Academic literature on the topic 'Social aspects of Public health'

This PhD by Publication has investigated contemporary management of change practice in health and social care. Through eight case studies it explores change within different sectors, roles and organisations within national, regional and local systems. More successful change programmes are better able to understand their contexts, to design change theories that will work within these contexts, to fully implement the activities planned on the basis of these theories, and to have the resources and autonomy to complete the programme to its conclusion. Despite the relative success of some programmes, there are common opportunities for change management practice to be improved. These include -the meaningful engagement of service users throughout the process; setting of intermediary and final outcomes that provide opportunity for formative and summative evaluation, and in the use of relevant data to enable reflective change practice. It would also appear that despite the considerable body of knowledge regarding management of change this rarely explicitly influences change programmes and therefore stronger collaboration between academia and practice is still required. A pragmatic approach in which different academic fields collaborate to directly respond to the problems faced in practice would be beneficial.

The assessment of need underpins the delivery of community-based care. Following the NHS and Community Care Act (1990), the principle of needs-led assessment was reinforced as it applied to the assessment and care management process. Translation of needs-led assessment into practice in Scotland has been further influenced by policy-based organisational change including the introduction of Single Shared Assessment and Community Health Partnerships. This study seeks to describe the political and practice landscape within which needs-led assessment exists, identify and explore factors which influence needs-led assessment, and consider the practice implications of the policy driver for community-based practitioners across the main disciplines of health and social care. Following a short pilot, the main study was undertaken using sequences vignettes within a semi-structured interview involving 105 social workers, health and housing staff. Key findings indicated a cloak of consensus around definitions of need and assessment with perceptions based upon a medical or social model of care or a professionally or personality-driven assessment of need. A preoccupation with the outcome of assessments caused many respondents to describe needs with reference to the interventions or resources required to address them. The practice of needs-led assessment, according to study results, was hampered by an awareness of resource availability, concerns over client compliance and risk and, an underlying alignment to the values and principles upheld by the employing discipline.

Saúde bucal pode ter uma definição diferente para cada contexto e para cada grupo social. Para alguns profissionais da Odontologia pode representar uma boca com dentes livres da doença cárie, perfeitamente alinhados e em boa oclusão; para outros, pode representar uma pessoa integrada na sociedade, satisfeita com as funções de sua boca. Saúde bucal, para cada indivíduo, pode, ainda, modificar-se ao longo dos anos, de seus ciclos de vida, de seus problemas e do ambiente no qual está inserido. Compreender o que representa saúde bucal é compreender um pouco das necessidades e do cotidiano das pessoas. Penetrar no cotidiano de um grupo de pessoas e extrair dele o significado de saúde bucal exige a utilização de instrumentos confiáveis e seguros sob as perspectivas da ética e da ciência. A teoria das Representações Sociais, proposta por Moscovici em 1961, que busca conhecer os conceitos formados no senso comum, através das ideias, valores e práticas do cotidiano de um grupo social, foi a base do presente estudo. O instrumento DIDL (Impactos Dentais na Vida Diária) construído por Leão em 1995, o índice CPOD (Dentes Cariados Perdidos e Obturados), um questionário semiestruturado e entrevista, serviram de guia para a identificação das Representações Sociais de Saúde Bucal dos Usuários Adultos do Serviço Público de Saúde de Vitorino. A preocupação em compreender como este grupo social perde tantos elementos dentários, foi o que despertou o interesse pela presente pesquisa. A população da pesquisa foi obtida através de amostra temporal por adultos da faixa etária de 35 a 44 anos, que procuraram os serviços públicos de saúde para receber tratamento odontológico. No total, 40 indivíduos participaram de todas as etapas da pesquisa, sendo 20 do sexo feminino e 20 do sexo masculino, a renda familiar média foi de 2,40 salários mínimos, com média de 6,88 anos de estudo, e, ocupação que favorecesse a flexibilidade no horário de trabalho como: donas de casa, agricultores e motoristas. Os resultados apontam para um quadro de iniquidade em saúde. O valor do índice CPOD de 20,50 encontrado para o grupo, segundo Classificação da Organização Mundial da Saúde, é considerado elevado para valores acima de 13,9 para esta faixa etária. O coeficiente de confiabilidade para as 36 questões do DIDL, obtido através do alfa de Cronbach, foi de 0,909. Os resultados do DIDL demonstraram que 22,5% dos usuários estavam insatisfeitos, 60% relativamente satisfeitos e 17,5% satisfeitos com a saúde bucal. Observou-se que o acesso aos serviços públicos de saúde durante a infância e adolescência, o paradigma curativo-reparador das práticas odontológicas e as condições sociodemográficas foram determinantes para condução a um quadro de iniquidade em saúde bucal (ou apenas saúde), e levou-os a queixar de muita dor durante a vida. A hipótese de que os usuários perdem seus dentes por falta e/ou dificuldade de acesso é comprovada pelo relato dos próprios usuários e pelos níveis de saúde bucal em que se encontram. Dentro do quadro de iniquidade, encontraram-se ainda desigualdades em relação ao grupo dos insatisfeitos, que apresentaram maior CPOD, menor renda, menor grau de escolaridade e maior média de idade; foram os que relataram mais dor e foram mais incisivos em suas queixas. As representações sociais de saúde bucal do grupo social, como um todo, foram concebidas por eles como “não sentir dor”. Concepção de saúde bucal que pode ser entendida como aquela em que a doença é percebida como uma “ocupação”, ou seja, que a pessoa pode lutar contra a doença, que é possível tratar, não é destrutiva, é temida pela dor, mas sempre é aceita por este grupo social.<br>Oral health can have a different definition for each context and each social group. For some dental professionals, it may represent cavity-free, perfectly aligned teeth in good occlusion; for others, it may represent a person integrated into society, satisfied with his or her mouth’s functions. Oral health, for each individual, can also change over the years, from its life cycles, its problems and the environment in which it’s in. Understanding what oral health represents is to understand a little about people’s needs and daily lives. Getting inside the daily life of a group of people and extract the meaning of oral health from it requires the use of reliable and safe resources under the perspectives of ethics and science. The theory of Social Representations, proposed by Moscovici in 1961, which seeks to understand the concepts in the common sense, through the ideas, values and practices of everyday life of a social group, was the basis of this study. The DIDL (Dental Impact on Daily Living) tool, developed by Leão in 1995, the DMFT (Decayed, Missing and Filled Teeth) index, a semi-structured survey and interview, served as a guide for the identification of Social Representations of Oral Health in Adult Users of the Public Health Services of Vitorino. The concern over understanding how this social group loses so many dental elements was what sparked interest in this research. The research population was obtained by temporal sample of adults in the 35 to 44 age group, who sought public health services to receive dental treatment. In total, 40 individuals participated in all stages of research, 20 being female and 20 male, the median household income was 2.40 times the minimum wage, with an average of 6.88 years of education, and an occupation that allowed for flexibility in working hours, such as homemakers, farm workers and drivers. The results point to a picture of health inequity. According to the World Health Organization’s Classification, the DMFT index value of 20.50 found for the group is considered high for values above 13.9 for this age group. The reliability coefficient for the 36 questions in the DIDL, obtained through the Crombach’s alpha, was 0.909. The DIDL results showed that 22.5% of users were dissatisfied, 60% relatively satisfied and 17.5% satisfied with their oral health. It was observed that access to public health services during childhood and adolescence, the remedial-restorative paradigm of dental practices, and the socio-demographic conditions were determining factors leading to a framework of inequity in oral health (or just health), and led them to complain of great pain during their lives. The hypothesis that users lose their teeth due to lack and/or difficulty of access is proven by the account of the users and the level of oral health in which they find themselves. Within the framework of inequity, there were still inequalities regarding the group of dissatisfied, which presented higher DMFT, lower income, lower educational level, and higher age average; they were the ones that reported more pain and were more incisive in their complaints. The social representations of oral health of the social group, as a whole, were conceived by them as “not feeling pain”. Concept of oral health that can be understood as one in which the disease is perceived as an “occupation”, i.e., that one can fight against the disease, that can be treated, is not destructive, is feared for the pain, but is always accepted by this social group.

This study explores the defining moments in six men’s lives. The empirical dimension of the research is built around the personal narratives these men tell of their lives across a series of four interviews. The central research theme is the notion of the defining moment as a key element in the processes of establishing how men understand and interpret the events and incidents that have shaped their lives. In the context of this study, the defining moment is seen as the moment or period in time when an individual gives definition to a specific event or experience, as a transition point with (potentially) life-altering consequences. Some of the thematic structures presented include relationships with significant adults (parents, teachers), masculinity, self-harm, schooling, mental illness, isolation, loneliness, stress and relationships with peers. In my pursuit of a methodology that could accommodate the aims of this study, I explored the process of meaning through the qualitative paradigm. Drawing on the principles of qualitative research, as applied through narrative inquiry, I deployed a semi-structured interview format to collect the lived experiences of participants. By privileging the stories that individuals tell of their experiences, the narrative method recognises that data are inexorably located in the contextual and contingent. The experiences and narratives that are presented in this thesis are built around the authentic voices of participants. The study presents a warrant for working with men’s defining moments to disrupt, alter and redefine their attitudes and behaviours in order to improve their lives. Based on the insights gleaned through this study, I argue that there are defining times/points in people’s lives where their experiences can be life altering. When these experiences involve uncertainty, anxiety, stress and other pernicious effects, their longer-term consequences can be devastating. The study confirms existing research, that men are reluctant to seek help or reveal their insecurities during such times, therefore making them particularly vulnerable to defining moments. The conclusion of this thesis establishes some broad recommendations pertaining to working effectively with men and their defining moments. I focus particular attention on the place of schooling and education in helping individuals recognise and respond to the early symptoms of what is potentially a life-altering experience. Schools and, by association, teachers need to be actively and strategically involved in this process. To this end, I argue the need for targeted interventions that are both sensitive and timely. In their engagements with young males, parents, teachers, coaches and mentors need to be particularly attuned to their silent screams for help.

Thesis (MPhil)--University of Stellenbosch, 2007.<br>ENGLISH ABSTRACT: This reflexive study of responses to the HIV/AIDS pandemic was set in Stellenbosch, a town in the Cape Winelands that, with its diverse but disjointed population, in many ways is a microcosm of South African society. My question was what happens when the experience of HIV/AIDS, with its personal impacts and global connections, reaches a particular locality in South Africa. I worked on the assumption that the reach of the disease in this specific locality reflects the disconnectedness of people through historical, political, social and economic processes, and that responses to the disease attempt to repair ruptures through integrating people into caring systems of support. By tracking and interrogating responses at public health and service organisation levels as a participant observer, I noted recurrent references to the importance of engaging patients in the treatment process. My observations revealed a transformation in the dyadic relationship between doctor and patient, as well as an embracing reach of networked service organisations, both initiatives striving to render more effective services. In the process relationships developed between patients and service providers at health and social levels, and between providers themselves. Much of the impetus for these local developments was derived from global inputs as local players draw down packaged practices and funds from the global assemblage that Nguyen refers to as the “AIDS industry” (2005a). Thus, I suggest that HIV/AIDS becomes a catalyst for local innovation within globally standardised structures, such innovation being driven principally by building social relationships.<br>AFRIKAANSE OPSOMMING: Hierdie reflektiewe studie aangaande die response tot die MIV/VIGS pandemie is in Stellenbosch, ‘n dorp in die Kaapse Wynlande, gedoen. Stellenbosch se diverse, maar tog onsamehangende, populasie is in verskeie maniere ‘n mikrokosmos van die Suid- Afrikaanse samelewing. My vraag het gevra wat gebeur as die ondervinding van MIV/VIGS, wat persoonlike impakte en globale konneksies insluit, ‘n spesifieke lokaliteit in Suid-Afrika bereik. Ek het gewerk volgens die aanname dat die omvang van die siekte in dié spesifieke lokaliteit die uitskakeling van mense deur historiese, politieke, sosiale en ekonomiese prosesse reflekteer, en dat response tot die siekte poog om ontwrigtings te herstel deur die integrasie van mense in versorgende ondersteunings sisteme. Deur response, op publieke gesondheid en dienslewerings organisasie vlak, as deelnemende waarnemer op te volg en te ondersoek, het ek herhaaldelike verwysings gekry na die noodsaaklikheid om pasiente te betrek in die behandelings proses. My observasies het ’n transformasie in die wederkerige verhouding tussen dokters en pasiente ontbloot, sowel as ’n omvattende omvang van netwerke van dienslewerings organisasies. Beide inisiatiewe streef daarna om meer effektiewe dienste te lewer. In die proses ontwikkel verhoudings tussen pasiente en diensverskaffers op gesondheids and sosiale vlakke, asook tussen diensverskaffers. ’n Groot gedeelte van die dryfkrag agter hierdie plaaslike ontwikkelings spruit uit globale insette namate plaaslike spelers verpakte praktyke en fondse ontvang/trek van die globale groep, wat Nguyen na verwys as die ’VIGS industrie’ (2005a). Daarvoor, stel ek voor dat HIV/VIGS ’n katalisator vir plaaslike innovasie binne globaal gestandardiseerde strukture word, en dat inovasies van die aard hoofsaaklik deur die bou van sosiale verhoudings gedryf word.

Whilst there is evidence of a range of effective treatments available for people with severe mental health problems (SMHP), people frequently disengage from mental health services (MHS). This thesis investigates experiences of disengagement of people with SMHP and comprises two studies: 1) semi-structured interviews to elicit the experiences of people with SMHP and a history of disengagement from MHS; and 2) building on those findings, focus groups with staff from assertive outreach teams (specialising in providing care for people with SMHP and a history of disengagement). The participants were those perceived as the most disengaged from MHS yet they were willing to engage with the research. Interpretative phenomenological analysis was used to develop themes for individual participants and then across the participants. Disengagement from MHS was part of a wider experience of a limited connection to social structures, including an ambivalent and complex relationship with MHS. There was a sense of sadness in all aspects of the participants’ experience but they had developed strategies to reinforce personal resilience and to reassert personal identity. The findings of this thesis can be employed to better understand the context of disengagement from MHS and consequently better inform future engagement with this client group.

The quality of healthcare is increasingly the subject of scrutiny by a range of stakeholders, including healthcare provider organisations, health professionals and their representative bodies, healthcare purchasers and funders, policy makers and national governments, patients and users of health services. The use of a variety of quality measures has become widespread in the healthcare systems of many developed countries, including the United Kingdom. The twin tasks of measuring and improving the quality of care - often termed quality assurance - have been addressed by new arrangements for professional accountability, new approaches to managing and comparing organisational performance, and new statutory and legal mechanisms. Adverse events in healthcare, which can be loosely defined as instances which indicate or may indicate that a patient has received poor quality care, offer an important opportunity for quality measurement and improvement. There is extensive evidence that adverse events are relatively common, that they can have serious and lasting impacts on patients, and that they represent a considerable cost to healthcare organisations. Equally importantly, evidence in healthcare and experience in other sectors suggests that adverse events offer an important insight into the strengths and weaknesses of healthcare processes, and an invaluable opportunity to bring about improvements in the quality of care. Adverse events have been used quite widely, particularly in the United States of America, as the basis of a number of measures of the quality of healthcare. However, these measures have rarely been developed and tested rigorously before they have entered widespread usage, and there has been considerable debate about their advantages and disadvantages. A series of empirical studies were undertaken, using data collected through the use of adverse-event measures of quality in a British acute hospital, aimed at investigating the validity and reliability of those measures. The results showed that the adverse-event measures being tested had moderate to good face, content and construct validity. Although their validity was capable of improvement, it was still clear that they were measuring meaningful and important dimensions of the quality of healthcare. However, the reliability of the measures being tested was more mixed. While experimental studies of interrater and intrarater reliability indicated that they had moderate to good reliability (though, again, it was capable of improvement) observational studies suggested that the reliability in actual use might be lower than that found during testing. This research concludes that adverse-event measures of quality are important measures of the quality of healthcare, which should be used in healthcare quality assurance with two main provisos. Firstly, the development of measures should be more rigorous, and should pay more attention to both validity and reliability issues. Secondly, the routine use of such measures should incorporate some element of ongoing reliability testing, in order to ensure that good reliability is maintained.