

Thesis (Psy. D.)--Wheaton College Graduate School, 2007. / Abstract. Includes bibliographical references (leaves 78-83).

Mental health has become an increasingly importantly focus in the UK policy landscape because of its social and economic impact. However, most research to date has focused on living with mental health issues, or providing mental health services, in urban settings. There is limited understanding of the experiences of rural dwellers with mental health issues or the role of the voluntary sector in terms of its contribution to mental health service provision in rural areas. Thus, this PhD explores the experiences of rural mental health service users and providers in Scotland and Canada, and also considers the contribution of mental health voluntary organisations in helping to overcome the challenges of social exclusion for service users, as identified in previous research. Two theoretical lenses were used to frame the research questions. First, the concept of social inclusion provided a lens to analyse the processes by which service users achieve, or not, a sense of belonging and connection in society (Philo 2000). Second, Putnam's (2000) theory of social capital provided a further analytical lens by which to explore the contribution of rural voluntary organisations. Social capital focuses on the features of populations such as social networks, trust and norms of reciprocity that shape the quality and quantity of social interactions (McKenzie & Harpham 2006). The aims of the research were to: To explore the impact of rural life for mental health service users' daily life and access of services To understand the contribution of rural mental health services to tackling social exclusion for service users The five research questions used in this thesis were: What does it mean to experience mental health problems in remote and rural areas? What are the challenges that service providers face in remote and rural areas? What benefits are there for service users attending voluntary groups in remote and rural areas?

Blindness is one of the most debilitating health disorders and avoidable blindness is a major international health problem. The World Health Organization has estimated that globally, there are 45 million persons who are blind - a figure that is expected to increase to approximately 76 million by the year 2020. Approximately 80% of blindness is avoidable and can be prevented or cured with appropriate service delivery efforts. Research suggests that the combined annual global GDP loss from blindness in 2000 was more than $40 billion. Yet blindness has received relatively little attention in worldwide efforts to promote health and it is not at present a high health priority in many countries. Consequently, unless there are alternative and more efficient and extended endeavours to address this situation and model an approach that will provide a long-term solution, avoidable blindness will continue. In recent years, eye care service delivery organisations have assumed a greater level of responsibility for addressing the problem of avoidable blindness. A number of successful approaches have been designed and implemented to expand the delivery of eye care services. The approaches have focused on the development of organisational capacity and on sustainability, and they have effectuated a reduction in avoidable blindness in particular target populations. However, despite their importance, contemporary eye care service delivery models have largely been neglected in the literature and few formal organisational approaches to eye care have been developed and documented. There are few definitive independent studies available that outline the bases of these approaches and no explicit and standardised methodologies that can assist service delivery organisations to replicate the approaches. Objective and comprehensive research is accordingly required to promote current and new approaches to eye care and to develop ways of facilitating their adoption. The thesis attempts to address this problem by developing a theory–based, case study–supported practical methodology to identify, support the progression of, and measure the strategic and operational objectives of eye care service delivery organisations. The research seeks to identify the issues relevant to the management of eye care service delivery organisations and subsequently evaluate whether they can be incorporated into a distinct and explicit management framework. It seeks to present the value of the process and the possibility that it can be accomplished elsewhere and in dissimilar organisations. By developing a widely applicable management framework, the research's primary contribution is that it extends eye care organisational management theory to assist in the facilitation of blindness reduction. A conceptual management framework is developed in the thesis which unifies contemporary eye care organisational approaches with the Balanced Scorecard management framework. The framework was devised for and evaluated by undertaking two case studies – one in India and one in South Africa. The significance of developing such a framework is demonstrated at various points throughout the thesis. The research process reveals the potential applicability of the framework – the Strategic Management Framework (SMF). The research concludes that the SMF is able to support and enhance organisational development, performance management, and scenario analyses in eye care service delivery organisations operating in developing countries. Although the framework developed in the thesis is specific to eye care organisations it is flexible enough to be transferable to other healthcare organisations in developed countries. The final conclusion of the thesis is that, while the SMF is not in itself a solution to the problem of avoidable blindness, it is an appropriate and practical management tool which will improve existing, and assist in the establishment of new, eye care service delivery organisations. In this context, the research makes a number of significant and original contributions to prevention of blindness literature and theory. / Thesis (Ph.D.)--School of History and Politics, 2004.

Thesis (Ph.D.) -- McMaster University, 1998. / Includes bibliographical references (leaves 143-147). Also available via World Wide Web.

Thesis equivalent (M.P.H.)--University of Michigan, 1947.

Thesis equivalent (M.P.H.)--University of Michigan, 1947.

Introduction: Occupational therapy in the UK has been heavily shaped by the medical model, however developments within the occupational therapy profession that have led to a re-focussing on the centrality of occupation for health have resulted in the need for new areas for practice outside of traditional, medicalised settings. The recent changing landscape of health and social care provision in the UK provides occupational therapists with new and different environments for practice. This research explored the provision of occupational therapy within social enterprises in the UK, and the compatibility of the occupational therapy philosophy with a social enterprise model. Methods: This mixed methods exploratory study that was conducted within the pragmatic paradigm and had two phases. In Phase 1, twenty-one online questionnaires were completed by occupational therapists working in social enterprises in the UK and focused on their practice and the social enterprise they work for. Social enterprises that employed occupational therapists were also identified through desk based research. In Phase 2, eight of these social enterprises (which were identified in Phase 1) participated as case studies, using case study methodology to explore occupational therapists perceptions of their practice; service users’ experiences; and the social entrepreneur’s involvement in the provision of occupational therapy. The data collection in the case studies consisted of twenty-six semi-structured interviews with occupational therapists, social entrepreneurs and service users; unstructured observation and formal documentation was used for triangulation. The interviews were analysed using qualitative thematic analysis and the findings of the case studies were combined with findings from Phase 1. Findings: Social enterprise has been used as an effective model for implementing holistic occupational therapy services that promote health, wellbeing and occupational justice. Occupational therapists benefit social enterprises to achieve their social and business aims. Funding social enterprise start-ups and ensuring their sustainability continues to be a challenge and government policy needs to be supported with finance to implement it, without which there is a risk of private companies taking over public sector services. Conclusions: Social enterprises can provide an environment where occupational therapists have freedom to practise according to the principles of their profession without the limitations of the medical model and in a socially inclusive environment. Social enterprise can provide a rewarding and satisfying environment for occupational therapists to practise in client centred, holistic ways. The current health and social care climate provides many opportunities for occupational therapists to create and shape their own environments for practise. Alternatively, occupational therapists may need to promote the profession to existing social enterprises to gain employment in the new organisations that deliver public services.

This research has emanated from the geographical concerns raised by organisational change in the British National Health Service (NHS), namely the ongoing debate relating to health and health care inequalities. This thesis develops a flexible, portable and predictive model of health care utilization capable of assisting improved health care planning and analysis. In so doing it contributes to the current resurgence in medical geography. An applied approach to this research is identified which builds upon methods of modelling spatial patterns and processes in geography and the upsurge of interest in Geographical Information Systems (GIS) technology. In these terms, the use of GIS is central to the research; it supports construction and application of the model; facilitates a wide range of analyses; and provides a basis for visualisation and interpretation of model results. The value of modelling in analysing relationships between health inequalities and the location and allocation of health care is identified through a discussion of previous NHS policy initiatives and previous research. From this, a conceptual model of utilization is developed which incorporates components of need, accessibility and provision. A patient survey of asthmatics and diabetics informs the development of the model and validates the choice of indicators used to measure utilization. Indicators of need, accessibility and utilization are thus defined and subsequently measured using a signed chi-square scoring method. The model was developed and tested for primary care General Practitioner services in the Northampton District Health Authority area and outcome measures are proposed and evaluated. Rigorous testing of the model’s sensitivity and robustness is undertaken and potential for its simplification explored. Components are critically evaluated through a comparison with alternative methods of determining spatial inequalities in disadvantage. The potential of the model of utilization for health care planning and analysis is extensively demonstrated through the application of a variety of modelled scenarios. Emergent issues from the research are considered and potential for future geographical research in this area of study, and the impact upon research agendas more generally, is explored