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Harrison, Helen E. "In the picture of health, portraits of health, disease and citizenship in Canada's public health advice literature, 1920-1960." Thesis, National Library of Canada = Bibliothèque nationale du Canada, 2001. http://www.collectionscanada.ca/obj/s4/f2/dsk3/ftp04/NQ63424.pdf.
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Boardman, Jason David. "The social determinants of health race, resources, and neighborhoods in the Detroit tri-county area /." Access restricted to users with UT Austin EID Full text (PDF) from UMI/Dissertation Abstracts International, 2002. http://wwwlib.umi.com/cr/utexas/fullcit?p3077407.
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Miller, Robin. "Managing change in health and social care." Thesis, University of Birmingham, 2016. http://etheses.bham.ac.uk//id/eprint/6672/.
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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.
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Cameron, Kirsteen Sarah. "Needs-led assessment in health and social care : a community-based comparative study." Thesis, University of Glasgow, 2006. http://theses.gla.ac.uk/2984/.
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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.
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Hepburn, Sharon Jean. "Western minds, foreign bodies : the anthropologist in third world health development." Thesis, McGill University, 1987. http://digitool.Library.McGill.CA:80/R/?func=dbin-jump-full&object_id=63795.
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Yamada, Raquel Tieko Tanaka. "Representação social de saúde bucal de usuários do sistema público de saúde de Vitorino - PR." Universidade Tecnológica Federal do Paraná, 2012. http://repositorio.utfpr.edu.br/jspui/handle/1/416.
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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.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.
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Boyer, Duane, and mikewood@deakin edu au. "Defining moments in men's lives: A study of personal narratives." Deakin University, 2004. http://tux.lib.deakin.edu.au./adt-VDU/public/adt-VDU20050727.123714.
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This study explores the defining moments in six mens 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 mens 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 peoples 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.
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Ward, Vivienne. "Networks, NGOs and public health : responses to HIV/AIDS in the Cape Winelands." Thesis, Stellenbosch : Stellenbosch University, 2007. http://hdl.handle.net/10019.1/19890.
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Thesis (MPhil)--University of Stellenbosch, 2007.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.
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.
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Wagstaff, Christopher. "Experiences of disengagement from mental health services : an interpretative study." Thesis, University of Birmingham, 2016. http://etheses.bham.ac.uk//id/eprint/6980/.
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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.
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Walshe, Kieran. "The reliability and validity of adverse-event measures of the quality of health care." Thesis, University of Birmingham, 1998. http://etheses.bham.ac.uk//id/eprint/342/.
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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.
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Willis, Eileen. "Accelerating control : an ethnographic account of the impact of micro-economic reform on the work of health professionals /." Title page, table of contents and abstract only, 2004. http://web4.library.adelaide.edu.au/theses/09PH/09phw7341.pdf.
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Acharya, Manju Prava, and University of Lethbridge Faculty of Arts and Science. "Constructing cultural diversity: a study of framing clients and culture in a community health centre." Thesis, Lethbridge, Alta. : University of Lethbridge, Faculty of Arts and Science, 1996, 1996. http://hdl.handle.net/10133/29.
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Introduction
The clinical community in Western society has long practised medicine as organized by "two dominant principles: 1) the principle of essentialism which states that there is a fixed "natural" border between disease and health, and 2) the principle of specific treatment which states that having revealed a disease, the doctor can, at least in principle, find the one, correct treatment. These principles have served as the
legitimization of the traditional, hierarchical organization of health-care" (Jensen, 1987:19). A main feature of medical practices based on these principles has been to address specific kinds of problems impeding or decaying health. This research is centrally concerned with essentialism and the institutional fixation of problems as two important nodal points of Canada's biomedical value and belief system. More specifically, I hope to show in an organized way how these principles shape staff knowledge of client and culture in a community health centre (CHC) in Lethbridge, Alberta. My analysis is based on four guiding points: 1) that in our polyethnic society health care institutions are massively challenged with actual and perceived
cultural diversity and cross cultural barriers to which their staff feel increasingly obliged to respond with their services; 2) while the client cultural diversity is "real", institutional responses depend primarily on how that diversity is imagined by staff -often as a threat to a health institution's sociocultural world; 3) that problem-specific, medicalized thinking is central in this community health centre, even though its mandate is health promotion and this problem orientation often combines with medical essentialism to reduce
"culturally different" to a set of client labels, some of which are problematic; and 4) while a "lifestyle model" and other models for health promotion are at present widely advocated and are to be found centrally in this institution's (CHC) charter, they have led to little institutional accomodation to cultural diversity.
In this thesis my aim is to present an ethnographic portrait of a community health centre, where emphasis is given to the distinctive formal and informal "formative processess" (Good 1994) of social construction of certain perceived common core challenges facing the Canadian biomedical community today - challenges concerning cultural difference and its incorporation into health care perception and practice. I am particularly interested in institutions subscribing to a "health promotion model" of health care, a term I have borrowed from Ewles and Simnett (1992). Ewles and Simnett descrive the meaning of "health promotion" as earlier defined by WHO (World Health Organization): this perspective is derived from a conception of "health" as the extent to which an individual or group is able, on the on hand, to realise aspirations and satisfy needs; and, on the other hand, to change or cope with the environment. Health is, therefore seen as a resource for everyday life, not the objective of living; it is a positive concept emphasising social and personal resources, as well as physical capacities (Ewles & Simnett, 1992:20) Health is therefore concerned with "a state of complete physical, mental and social wellbeing, and not merely the absence of disease and infirmity" (Ewles and Simnett, 1992:6), I am interested in determing how threats to this defintion prevail in a community health centre's ideology of preventive care, and how that ideology encodes dimensions of diversity. I, however, want to go much further than this by exploring everyday staff discourse and practice, to understand how client cultural diversity is formed and informed by what staff do and say. How, in short,
do individuals based in a health promotion organization socially construct their clients as objects of institutional concern? We need, as Young (1982) suggest, "to examine the social condition of knowledge production" in an institutionalized health care service provision subculture. There are, I believe, also practical reasons for conducting this research. Over the past ten years the Canadian health care system increasingly has had to focus on two potentially contradictory goals: reducing costs, and lessening persistent inequalities in health status among key groups and categories of persons in the Canadian population. Many now argue that one of the most central dimensions of the latter - of perisistent health inequalities in Canada - is ethnocultural. Few would seriously argue, for example, that Canadian First Nation health statistics are anything but appalling. Moreover, radical changes in immigration patterns over the past three decades have greatly increased urban Canadian cultural diversity. Caring "at home" now assumes international dimensions (McAdoo, 1993; Butrin, 1992; Buchignani, 1991; Indra, 1991, 1987; Galanti, 1991; Dobson, 1991; Waxler-Morrison, 1990; Quereshi, 1989). A growing voiced desire to provide more pluralistic health care and health care promotion has become persistently heard throughout the clinical community in Canada (Krepps and Kunimoto, 1994; Masi, 1993). Even so, for many health professionals cultural difference evidently remians either irrelevant or a threat to the established order of things. Applied research on health care institutions undertaken to investigate how better to meet these challenges nevrtheless remains very incomplete and highly concentrated in two broad areas. One of these is structural factors within the institution that limit cross-cultural access (Herzfeld, 1992; Hanson, 1980). Some of these studies have shown the prevalence of a strictly conservative institutional culture that frequently makes frontline agency workers gate-keeprs, who actively (if unconsciously) maintain client-institution stratification (Ervin, 1993; Demain, 1989; Ng, 1987; Murphy, 1987; Foster-Carter, 1987; de Voe 1981). In addition, extensive research has been conducted on disempowered minority groups. This research has examined the frequency, effectiveness and manner with which ethnic and Native groups make use of medical services. Some institutional research on cross-cultral issues shows that under appropriate conditions health professional like nurses have responded effectively to client needs by establishing culturally sensitive hiring and training policies and by restructuring their health care organizations (Terman, 1993; Henderson, 1992; Davis, 1992; Henkle, 1990; Burner, 1990). Though promising, this research remains radically insufficient for learning purposes. In particular, little work has been done on how such institutions come to "think" (Douglas, 1986) about cultural difference, form mandates in response to pressure to better address culturally different populations and work them into the institution's extant sub-cultral ideas and practice (Habarad, 1987; Leininger, 1978), or on how helping instiutions categorize key populations such as "Indians" or "Vietnamese" as being culturally different, or assign to each a suite of institutionally meaningful cultural attributes (as what becomes the institution's working sense of what is, say, "Vietnamese culture"). This is so despite the existence of a long and fruitful ethnographic institutional research tradition, grounded initially in theories of status and role (Frankel, 1988; Taylor, 1970; Parson, 1951), symbolic ineractionism (Goffman, 1967, 1963, 1961), ethnomethodology (Garfinkle, 1975), and organizational subcultures (Douglas, 1992, 1986, 1982; Abegglen & Stalk, 1985; Ohnuki-Tierney, 1984; Teski, 1981; Blumers, 1969). More recent work on anthropological social exchange theory (Barth, 1981), on institutional and societal discipline (Herzfeld, 1992; Foucault, 1984, 1977), on the institution-client interface (Shield, 1988; Schwartzman, 1987, Ashworth, 1977, 1976, 1975), and on framing the client (Hazan, 1994; Denzin, 1992; Howard, 1991; Goffman, 1974). I also hope that this study makes a contribution to the study of health care and diversity in southern Alberta. Small city ethnic relations in Canada have been almost systematically ignored by researchers, and similar research has not been conducted in this part of Alberta. Local diversity is significant: three very large Indian reserves are nearby, and the city itself has a diverse ethnic, linguistic and ethno-religious population. Also, significant province wide restructuring of health care delivery was and is ongoing, offering both the pitfalls and potentials of quick institutional change. Perhaps some of the findings can contribute to making the future system more responsive to diversity than the present one.202 p. ; 29 cm.
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Kim, Myung Hun. "A comparison of health technology adoption in four countries (Japan, Korea, the UK, and the US)." Thesis, University of Birmingham, 2008. http://etheses.bham.ac.uk//id/eprint/166/.
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This research empirically examines and compares the adoption of health technologies through case studies. The health technologies under review are assisted reproductive technologies, cochlear implants, haematopoietic stem cell transplantations, caesarean section deliveries, Gamma knife units and kidney transplants in four countries: Japan, Korea, the UK and the US. The interactions between the micro factors of health technologies and the macro environment in the adoption of health technologies are examined on the basis of a literature review and analysis of data. The micro factors were evaluated in terms of economic, clinical and technical aspects. In assessing the macro factors, payment systems and regulations related to the selected health technologies were taken into account. To examine the micro factors, the results of health technology assessments in earlier studies were reviewed. In order to explore the macro factors, historical changes in the payment systems affecting the selected health technologies and legal regulations, including legislation, directives, guidelines and court orders related to the technologies, were investigated. The adoption level of health technologies was evaluated in time-series and cross-sectional terms, measuring the trend of technology adoption and comparing the experience of the four countries under review. This research suggests clustering health technologies into “welfare oriented technology” and “private benefit oriented technology” by considering the economic incentives of adopters, individual desires of consumers and public concern over the technology. Private benefit oriented technologies are those which adopters expect to increase income from the providers or which meet the personal desires of the consumers. For welfare oriented technology, the decision is dominated by the aims of public welfare. As the model predicted, the adoption of welfare oriented technologies was higher in the health systems under national planning, while that of private benefit oriented technologies was higher in the systems whose health provisions accept market conditions.
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Jarumai, Cyril Joshua. "Some aspects of modern Irish law." Thesis, National Aviation University, 2021. https://er.nau.edu.ua/handle/NAU/48765.
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By the early 21st Century further amendment to the Constitution has been necessitated by Ireland’s membership of the European Union, which has involved the cession of a degree of sovereignty and the subordination of national law to European law. A significant amendment was effected pursuant to the Good Friday Agreement, when Ireland removed its territorial claim to Northern Ireland and replaced it with the principle of unity by consent.Today’s Irish law due to the pandemic conditions of its development is on
the way to its own improvement to regulate social relations effectively and protect the interests of their participants.
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Hickson, Kerry. "The contribution of improved health to standards of living in twentieth century England and Wales." Thesis, London School of Economics and Political Science (University of London), 2006. http://etheses.lse.ac.uk/22/.
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The thesis will highlight both qualitatively and quantitatively that during the twentieth century the English population experienced unprecedented improvements in mortality and particularly morbidity, which has provided a substantial boost to standards of living and economic development. Despite the extensiveness of these health improvements, there have been a very limited number of attempts to evaluate and quantify these valuable improvements. None of the existing studies that quantitatively assess improved health actually measure health per se, as they all utilise mortality as a proxy. Furthermore, there have been no historical studies that aim to map the evolution of improving health from the perspective of quality of life for illness sufferers. The thesis will fill all of these voids through developing a quantitative health (mortality and morbidity) measuring tool that is capable of providing (monetary) estimates about the contribution of improved health to standards of living and economic developments in twentieth century England. This will be applied to key case study illnesses (blindness, breast cancer, stomach cancer and tuberculosis) and then extrapolated forward to include all illnesses which will be combined with mortality in order to provide an aggregate health index for twentieth century England. The results of this exercise provide a significant contribution to the twentieth century health and economic history of England. The thesis findings that, at a most conservative estimate, the value of twentieth century health improvements is in excess of 33 billion (1990 international $) substantially adds to a new view of the economics of health and provides very valuable historical detail. This new view is that improvements in health have been a major contributor to economic welfare in twentieth century England. Put another way: the thesis will highlight that during the twentieth century increases in life expectancy and improvements in the quality of life associated with morbidity have provided a considerable contribution to standards of living and the growth of GDP defined on a utility, 'Fisherian' basis, whereby economic growth nearly doubles, from 1.4 percent for GDP only versus 2.6 percent when GDP is adjusted for improved health.
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Bollard, Martin. "Disability, relative poverty and gender : how men with learning disabilities perceive and experience the impact of social divisions on their health." Thesis, University of Warwick, 2013. http://wrap.warwick.ac.uk/57902/.
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This thesis explores how men with mild to moderate learning disabilities perceive and experience how disability, relative poverty and gender impact on their health. Its theoretical framework grounded in analysis of these social divisions, and informed by the men’s own accounts - previously neglected in research, reveals complex challenges affecting their health on a daily basis. Consistent with the thesis’ overarching perspective, key elements of a participatory approach were adopted in the fieldwork to ensure men with learning disabilities’ active research involvement. They comprised the steering group, and twenty men participated in qualitative interviews facilitated by accessible materials and detailed preliminary preparations. The findings showed the men were aware of health issues, but were grappling with the adverse health effects of impairment, including disabilist health care and victimisation. Low income associated with limited employment confined most men to relative poverty with negative effects on health. The findings demonstrated a sharp appreciation of masculinity. Marginalised by other men, they experienced health threatening abuse, but their resistance to conventional male disregard for health care, had positive implications for their health. The thesis provides a more informed, nuanced understanding of the adverse impact of different dimensions of social disadvantage on the health of men with mild to moderate learning disabilities. In doing so, it demonstrates the value of developing knowledge grounded in their perspectives and experience.
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Issarayangyun, Tharit Civil & Environmental Engineering Faculty of Engineering UNSW. "Aircraft noise and public health : acoustical measurement and social survey around Sydney (Kingsford Smith) Airport." Awarded by:University of New South Wales. Civil and Environmental Engineering, 2005. http://handle.unsw.edu.au/1959.4/22394.
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The development of major commercial airports promotes the air transport industry and generates positive economic benefits to the airport and to its host economy. However, external costs are associated with these benefits. Any increase in aircraft movement causes negative environmental impacts, especially noise pollution. Governments have reduced aircraft noise levels at their sources, or introduced aircraft noise management strategies (ANMS); however the problems have never been satisfactorily resolved. This research aims at developing a better understanding of the impacts of aircraft noise on community health and well-being by exploring two core research questions: (1) ???Is health related quality of life worse in communities chronically exposed to aircraft noise than in communities not exposed????; and (2) ???Does long-term aircraft noise exposure associate with adult high blood pressure level via noise stress as a mediating factor????. The Sydney (Kingsford Smith) Airport has been selected as a case study. The health survey instruments have been developed and piloted, and then translated from English into Greek and Arabic. A postal self-administrative health survey (with follow-up letters) has been implemented in the areas surrounding Sydney Airport (called ???aircraft noise exposure group???) and in the matched control group. The total sample size was 1,500 with 47% response rate. This thesis has developed a ???new??? noise index (named Noise Gap Index, NGI) to describe and assess aircraft noise in such a way that is easily understood by the layperson. Factorial analysis of covariance revealed that ???Health related quality of life, in term of physical functioning, general health, vitality, and mental health, of community chronically exposed to high aircraft noise level were worse than the matched control area???. Binary logistic regression analysis found that ???Subjects (aged 15 ??? 87) who have been chronically exposed to high aircraft noise level have the odds of 2.61 of having chronic noise stress. In addition person who have chronic noise stress have the odds of 2.74 of having hypertension compared with those without chronic noise stress???. Finally, the robust hypotheses of effects of aircraft noise on community health and well-being for future experimental study were proposed.
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Apperley, Alan Robert. "Personal autonomy and health policy : some considerations in political theory." Thesis, University of Warwick, 1991. http://wrap.warwick.ac.uk/37880/.
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This thesis examines some of the implications for social policy of an account of human nature frequently associated with liberal political theory. Taking as its starting point the claim that the objectives of social policy are contested, it seeks to develop an account of autonomy that will serve as a neutral 'organizational principle' around which to construct social policy. A particular version of personal autonomy is developed and defended against both abstract Kantian moral autonomy, and the individualism often associated with liberal theories. This project is pursued first through a discussion of the relationship of autonomous persons to 'social forms', and then through a critique of libertarian and 'intellectualist' accounts of autonomy. It is argued that, since autonomy is not only employed in the making of choices, but also in the implementing of those choices, it follows that the autonomous person must, of necessity, be viewed 'holistically' for the body is the primary means of implementing the choices autonomous persons make. The health of the body, as well as that of the mind, therefore assumes importance for any social policy that takes autonomy to be a fundamental objective. The implications for such an account of social policy are then explored in two ways. First, through a discussion of the phenomenon of 'medicalization'. Second, through a discussion of the Prevention and Health campaign. In the first instance, it is argued that the assumption that medicalization systematically undermines autonomy is ill-founded because theories of medicalization misunderstand what it is to be autonomous. In the second instance, the discussion of preventive health-care policy serves to illustrate the fundamentally erroneous assumptions of individually-focussed health-care programmes. In conclusion, it is argued that a unified account of autonomous persons must inevitably lead to a more integrated social policy.
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Fleming, Brian James. "The social gradient in health : trends in C20th ideas, Australian Health Policy 1970-1998, and a health equity policy evaluation of Australian aged care planning /." Title page, abstract and table of contents only, 2003. http://web4.library.adelaide.edu.au/theses/09PH/09phf5971.pdf.
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Armeni, Elizabeth. "Menstruation goes public : aspects of womens's menstrual experience in Montreal, 1920-1975." Thesis, McGill University, 1996. http://digitool.Library.McGill.CA:80/R/?func=dbin-jump-full&object_id=26674.
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Menstruation is all at once a cultural, social, historical, and biological process. Intertwined, these forces create menstrual experiences which are neither fixed nor universal, but rather adaptable and transformable not only between cultures, but from within cultures as well. How these factors interrelate, what menstrual discourse they create, and how that translates into women's everyday lives, becomes the focus of this research. Structured around the relationship between prescription and reality, this study examines the interplay of those who defined the menstrual discourse: doctors, mothers, and the sanitary napkin industry, and those who experienced it.Listening to the lives of twenty-four women, born between 1910 and 1965, a complex and ambiguous tale of the menstrual experience emerges. Through their narratives, we learn the importance of early instruction by mothers; the emphasis placed on hygiene and concealment; the effect menstruation had on women's sexual, feminine, and (re)productive identity. Once women's voices are taken into consideration, it becomes clear that the dynamic between prescription deeming menstruation as unclean or deviant and women's reality is not straightforward. Women reacted to the menstrual discourse, at times they rejected it, other times adhered to it, but for the most part, simply transformed it to meet their daily needs.
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Du, Plessis Gretchen Erika. "A critical ethnography of HIV-positive women attending public health care facilities in Gauteng." Thesis, Nelson Mandela Metropolitan University, 2008. http://hdl.handle.net/10948/777.
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Women living with HIV have a variety of reproductive health and psychosocial needs. The purpose of this critical ethnographic study was to examine how HIV, empowerment and reproduction are experienced by a volunteer sample of HIVpositive women attending public health care facilities in Gauteng. Feminist and critical approaches were used to guide the methodology of the research and the interpretation of the findings. Data were collected through in-depth interviews and observation. An overview of literature pertaining to the social construction of HIV-AIDS, women’s empowerment and reproductive decision-making is presented. A discourse of “healthy lifestyle” as technologies of the self is considered. Women’s empowerment as an ideal is described and structural barriers to its achievement are discussed. Stigma and discrimination as products of hegemony are discussed as important issues in the disempowerment of women living with HIV. HIV-AIDS as illness experience is reviewed with reference to the social context and to the individual context. Reproductive decision-making models and theories are critically analysed for their applicability to women living with HIV. The need for a conceptual shift in the notion of empowerment in order to understand constrained decision-making for women living with HIV is propagated. The stories of women living with HIV and dependent on public health care services are presented. Through the principles of a critical ethnography the lived experiences of these women are described by means of emerging themes. A historiography of family planning and HIV-AIDS services throws the narrations of the research participants into broader historic relief. Findings revealed that biomedical hegemonic power contoured and marked the lived experiences of women following an HIV-positive diagnosis. Taken-for-granted views of passivity and of own responsibilities regarding reproductive health are challenged. The women in the study were dependent upon public health care personnel for treatment, testing, dietary advice/supplementation and recommendations for a social xii disability grant. ARV-treatment was regarded as a low point in the illness career. All of the participants reported that the overriding problems in their lives were having too few material resources and not having the means to change this. This made them vulnerable to compounded health problems and decreased their ability to voice their own opinions about treatment. They did not regard themselves as having been at risk for contracting HIV and some harboured resentment towards men who were seen as being absolved from testing and responsibilities towards female partners, born and unborn children. Women who were not tested as part of antenatal sentinel groups tended to suffer symptoms of ill health for some time prior to being tested for HIV. Social support systems were either absent or consisted of trusted family members and friends. In many cases, women became the silent care-givers for those affected and infected by HIV. Anticipated stigma permeated the participants’ narrations of living with HIV and disclosure of their statuses was difficult. The use of male condoms, stressed during counselling sessions, was narrated as a difficult burden for women to bear. Although the research participants expressed low fertility preferences, HIV-AIDS was seen as disrupting the link between heterosexual conjugal relations and the taken-for-grantedness of procreation. HIV-AIDS also disrupted norms in infant feeding practices and bottle-feeding was regarded as a sign of possible HIV-infection and hidden. The research participants were not empowered with knowledge about how to deal with side-effects, condom failures and the reluctance of male partners to be tested for HIV. They enacted, resisted and lived with HIV in different ways, incorporating some of the biomedically prescribed posturing as women living positively and blending it with stigma-negating performances and gender-prescribed ways of dressing, walking and acting. Participation in a support group validated their experiences and promoted positive self-perception. The formation of a collective voice in the support group was hampered by irregular attendance, the interference of community leaders and horizontal violence. Power relations, yielded by biomedical hegemony, androcentric sociocultural practices, material deprivation, fear, discrimination and stigma potentially undermined the women’s abilities to become empowered. Expansion of choices in various spheres or fields and collective action xiii are proposed as dimensions to be added to an empowerment-of-women approach to the problems of reproductive health in the age of HIV-AIDS. The contribution of the study as an emancipatory project is evaluated and implications for policy and practice are suggested. On a methodological level, this study is a demonstration of the contribution to be made by a micro-level, critical analysis to the body of knowledge about female reproductive health in the era of HIV-AIDS in South Africa. On a theoretical level, this study contributes to a wider conceptualisation of women’s empowerment by recognising the interplay between micro-level elements of situated experience, knowledge and preferences and the macro-level elements of sociocultural, biomedical and material influences on health and reproductive behavior.
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Hiscock, Rosemary Esther. "The relationship between housing tenure and health : does ontological security play a role?" Thesis, University of Glasgow, 2001. http://theses.gla.ac.uk/6146/.
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Previous research in the UK and elsewhere has found that housing tenure (i.e. whether the dwelling is owned or rented) predicts mortality and morbidity. This thesis aims to explain whether ontological security (a long term tendency to believe things are reliable and secure as opposed to threatening) is more likely to be associated with owner occupation, and therefore whether it helps to explain the observed association with tenure and health. For the purposes of this study ontological security was operationalised as being formed of three components: protection, autonomy and prestige. A scale was devised to measure ontological security arising from the home through these three components. This scale was included in a postal survey that also included questions on health, housing area, psychological and sociodemographic characteristics. The postal survey was sent to a random sample of adults in the West of Scotland and nearly 300 completed questionnaires were returned. I found that ontological security was associated with owner occupation but not independently of features of housing. Ontological security was not independently related to housing tenure itself. Owner occupiers reported more ontological security from their homes because their homes were in better condition, situated in better areas and of higher value than social renters. Ontological security appeared to be related to health particularly through psychological characteristics. Other reasons for the associations between tenure and health were that owners were on average younger and richer than social renters. This study suggests that social meaning per se may not be health damaging, but that social rented homes might put their occupants at greater health risk because they are in poorer condition, located in more poorly resourced and problem ridden areas and of lower status. These features of social renting may also be observed in other countries (e.g. USA).
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Fragassi, Christopher. "SCHIZOPHRENIA AND STIGMA: AN OUTLOOK ON THE MEDICAL, LEGAL, AND SOCIAL ASPECTS OF LIVING WITH SCHIZOPHRENIA." Master's thesis, Temple University Libraries, 2018. http://cdm16002.contentdm.oclc.org/cdm/ref/collection/p245801coll10/id/488872.
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Urban BioethicsM.A.
Schizophrenia is a disease which presents many challenges. Medically, legally, and socially, afflicted individuals face obstacles that decrease their overall quality of life. Some of these are sequela of the disease and its decrease in social functioning, or symptoms of paranoia and disorganization. However, others are placed on these individuals by society. This has created a lifestyle which is marred by comorbid medical conditions and a resistance to receive treatment. It also creates frequent contact with the legal system, leading to a disorganized home life, and a significant amount of time spent behind bars, and being victimized by others. Finally, many schizophrenic patients are unable to find jobs, and report being without significant supportive relationships in their lives, creating stress both on themselves and their families and caregivers. These difficulties in life can be inseparable from their disease and place schizophrenic patients at a further disadvantage.
Temple University--Theses
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Chipperfield, Sarah R. "An exploration of the influence of social ballroom dancing on health and well-being for older adults." Thesis, University of Huddersfield, 2018. http://eprints.hud.ac.uk/id/eprint/34749/.
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Background The world’s ageing population is frequently cited as presenting economic and social burdens and critical challenges to healthcare systems, with falls and mental health featuring as two of the biggest burdens. Whilst physical activity is recommended for older adults to optimise functional independence and guidelines for the intensity, duration and frequency of physical activity exist, there are few guidelines on the specific types of exercises that are recommended. As a physical activity that incorporates the recommended aspects of aerobic, strengthening and balance work, the aim of this study was to explore the influence of ballroom dancing on the physical, mental and social health of community-dwelling older adults. Method A qualitative-dominant, concurrent mixed-methods design was utilised. Ethical approval was granted via the University of Huddersfield’s research ethics panel. Participants were community-dwelling older adults (over 55 years of age) who were recruited from local ballroom dancing classes in West Yorkshire. They participated in ballroom dancing classes for at least one hour per week for 12 months and were tested during this period at baseline, and after 3, 6, 9 and 12 months. Demographic details were collected at baseline and the incidence of falls, changes to medical history or medications and levels of exercise were recorded at each data collection point. Quantitative measures of physical function were assessed using the Functional Reach Test (FR test), Timed-Up-and-Go Test (TUGT), the Four Square Step Test (FSST) and Tinetti’s test. In addition, balance was specifically assessed using a Biodex Balance System SD (BBS). The Falls Efficacy Scale-International (FES-I) was completed alongside the Clinical Outcomes in Routine Examination-General Population (CORE-GP) for well-being. The qualitative aspect of the study used semi-structured interviews at baseline, 6 and 12 months. Forty-one interviews were performed with participants individually or in dancing pairs. Qualitative data were managed and analysed using the Framework Analysis approach. Results Of the 26 older adult ballroom dancers recruited to the study who consented to participate, 23 (10 male, 13 female) completed the 12-months of data collection (mean age 66.5 years (SD 5.96 years; age range 58-83 years)). Using a Framework Analysis approach, 4 key themes were identified amongst the sample of older adults. ’Active ageing’ considers physical health perceptions, the acceptance, adaptation and frustrations of ageing and maintaining an active body and mind. The theme ‘class commitment and congruence’ highlights factors that were deemed important to the success of a dancing class and would encourage participants to keep dancing. The ‘Social dance community’ theme considers the influence and dynamics of dancing partnerships and the importance of building social networks. Finally, ‘enjoyment’ acknowledges the role of ballroom dancing for well-being. This study demonstrated a low attrition rate, no adverse effects due to ballroom dancing and a low falls risk in this sample of older adults. The primary outcome was assessment of functional changes between baseline and 12 months, with the 3-monthly intervals serving as interim data collection points. Over the 12-month period, whilst not expected in a feasibility study, there were no significant changes in the FR test, TUGT, FSST or Tinetti’s test. For the CORE-GP scale 97.5% of recordings were within the ‘healthy’ well-being score range, and there was a 10% decrease in points-score for the FES-I, indicating a possible substantive finding for clinical practice. The BBS tests demonstrated women had a statistically significant better level of postural stability then men, and as a group, their scores on the FR test were significantly lower than normalised scores for their age group. Discussion The findings suggest that ballroom dancing should be promoted by health professionals as a socially inclusive,safe physical activity that provides considerable pleasure. In addition to the current literature, the ‘pleasure of practice’and the ‘pleasure of community’are two types of pleasure suggested to be associated with ballroom dancing. Ballroom dancing also enhances opportunities for physical, psychological and social resilience in older adults by resisting age-related physical decline, assisting with acceptance of the ageing body, providing a strong sense of enjoyment and well-being and helping to form strong social connections, which are all important factors for resilient ageing. It is recommended that future comparative studies are of an adequate power to detect group differences that may exist in quantitative outcome measures, such as assessing balance with the BBS. A control group should be used for comparison with the ballroom dancing intervention group, with the intervention group all starting ballroom dancing at baseline. Given the findings of this study that the participants appeared to be high functioning when performing physical tests, it is recommended that alternative outcome measures are sought that will discriminate sufficiently amongst community-dwelling older adults.
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Shepherd, Jonathan Paul. "Assessing quality in systematic reviews of the effectiveness of health promotion : areas of consensus and dissension." Thesis, University of Southampton, 2009. https://eprints.soton.ac.uk/67475/.
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Systematic reviews have played an increasingly important role in health promotion in recent years. Yet there are debates about how they should be conducted, particularly about how the quality of evidence should be assessed. The aim of this research was to assess current approaches to, and general views on, the use of quality assessment in systematic reviews of effectiveness in health promotion, and to identify areas of consensus and dissension around the choice of techniques, methods and criteria employed. There were two stages of data collection. The first was a structured mapping of a random sample of 30 systematic reviews of the effectiveness of health promotion to identify and explain trends and themes in methods and approaches to quality assessment. During the second stage semi-structured interviews were conducted with a purposive sample of 17 systematic reviewers who had conducted at least one review of a health promotion topic, to investigate some of these trends and approaches in greater detail. The mapping found that the majority of systematic reviews had assessed the quality of the included studies, to varying degrees. However, procedures were not always explicitly reported or consistent. There was some degree of consensus over criteria, with experimental evaluation methods commonly favoured. Most frequently used quality assessment criteria included participant attrition, the validity and reliability of data collection and analysis methods, and adequacy of sample sizes. External validity was commonly assessed, primarily in terms of generalisability and replicability, but less so in terms of intervention quality. The interviews revealed some of the barriers to effective systematic reviewing, including: lack of time and resources, complexity of some health promotion interventions, inclusion of observational evaluation designs, and poor reporting of primary studies. Systematic reviewing was commonly done in small teams, mostly comprising academics, sometimes with practitioners. Interviewees learned systematic review skills through a combination of training, support from colleagues and mentors, literature and a strong emphasis on hands-on practical learning. Subjective judgement was often required, contra to the popular belief that systematic reviews are wholly objective. The overall conclusions of this study are that systematic reviewing in health promotion is often challenging due the complexity of interventions and evaluation designs. This places additional demands on reviewers in terms of knowledge and skills required, often exacerbated by finite time scales and limited funding. Initiatives are in place to foster shared ways of working, although the extent to which complete consensus is achievable in a multi- disciplinary area such as health promotion is questionable.
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Skivington, Kathryn. "Incapacity benefit, employment transitions, and health : evidence from longitudinal data and a qualitative study." Thesis, University of Glasgow, 2013. http://theses.gla.ac.uk/4743/.
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Background: UK welfare reform endeavours to reduce out-of-work health-related benefit receipt and support people into employment. Such reforms assume that work is good for health and that targeting welfare-to-work interventions at individuals will result in moves from benefit receipt to employment. The research in this thesis tackles two questions associated with UK welfare reforms: (1) Is work always good for health? And, (2) Is the focus on motivating individual Incapacity Benefit (IB) and Employment and Support Allowance (ESA) recipients appropriate, or are there barriers to return to work that this approach cannot address? Methods: Three approaches were taken to address the aims: 1) Longitudinal analysis, using Generalised Estimating Equations, of the West of Scotland Twenty-07 Study (Twenty-07), to explore transitions from worklessness to employment. The analyses looked at both employment and health outcomes (self-rated and anxiety or depression) and took account of the psychosocial quality of the jobs obtained. 2) A systematic review of qualitative studies that explored the barriers and/or facilitators to employment from the perspective of people out of work because of health conditions or disabilities. A qualitative synthesis, using meta-ethnography, of the included studies was conducted. 3) A primary study utilising in-depth interviews with IB and ESA recipients, General Practitioners (GPs), and Employment Advisors (EAs) in Glasgow, to gain more understanding about barriers and facilitators to work and to fill the gaps identified in the qualitative synthesis. The interviews were analysed using Framework Analysis methods. Findings: Findings from Twenty-07 data showed that only 6.6% of those out of work because of ill health returned to work within the follow-up period. After a transition from worklessness to employment those in low-quality jobs had higher odds of poor health than those who moved to high-quality jobs, even after taking account of prior health. Those who remained workless had higher or similar odds of poor health as those who had moved to low-quality jobs. Nine studies were synthesised in the systematic review. Participants in the studies identified similar barriers and/or facilitators to return to work. Barriers and facilitators were related to health, workplace factors, the need to change job, financial issues, life stage and social circumstance, support, and self-construct. Synthesis and interpretation of the studies led to themes that were then further explored. These themes were: the complex pathway of return to work; competing participant and author narratives, and a difficulty of interpretation; the distinction between expected and experienced barriers to work; differences in barriers and facilitators by participant characteristics; job quality; and work-role centrality, adaptation, and financial risk. Seventeen IB or ESA recipients, six GPs, and six EAs participated in the qualitative study. Their barriers and facilitators to work confirmed the findings of the systematic review. All IB/ESA recipients had multiple and interacting barriers that were not limited to their motivation but also related to wider labour-market and social-context issues. Those with complex social situations and mental health conditions had lower expectation that they would successfully return to work. All participant groups were concerned that the policies of the welfare system did not match up with the labour-market or the social context. Conclusions: A very low proportion of those out of work because of ill health transitioned into employment. This is concerning because current policy is to reduce the number of people receiving IB and ESA. The research showed that there is a significant challenge to support this group into employment and that policies focusing on motivating individuals may miss important barriers to return to work. There appear to be health benefits from return to work; however, job quality is important, and the potential for health improvement is limited if the job is of poor quality. Supporting people into work has the potential to improve health, but more effort is required to determine how to improve support and target where it is most needed. Further research is necessary to explore the results of the current welfare reform i.e. whether IB/ESA recipients move into work, what helps them do so, and whether they experience a change in health.
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Thompson, Brittany, and University of Lethbridge Faculty of Arts and Science. "Under pressure : Women's Health and the social constructions of aging / Brittany Thompson." Thesis, Lethbridge, Alta. : University of Lethbridge, Dept. of Kinesiology, c2011, 2011. http://hdl.handle.net/10133/2610.
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This thesis project explores social constructions of aging women within Women’s Health magazine. There is limited scholarly literature on representations of aging women within popular health/fitness media, such as magazines. The limited current research which does exist suggests that aging women are subjected to negative stereotypes and gendered myths within our societal and cultural values with respect to aging (Vertinsky, 1994). Media representations are strong and pervasive reflections of societal norms and expectations and may impact the way women view themselves. I therefore undertook a Foucaultian discourse analysis of Women’s Health magazine to examine if/how gendered constructions of aging are functioning within representations of health directed to women of all ages. I found that Women’s Health reproduces aging women as useless, failures, problems to be managed, and other to normative femininity. Women’s Health reinforces that aging can and should be managed through the consumption of anti-aging products, procedures, and surgeries endorsed within the magazine.v, 125 leaves ; 29 cm
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Stewart, Jill Louise. "Evidence based strategies to enable health promoting housing and communities in the private sector." Thesis, University of Greenwich, 2006. http://gala.gre.ac.uk/6310/.
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This work contains 18 publications exploring evidence based strategies to enable health promoting housing and communities in the private sector. It examines housing’s contribution to health in the public health agenda; policy priorities and arrangements to deliver healthier housing; partnership working and health outcomes in housing; and measuring evidence of health gain in housing from practitioner interventions and has required a multi-method research programme of theory and practice including case studies, focus groups, comparative studies, telephone and face-to-face interviews/semi-structured discussion in a variety of settings. The work consolidates housing and public health policies, exploring their wider ideological shaping. It particularly focuses on New Labour policies since the launch of the current public health agenda in delivering new evidence-based interventions. These rely on a new relationship between government (as governance) and communities to deliver health improvement and to address health inequalities through partnership working, although barriers remain. Simultaneously, policy developments in private sector housing renewal have emphasised personal responsibility in the sector, and focus more closely on meeting individual and community need. The current situation can present something of a dilemma between seeing housing as a health determinant or as a commercial asset for both owner-occupiers and private sector landlords. The work brings together different sets of literature and fields of research which link housing and health in the private sector, and also different elements of policy as part of the government’s emphasis on joined up government, finding that although the strategic public health frameworks are in place, there remains pressure for organisations to revert to core activities.
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Nicholson, Laura. "The health, support needs, access to healthcare services and social exclusion of adults with intellectual disabilities living in rural areas : a rural-urban comparison." Thesis, University of Glasgow, 2012. http://theses.gla.ac.uk/3738/.
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Background: Almost all intellectual disabilities research is conducted in urban areas, and very little is known about the population of adults with intellectual disabilities living in rural areas. It is important to know whether there are significant rural-urban differences, in order to provide appropriate services and address inequalities. In particular, the general rural population is known to be disadvantaged with respect to access to healthcare and social exclusion. Adults with intellectual disabilities are also disadvantaged in these areas, and therefore adults with intellectual disabilities living in rural areas may have a double disadvantage. Method: A sample of adults with intellectual disabilities living in a rural area on the West Coast of Scotland participated in a face-to-face semi-structured interview; their medical notes were also accessed. Demographics, healthcare, access to services, daytime opportunities, access to community facilities, recent contact with others, the quality of personal relationships, and area deprivation by postcode were measured. Data were already available for a pre-existing urban sample. Data were analysed using direct comparison and binary logistic regression. Results: A representative sample of adults with intellectual disabilities from rural (n=39) and urban (n=633) areas were compared. There were no significant rural-urban differences over a wide range of variables including: age, gender, ethnicity, level of intellectual disabilities, mental ill health and common co-morbidities such as mobility, visual impairment, incontinence and epilepsy. Both direct comparison and binary logistic regression showed the rural sample to have had significantly more contact with primary (Odds Ratio = 4.02, 95% CI 1.56 -10.35, P = 0.004) and secondary health care (OR = 3.93, 95% CI = 1.81 – 8.55, P = 0.001.) Participants from rural areas were significantly more likely to have any regular daytime opportunity (Odds Ratio = 10.8, 95% CI = 2.3 – 51.5) including employment (OR = 22.1, 95% CI = 5.7 - 85.5) and attending resource centres (OR = 6.7, 95% CI = 2.6 – 17.2) than were participants from urban areas. They were also more likely to have been on holiday (OR = 17.8, 95% CI = 4.9 – 60.1); however, were less likely to use community facilities on a regular basis. Participants from urban and rural areas had a similar number of contacts with other people in a wide range of situations, but the quality of relationships may have been less close in rural areas. Finally, rural participants lived in significantly less deprived areas (Mann Whitney U = 7826, Z = -3.675, P ≤ 0.001). Conclusion: There were no significant demographic and health differences between the rural and urban samples. The study was underpowered with respect to some of these findings, and some results may reflect a Type II error. Nevertheless this is an important negative finding. Contrary to original hypothesis, the rural sample was found to have better access to healthcare services, had better opportunities and lived in less deprived areas than adults with intellectual disabilities living in urban areas. However, the results suggest that the rural sample may not have held such positive or close relationships, and this may be important when considering the subjective experience of social exclusion. Additional qualitative sub-study: A qualitative sub-study investigated the difficulties experienced with recruitment to the original study. 10 semi-structured telephone interviews were held with professionals who had helped with recruitment. These were transcribed verbatim and anonymised, then analyzed using the Framework approach. A number of themes arose, including participant factors (interview anxiety, worry about negative feedback), the importance of the researcher (using a personal approach, meeting potential participants prior to recruitment) and motivators (enjoyment of the research interview (participant), obtaining a medical assessment (carer)). The themes were then used to generate strategies to improve recruitment to intellectual disabilities research: these include the research team applying a more personal approach, and considering motivators for both participants and carers. The findings of this study have implications in terms of both time and money. However, successful recruitment is essential to intellectual disabilities research, and the results can be used by intellectual disabilities researchers to review and improve their recruitment processes.
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Babbel, Breannon E. "Tackling health inequalities in primary care : an exploration of GPs' experience at the frontline." Thesis, University of Glasgow, 2016. http://theses.gla.ac.uk/7692/.
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In Scotland, life expectancy and health outcomes are strongly tied to socioeconomic status. Specifically, socioeconomically deprived areas suffer disproportionately from high levels of premature multimorbidity and mortality. To tackle these inequalities in health, challenges in the most deprived areas must be addressed. One avenue that merits attention is the potential role of general medical practitioners (GPs) in helping to address health inequalities, particularly due to their long-term presence in deprived communities, their role in improving patient and population health, and their potential advocacy role on behalf of their patients. GPs can be seen as what Lipsky calls ‘street-level bureaucrats’ due to their considerable autonomy in the decisions they make surrounding individual patient needs, yet practising under the bureaucratic structure of the NHS. While previous research has examined the applicability of Lipsky’s framework to the role of GPs, there has been very little research exploring how GPs negotiate between the multiple identities in their work, how GPs ‘socially construct’ their patients, how GPs view their potential role as ‘advocate’, and what this means in terms of the contribution of GPs to addressing existing inequalities in health. Using semi-structured interviews, this study explored the experience and views of 24 GPs working in some of Scotland’s most deprived practices to understand how they might combat this growing health divide via the mitigation (and potential prevention) of existing health inequalities. Participants were selected based on several criteria including practice deprivation level and their individual involvement in the Deep End project, which is an informal network comprising the 100 most deprived general practices in Scotland. The research focused on understanding GPs’ perceptions of their work including its broader implications, within their practice, the communities within which they practise, and the health system as a whole. The concept of street-level bureaucracy proved to be useful in understanding GPs’ frontline work and how they negotiate dilemmas. However, this research demonstrated the need to look beyond Lipsky’s framework in order to understand how GPs reconcile their multiple identities, including advocate and manager. As a result, the term ‘street-level professional’ is offered to capture more fully the multiple identities which GPs inhabit and to explain how GPs’ elite status positions them to engage in political and policy advocacy. This study also provides evidence that GPs’ social constructions of patients are linked not only to how GPs conceptualise the causes of health inequalities, but also to how they view their role in tackling them. In line with this, the interviews established that many GPs felt they could make a difference through advocacy efforts at individual, community and policy/political levels. Furthermore, the study draws attention to the importance of practitioner-led groups—such as the Deep End project—in supporting GPs’ efforts and providing a platform for their advocacy. Within this study, a range of GPs’ views have been explored based on the sample. While it is unclear how common these views are amongst GPs in general, the study revealed that there is considerable scope for ‘political GPs’ who choose to exercise discretion in their communities and beyond. Consequently, GPs working in deprived areas should be encouraged to use their professional status and political clout not only to strengthen local communities, but also to advocate for policy change that might potentially affect the degree of disadvantage of their patients, and levels of social and health inequalities more generally.
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Kossarova, Lucia. "Assessing the performance of the Slovak and the Czech health systems : a case study examining the double transition and beyond." Thesis, London School of Economics and Political Science (University of London), 2014. http://etheses.lse.ac.uk/890/.
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Measuring health system performance is essential for improving health and quality of care. It is relevant in any context, but especially in countries whose health care systems have undergone major changes. The 1989 transition from communism to democracy in Czechoslovakia followed by the 1993 split into two independent countries (the Czech Republic and Slovakia) have been studied extensively but little research has addressed the effects of these events on health and the quality of care provided. The overarching objective of this thesis is to examine pre- and post-transition health system performance at three levels: i) overall health and well-being, ii) quality of the health care system, and iii) quality of outpatient care. This is a policy piece intended to demonstrate the usefulness of various performance indicators, while applying a range of quantitative methods from different disciplines to unique datasets. The macro level findings suggest that the transition was not detrimental to overall health and wellbeing in neither of the two countries as demonstrated by a small continued height increase. Slovakia showed a larger capacity to benefit from the transition. The overall quality of the health care systems is measured by ‘avoidable’ mortality and also shows improvements. For some ‘avoidable’ mortality conditions Slovakia continues to lag behind the Czech Republic, while for others it outperforms its neighbour. The thesis also provides evidence on the absence of a significant relationship between health care inputs and ‘avoidable’ mortality. Finally, the assessment of the quality of outpatient care in Slovakia, using preventable hospitalisations and selected processes of care, shows that inappropriate care may be provided for asthma and diabetes. The findings also indicate a link between appropriate and inappropriate care and preventable hospitalisations. Overall, the results of this thesis provide the basis for policy makers to better understand the changes in health outcomes and quality of care in these two settings but also to inform future quality improvement efforts.
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Schaad, Ashley M. "An Examination of the Cognitive Aspects of the Stigma of Obesity." Marietta College / OhioLINK, 2012. http://rave.ohiolink.edu/etdc/view?acc_num=marietta1325871309.
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Kezh, Nilce Helena de Paula. "Participação social em saúde: aspectos históricos e sociais relacionados à representação dos trabalhadores de saúde no Conselho Municipal de Saúde." Universidade de São Paulo, 2014. http://www.teses.usp.br/teses/disponiveis/6/6135/tde-04092014-103542/.
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O Conselho Municipal de Saúde é uma instância colegiada de participação social no campo das políticas públicas em saúde. De caráter representativo e deliberativo o conselho é formado por usuários, trabalhadores e gestores do setor de saúde na esfera municipal. Esta pesquisa teve como objetivo conhecer os aspectos históricos e sociais relacionados à participação social dos trabalhadores no Conselho Municipal de Saúde de Guarulhos. Como objetivos específicos, pretendeu descrever o processo de formação do Conselho Municipal de Saúde de Guarulhos relacionando-o com a atual organização e dinâmica de funcionamento do conselho e descrever e analisar a participação do segmento dos trabalhadores de saúde no Conselho Municipal de Saúde de Guarulhos. A abordagem foi qualitativa e a coleta de dados foi feita por meio de análise documental, da observação participante e de entrevistas semiestruturadas, Como resultado, verificou-se que os dispositivos legais para a institucionalização dos conselhos de saúde foram utilizados pelos movimentos sociais do município de Guarulhos, o que garantiu através de procedimentos jurídicos o reconhecimento da legitimidade da sua participação. Também se verificou que há uma diluição do papel da representação do segmento do trabalhador, há um predomínio da visão liberal de participação entre os conselheiros, o que impõe obstáculos à efetiva participação da sociedade civil nas decisões relativas às políticas de saúde locais.The Municipal Health Council is a collegiate body of social participation in public health policies. The board is deliberative and composed by users, workers and managers of the health sector at the municipal level representatives. This research aimed to understand the historical and social aspects related to social participation of workers in the Municipal Health Council of Guarulhos. Additionally, intend to describe the process by which this Council was formed relating to the current organization and dynamics of functioning and analyzing the participation of the health workers. Methodology involves qualitative research and document analysis, participant observation and semi-structured interviews. Results show that the social movement of Guarulhos used legal mechanisms to legitimacy health participation; that the worker participation is diluted; there is a predominance of the liberal vision among participants. It may impose barriers to the effective participation of civil society in local health policies.
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Coombs, Ngaire Anne. "Health inequalities in New Zealand : an examination of mortality and hospital utilisation trends, with reference to the compression of morbidity hypothesis." Thesis, University of Southampton, 2011. https://eprints.soton.ac.uk/192871/.
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This thesis examines health inequalities by area-level socioeconomic deprivation, and health in later life in New Zealand. It identifies whether expansion or compression of morbidity is occurring at the end of life. It asks if overall morbidity at a population level is likely to increase or decrease in future as life expectancy increases, and if the same trend is seen for more and less deprived areas. The focus of this research is the identification and dissemination of mortality and morbidity patterns present in two large datasets, using powerful but relatively simple techniques. Large administrative datasets on morbidity and public hospital discharges in New Zealand between 1974 and 2006 are used in the analyses. The thesis consists of three papers. Each paper uses the same datasets, but addresses separate research questions using different methods. The first paper is an exploratory analysis of age-specific and age-standardised mortality and hospital bed day rates, which are used as a proxy for morbidity. The second paper explores lifetime morbidity by using period-prevalence life table functions including Hospital Utilisation Expectancies: a variation of health expectancies. The third paper uses individual record linkage between the mortality and hospital datasets to examine hospital use in the last few months of life. Hospital bed day and mortality rates declined over the time period, and convergence was seen between more and less deprived areas. Individuals at the oldest ages (80 years and over) saw little variation in hospital or mortality rates by area deprivation. Strong evidence for compression of morbidity was observed, particularly at older ages. This was in the absence of evidence for rectangularisation of the survival curve, considered by some to be a prerequisite for compression of morbidity. Rectangularisation of the survival curve would be denoted by life expectancy increases slowing, indicating the nearing of a limit to life expectancy. Instead, compression of morbidity was achieved through a decline in the severity of morbidity in the months prior to death. No evidence of a change in the point at onset of morbidity prior to death was observed. There was however some evidence that the decline in hospital utilisation prior to death (particularly for deaths at older ages) may be partly artefactual. Further research using a different measure of morbidity is required to either support or disprove this theory.
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Molinier, Muriel. "La voie de l'inclusion par la médiation au musée des beaux-arts : des publics fragilisés au public universel." Thesis, Montpellier 3, 2019. http://www.theses.fr/2019MON30039.
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Nous étudions le musée comme lieu privilégié d'inclusion pour les publics fragilisés par des problématiques médicales, sociales ou médico-sociales. Notre approche infocommunicationnelle s'établit dans la relation entre musée, public et tiers médiateur, dans la médiation. Premièrement le musée, par son enracinement social et sa volonté de démocratisation assoit sa pertinence dans la question de l'inclusion muséale et sociale. Deuxièmement les publics fragilisés, sont présentés à travers les représentations qui les entourent, les termes qui les qualifient, la place de leurs accompagnateurs au musée et celle de la culture dans le travail social et la santé. Troisièmement la médiation, à travers dispositifs et médiateurs, ainsi qu'en mobilisant des relations musée-santé, définit des approches médiationnelles à destination des publics fragilisés, entre intégration, inclusion et implication. Notre méthode de recherche compréhensive nous a permis d'extraire trois publics cibles (personnes : atteintes de la maladie d'Alzheimer, en apprentissage du français, déficientes visuelles) dans l'objectif de globaliser les approches. Six musées cibles (musée des Augustins, musée du Louvre-Lens, musée du Louvre, musée Fabre, Musée des Beaux-Arts de Montréal, Museum of Modern Art) ont permis de produire corpus et entretiens. Nos réflexions pour accéder à la voie de l'inclusion sont de penser : d'une part, une transversalité de la fragilité amenant à augmenter l'universalité d'une médiation en conception universelle et à considérer un seul public universel ; d'autre part, la fusion du partenariat médiateur / éducateur spécialisé à travers un nouvel acteur hybride musée-santé : le remédiateurWe study museums as a privileged place of inclusion for the audiences weakened by medical, social or medico-social issues. Our infocommunicational approach is based in the relationship between museum, audience and third party mediator, in museum education (mediation). Firstly, the museum's social roots and its desire for democratization make it relevant to the issue of museum and social inclusion. Secondly, vulnerable audiences are presented through the representations that surround them, the terms that describe them, the status of their accompanying persons in the museum, and that of culture in social work and health. Thirdly, museum education (mediation), through devices and museum educators (mediators), as well as by mobilizing museum-health relations, defines mediational approaches aimed at vulnerable audiences, between integration, inclusion and involvement. Our comprehensive research method allowed us to extract three target audiences (people : with Alzheimer's disease, learning French, visually impaired) in order to globalize the approaches. Six target museums (musée des Augustins in Toulouse, musée du Louvre-Lens in Lens, musée du Louvre in Paris, musée Fabre in Montpellier, Montreal museum of fine arts in Montréal, Museum of Modern Art in New-York) have allowed us to produce corpuses and interviews. Our thoughts for entering the path of inclusion are to think : on the one hand, a transversality of fragility leading to increase the universality of a mediation in universal design and to consider a single universal audience; on the other hand, the merger of the mediator / special educator partnership through a new hybrid museum-health operator : the remediator
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Mpofu, Nkosinothando. "Hiv/Aids communication and youth behaviour in South Africa: a study of female high school students in the Eastern Cape Province." Thesis, University of Fort Hare, 2012. http://hdl.handle.net/10353/d1015374.
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Human Immuno-Deficiency Virus and Acquired Immune-Deficiency Syndrome communication remains one of the most significant tools in the fight against HIV/AIDS given the absence of the cure to fight the growth and spread of the global pandemic. Through the use of information, HIV/AIDS communication seeks to empower recipients or societies with skills that will help reduce their risk of infection. South Africa has seen a high visibility of HIV/AIDS communication programmes or campaigns aimed at empowering different audiences, whilst paying particular emphasis on the most vulnerable. Young people, in particular young women, have a higher prevalence of HIV/AIDS in South Africa. This has prompted the development of many youth focused communication campaigns which have sought to address factors that increase young people`s vulnerability to HIV infection. However, despite the high visibility of HIV/AIDS communication campaigns targeting young people, high risk behaviours are still being seen among young women. Important to note are the high teenage pregnancy rates, growing abuse of substances and even the premature engagement of sexual activities among female youths. This, therefore, raises questions on the effect of HIV/AIDS communication programmes in encouraging protective behaviour against risky behavioural practices amongst young women. Using both quantitative and qualitative research approaches to this study, an investigation was conducted into whether current HIV/AIDS communication campaigns have been limited (in terms of effectiveness) when it comes to communicating with young women on issues relating to HIV/AIDS. Awareness of HIV/AIDS and HIV/AIDS communication programmes, relevance of HIV/AIDS communication programmes, the factors that influence the use and understanding of HIV/AIDS messages and the impact of HIV/AIDS communication on attitude and behaviour change amongst female youths is measured. A total of 350 questionnaire copies were self-administered to 350 participants, with a 100 percent response rate. From the 350 participants, seventy five took part in focus group discussions. Data obtained was analysed using SPSS (for descriptive statistics), and the grounded theory. The results of the study indicate that all participants were aware of HIV/AIDS with at least 60% of the participants aware of at least three HIV/AIDS communication campaigns. When measuring the relevance of HIV/AIDS communication campaigns, participants (58%) indicate that issues discussed in most HIV/AIDS communication campaigns increased the relevance of HIV/AIDS messages to young women although such relevance was, for some respondents, affected by limited access to communication campaigns. Results also show that levels of knowledge and understanding of factors that expose young women to HIV infections differed amongst participants in as much as the factors that hinder the use of advice contained in HIV/AIDS messages also differed. Sixty-nine percent of the participants have knowledge and a better understanding of factors that expose young females to HIV infections. Twenty-five percent of the participants identified peer pressure, whilst 23% identified limited access to HIV/AIDS communication campaigns and another 18% identified a disregard of HIV/AIDS messages as significant factors that limit the ability of individuals to implement advice contained in HIV/AIDS messages. The results also indicate that although HIV/AIDS communication campaigns seem to have played a role in empowering some participants, there is still a significant minority whom communication has not effectively communicated with. Based on these findings, the study suggests, amongst other things, the need to intensify current HIV/AIDS communication campaigns through the provision of consistent messages on appropriate condom use, the identification of easily accessible communication channels and the development of thought provoking and attention grabbing campaigns as well as the need to continue to directly involve young women in the processes of their own development.
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Orsini, Cesar A. "The self-determination theory of motivation in dental education : testing a model of social factors, psychological mediators, academic motivation and outcomes." Thesis, University of Glasgow, 2017. http://theses.gla.ac.uk/8022/.
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Background: Motivation plays a vital role in dental students' learning experience and wellbeing. Self-determination theory differentiates between autonomous and controlled motivation and amotivation, where autonomous motivation corresponds to the most selfdetermined form of regulation. Previous research has found that several social educational factors, mediated by students' satisfaction of their basic psychological needs of feeling autonomous, competent and related to important others, predicts autonomous motivation. In turn, autonomous motivation leads to more positive educational outcomes compared to controlled motivation or amotivation. So far, however, few studies have investigated the process of motivation in health professions education from the perspective of the Selfdetermination Theory. A systematic review was conducted within this thesis, identifying determinants, such as an autonomy supportive learning climate and feedback, that predicted students' autonomous motivation. No studies were found that tested mediation effects between determinants and motivation. In turn, students' self-determined motivation was found to predict different affective, behavioural and cognitive outcomes. These studies, however, came mainly from medical education. Despite its relevance for students' development, very little is known about the process of motivation in dental students. This indicates a need to understand its various aspects, which may lead to evidence-based interventions to foster students optimal functioning. Purpose: To test a model of academic motivation in dental education by analysing the associations between autonomy-support and quantity and quality of feedback, as determinants, and self-determined motivation, mediated by students' basic psychological needs satisfaction. This, followed by testing the associations between self-determined motivation and the behavioural outcomes of deep and surface study strategies and academic performance, and the affective outcomes of vitality and self-esteem. Finally, we aimed to test whether the model worked different for female and male students, and by year of curriculum. Methods: We conducted a correlational cross-sectional survey study at the dental school of the University San Sebastian in Chile. All dental students from year 1 to 6 were invited to participate and to answer a questionnaire package containing demographic data and previously validated self-reported instruments. Data on academic performance were obtained from the administrative department. Data analysis involved five phases. First, internal consistency of all measures was assessed by means of Cronbach alpha. Second, descriptive and group comparisons were computed by means of independent t-test to assess gender differences and MANOVA to assess year-of-curriculum differences. Third, bivariate correlations were assessed amongst all measures. Fourth, mediation was tested through a series of regression analyses. Finally, the entire model was assessed by means of structured equation modelling, for the overall student sample as well as for the subgroups of females and males and different years of study. Data were analysed with the PASW and AMOS software. Results: A total of 924 students (90.2% response rate) agreed to participate and completed the questionnaires. Cronbach's alpha values of all instruments ranged from .641 to .912. Students' autonomous motivation for attending university was higher than controlled motivation and amotivation, showing an overall self-determined profile. Females endorsed higher than men both autonomous and controlled motivation, while men endorsed amotivation higher. The overall motivation profile, however, did not show significant gender differences. Across the six years, students showed an overall self-determined profile, in which autonomous motivation decreased when transitioning to clinical years, to rise again in the final year. The contrary was found for students' amotivation scores, while controlled motivation declined as they entered clinical-based years. Bivariate correlations showed that both determinants were positively correlated with students' basic psychological needs satisfaction and with autonomous motivation. In turn, the latter was positively associated with behavioural and affective outcomes. All these associations showed a decreasingly positive correlation from autonomous motivation to amotivation. Mediation regression analyses showed both determinants predicting dental students' autonomous motivation, however, this influence was not direct, it was mediated by students' perceptions of the satisfaction of their basic psychological needs. Finally, structured equation modelling indicated that the data fitted the model well, and showed both determinants positively predicting students' satisfaction of their basic psychological needs, which positively influenced autonomous motivation over controlled motivation. In turn, the gradual shift from controlled to autonomous motivation positively predicted affective and behavioural outcomes. Moreover, the associations followed a similar pattern, with minor deviations, when tested by gender and by year of study. Discussion and conclusion: In the context of this research, dental students' autonomous motivation was indirectly predicted by the social educational factors of teachers' autonomysupport and quantity and quality of feedback, being mediated by students' satisfaction of their basic psychological needs. Students' acting out of autonomous motivation showed enhanced deep study strategies and better academic performance, experienced higher vitality and self-esteem, and showed lower surface study strategies. This suggests that autonomous motivation leads to important outcomes, decreasing from controlled motivation to amotivation. Whilst students in different years of study showed an autonomous motivation profile, there were important differences that showed that students' transition from basic/preclinical to clinical years influenced their motivation and should therefore be taken into account when planning interventions to enhance students' motivation. Results are discussed in light of self-determination theory and considering its implications on curriculum development, teaching and learning, clinical training, assessment, faculty development, peer-assisted-learning and dentist-patient relationship. Significance: This is the first study, in health professions education, to test a Selfdetermination theory-based model including determinants, mediators, motivation and outcomes. This research also expands to dental education the study of motivation based on an empirically verified psychological theory. The results provide strong support for the Selfdetermination theory of motivation in dental education and provide acceptable evidence that the quality of motivation and satisfying students' psychological needs are important in determining positive educational outcomes amongst dental students. Therefore, many successes and failures in a number of elements of dental and health professions education may be understood through the lens of this theory. As such, efforts should be made in various aspects of dental education to support learners' sense of autonomy, competence and relatedness, which may have an extensive influence on dental education and on students' wellbeing. Future research should confirm or refute our results in other dental education settings.
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Dare, Julie. "The role of information and communication technologies in managing transition and sustaining women's health during their midlife years." Thesis, Edith Cowan University, Research Online, Perth, Western Australia, 2009. https://ro.ecu.edu.au/theses/1977.
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This research has been motivated primarily by a desire to extend and enrich existing research on women’s uses of information and communication technologies (ICTs) to manage relationships, and access and construct social support during their transitional midlife years. In doing so, this research addresses a gap in the literature on women’s consumption of such technologies. Since the late 1980s, when several landmark studies investigated women’s use of the telephone, there has been little systematic evaluation of the degree to which newer communication technologies have become integrated into women’s communication practices.
Another key feature of this research is an examination of how ‘midlife’, as a stage of life characterised by several common transitions, is experienced by a group of women. These life experiences are modified by the availability of social support and, significantly for this research, by the communication conduits through which this support circulates. Given that midlife involves physical and emotional changes that may impact on a woman’s sense of self, this period of transition can be a source of stress. Numerous studies have identified the critical role social support plays in helping individuals cope with stress. For women, social support is commonly manifested through female networks, maintained through faceto- face encounters, and increasingly through mediated communication channels. In a region as geographically isolated as Western Australia, where over 27% of the population were born overseas, the importance of communication technologies in facilitating access to dispersed social support networks is arguably even more critical.
The research procedure, drawing on a qualitative, interpretive methodological approach, involved 40 in-depth, one-on-one ethnographic interviews with women aged between 45 and 55. Initial findings indicated that while women are actively appropriating a range of online communication channels, there was a risk in limiting the research focus to women’s use of the Internet, in isolation from their broader communication practices. In particular, this research makes clear that one significant aspect of women’s uses of ICTs lies in how different communication channels meet the needs of women and their families at particular moments in their lives. At the midway mark in the lifecycle, many of the women interviewed are either consciously, or in some cases intuitively, employing particular communication channels to manage difficult or sensitive relationships; their choices often constrained by the communication needs and/or preferences of their aging parents and/or their own children.
Despite such constraints, this research provides strong evidence to suggest that midlife women are as adept at strategically appropriating multiple communication technologies to satisfy their own needs, as are many younger people. This is manifested in a variety of ways, from women’s use of email as a safe conduit through which to maintain tenuous links with difficult siblings; to their strategic employment of email, instant messaging and webcam to foster a richer sense of connection with young adult children living thousands of kilometres away; through to their appropriation of a mix of ‘old’ and new channels such as face-to-face communication, the landline telephone, text messaging and email, as tools to help them manage their hectic lifestyles and sustain relationships with family and friends. Women’s active appropriation of multiple communication channels is therefore critical to the ongoing maintenance of relationships and, by extension, the health and emotional wellbeing not only of the women themselves, but also their loved ones and friends
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Chatterley, Marion Frances. "Reflecting theologically on the impact of HIV in Edinburgh, with particular reference to infected people, health and social care professionals, Scottish churches and local agency, Waverley Care." Thesis, University of Glasgow, 2017. http://theses.gla.ac.uk/7875/.
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This thesis discusses the impact of HIV in Edinburgh on infected individuals, professionals and the Scottish churches. It is grounded in contextual practical theology, offering reflexive responses to evidence gleaned from oral histories. The thesis documents the development of a local agency, Waverley Care, exploring the influences and pressures that contributed to its distinctive ethos. The author was employed as chaplain to people living with HIV from 2000 – 2016; the pastoral and professional relationships that emerged from that ministry form the foundation for the research. Unstructured interviews were conducted and Interpretative Phenomenological Analysis was used to analyse, interpret and reflect on the resultant material. Personal stories and perspectives were shared, both by people living with HIV and by professionals in the field. The impact of living with HIV is shown by discussing issues such as the ongoing impact of HIV-related stigma and the challenges associated with living long-term with the condition. Attention is paid to the challenges arising as a result of multiple bereavements and the resultant spiritual questions that emerge. The impact on physicians is also evidenced, in particular the transition from treating patients before the advent of effective medication, to the situation in 2016 when HIV has been re-classified as a chronic illness. Recommendations on areas of ongoing concern are made for decision makers in public health, the churches and Waverley Care. Deep reflective analysis is offered, using the Stations of the Cross and models from bereavement work to provide frameworks for understanding. The contribution of the Scottish churches to the establishment of support services is recognised; the churches’ influence, both positive and negative on discourse on human sexuality is discussed. The research evidences the impact of the provision of spiritual care within a secular agency, showing that it is possible to create sacred space and to deliver a sacramental ministry within a non-church setting.
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Lea, Emma J. "Moving from meat : vegetarianism, beliefs and information sources." Connect to this title online, 2001. http://web4.library.adelaide.edu.au/theses/09PH/09phl4335.pdf.
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Includes bibliographical references (leaves 327-346). A random population survey and a survey of vegetarians were conducted to examine South Australians' beliefs about meat and vegetarianism. Meat beliefs, barriers and benefits of vegetarianism, meat consumption, personal values, use of and trust in sources of food/nutrition/health information and demographic variables were measured.
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Pettersson, Mona. "Microchip implants and you : A study of the public perceptions of microchip implants." Thesis, Umeå universitet, Institutionen för informatik, 2017. http://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-133890.
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As technology advances with time, new devices are invented and old ones used in innovative ways. Microchips have been increasingly minimized to the point where they can now fit on a fingernail. When encased in a bio-friendly coating and equipped with the appropriate in- or output technology, new modes of natural digital interaction can be explored. This thesis studies how the general public perceives microchip implants as a digital interaction tool, as well as which features of microchip implants are important to them. Three different scenarios of implanted microchip use were created and used in eight semi-structured interviews. The results showed skepticism towards the technology due to worries about security and privacy, and a lack of knowledge of this technology. Benefits included keeping better track of health and making everyday actions easier, as well as excitement about this new technology.
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Blaber, Zlatinka N. "Hybrid professional identities and 'calculative practices' : the case of GPs in the English National Health Service acute care commissioning." Thesis, University of Essex, 2015. http://repository.essex.ac.uk/16269/.
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The objective of this research is to contribute to knowledge and understanding by exploring: first, the professional identities of English General Practitioners (GPs) and other clinicians in the newly-formed Clinical Commissioning Groups (CCGs) and second, their level of involvement in CCG ‘calculative practices’ (Miller, 1990, 2001). The institutional field studied is acute care, i.e. hospital, commissioning in contemporary England. To achieve its objective, this thesis asks four research questions: 1) ‘How appropriate is it for clinicians to be involved in CCG acute care commissioning?’ 2) What motivates clinicians to assume leadership roles in CCGs?’ 3) How involved are clinicians in CCG calculative practices?’ and 4) To what extent do hybridity and calculative practices affect clinicians’ professional identities in CCGs?’ The theoretical framework used is based on the concept of ‘calculative practices’ and elements of the Institutional Logics Theory (ILT). This research employs three research methods – documents’ content analysis, semi-structured, in-person interviews, and non-participant observation of CCG meetings with the public and NHS conferences. The interview subjects are NHS managers and accountants, as well as clinicians. This thesis answers the four research questions and then proposes some additional, incidental to this research findings and contributions to policy/legislation and practice. In conclusion, this study deliberates on the viability of the purchaser-provider split of the early 1990s that established the foundations and raison d’être of CCG commissioning and dwells on the possibility that one day the general taxation-funded and free at the point of service National Health Service (NHS) in England may cede its way to a US-inspired model of full blown privatisation.
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Nyatsanza, Tarsisio Majinya. "Developing a transformative approach to HIV/AIDS education : an analysis of Scotland and Zimbabwe." Thesis, University of Glasgow, 2015. http://theses.gla.ac.uk/6438/.
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Global statistics indicate that currently 35 million people are living with HIV of which 4, 634 are living in Scotland (out of a total population of 5 295 00) and the figure for Zimbabwe is estimated at 1, 400 000 (out of a total population of 14 149648). In this thesis, I have suggested a framework that goes beyond a limited analysis of the complexity of understanding the HIV/AIDS origins, its evolution and prevalence beyond the epidemiological mapping. The approach allows for the development of a more rational, inclusive, broader and sustainable HIV/AIDS Education (Wood 2014, Wood and Rolleri 2014). This approach is not only emancipatory but also empowers (Freire 2000, Freire 2004) both those affected and infected by the HIV/AIDS epidemic. I have chosen both Scotland and Zimbabwe as each of them has dealt with the epidemic in different ways. Scotland has had significant success in combating HIV/AIDS through various initiatives. Zimbabwe on the other hand, is an example of a developing country in sub-Saharan Africa with one of the highest levels of HIV/AIDS infected and affected people in the world (UNAIDS Country Report 2014). I used ‘selected’ documentary analysis that is, looking at selected documents that contain the major policy responses to the HIV/AIDS epidemic. I also conducted interviews with key informants using semi-structured interview questions and then analysed the resultant data using a range of heuristic tools. The main findings of this research included how a number of conspiracy theories were constructed in order to explain the origins and the evolution of HIV/AIDS. Examples of these conspiracy theories included the homosexual link to HIV/AIDS,witchcraft and biological warfare among others. Other issues discussed focused on conspiracy as the construction of otherness, moralising the epidemic, assessing the impact of culture, religion and politics on the epidemic as well as the implications of these issues on Sex Education. The thesis concluded with suggesting a framework for developing a transformative approach to HIV/AIDS and Sex Education.
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Romero, Mariel Sintora. "A Critical Medical Anthropology Approach to Advocating for Social Justice and Policy Change in Pesticide Use and Practice to Reduce Health Risks Among Hispanic/Latinos in Central California." Thesis, University of North Texas, 2015. https://digital.library.unt.edu/ark:/67531/metadc804957/.
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This mixed methods research was conducted in the fall of 2014 to understand the perceptions and experiences of health risks and health outcomes due to pesticide exposure among community members (n=13) - concerned community members, agriculture workers and teachers- that live in the Central California agriculture counties of Monterey, Santa Cruz, Tulare, Fresno and Madera. This research explored: 1) The crops growing in participants’ communities, and how exposure to pesticides used in these crops pose potential health risks to participants and their communities 2) How pesticide exposure is impacting Hispanic/Latino communities in Central California, particularly those that are most vulnerable including school children, agriculture workers, and community members 3) The major public health concerns of impacted communities 4) Feelings of empowered to advocate for community health and environment and 5) What impacted communities wish to see on behalf of government and agribusiness to protect public health from pesticide exposure and toxins.
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Papole, Magdeline Kgomotso. "Exploring the factors influencing non-participation of women living with HIV/AIDS in empowerment projects attached to primary health care clinics, Tembisa, South Africa." Thesis, Stellenbosch : University of Stellenbosch, 2010. http://hdl.handle.net/10019.1/4322.
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Thesis (MPhil (Public Management and Planning))--University of Stellenbosch, 2010.ENGLISH ABSTRACT: The research was conducted to explore the experiences of people living with Acquired Immunodeficiency Syndrome (AIDS) (PLWAs), especially women, as well as the factors influencing their non-participation in development projects aimed at improving their socio-economic status. The study was conducted amongst PLWAs who are members of the Tembisa Main Clinic and Winnie Mandela Clinic support groups in Tembisa, South Africa. The researcher was motivated to conduct the research because in her work as a social worker she is confronted daily with PWLAs who are from disadvantaged backgrounds and are struggling to make ends meet. Initiatives have been undertaken to try and encourage self–reliance and improve the health status of these women by developing food gardens to provide them with fresh vegetables and possible income sources from these gardens. The reluctance of members of two support groups of PLWAs to stay involved in these projects encouraged the researcher to explore these issues. The researcher consulted various sources to obtain literature on the factors influencing non-participation in development projects. In addition she undertook a qualitative study, wherein twenty participants participated. The data from this study was then interpreted and compared to the literature. The findings of this study highlighted several factors such as discrimination, local beliefs, stigma and lack of support, which influence the non- participation of PWLAs in sustainable development projects. The findings of this research also indicate that developments projects often fail to thrive because of topdown decisions about the projects, the fact that there is no start-up funding available for the projects and participants who become demotivated to participate. The research therefore concludes with recommendations in order to address these problems.
AFRIKAANSE OPSOMMING: Die navorsing is onderneem om die ondervinding van mense, veral vroue, wat met Verworwe Immuniteitsgebrek Sindroom (VIGS) lewe, te ondersoek, asook die faktore wat hulle daarvan weerhou om deel te neem aan ontwikkelingsprojekte wat daarop gemik is om hul sosio-ekonomiese status te verbeter. Die studie is onderneem onder pasiënte wat lede was van ondersteuningsgroepe by Tembisa Hoofkliniek en Winnie Mandela Kliniek in Tembisa, Suid-Afrika. Die navorser is gemotiveerd om die studie te onderneem omdat sy daagliks in haar werk as sosiale werker gekonfronteer is deur mense wat met VIGS lewe, wat uit minder bevoorregte agtergronde kom en wat sukkel om te oorleef. Inisiatiewe is onderneem om hierdie vroue se selfstandigheid te bevorder en om hul gesondheidstatus te verbeter deur groente tuine te ontwikkel om hulle van vars groente te verskaf, asook moontlike inkomstebronne uit hierdie tuine. Die onwilligheid van die lede van twee ondersteuningsgroepe om in hierdie projekte betrokke te bly, het die navorser aangemoedig om hierdie aangeleentheid verder te ondersoek. Die navorser het verskeie bronne geraadpleeg om literatuur te verkry oor die faktore wat die nie-deelname in ontwikkelingsprojekte beïnvloed. Sy het ook kwalitatiewe studie onderneem waaraan twintig respondente deelgeneem het. Die data van hierdie navorsing is daarna geïnterpreteer en met die literatuur vergelyk. Die bevindinge van hierdie navorsing het verskeie faktore uitgelig wat die niedeelname beïnvloed van mense wat met VIGS lewe, soos diskriminasie, plaaslike gelowe, stigma en gebrek aan ondersteuning. Die navorsing het ook bevind dat ontwikkelingsprojekte dikwels nie floreer nie as gevolg van die ‘topdown’ besluitneming oor die projekte en omdat daar nie genoegsame vooraf befondsing beskikbaar is vir die projekte nie en die deelnemers dus demotiveer om verder deel te neem. Die navorsing sluit dus af met voorstelle om hierdie probleme aan te spreek.
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Khan, Shaghaghi Legrand Richard. "La régulation de l'accès aux médicaments (aspects de droit comparé)." Thesis, Sorbonne Paris Cité, 2018. http://www.theses.fr/2018USPCB099.
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Alors que les pays européens font face à des dépenses croissantes en matière de médicaments, la prise en charge d'un nouveau produit de santé par les financeurs publics apparaît comme un enjeu primordial dans le contrôle de ces dépenses. La plupart des pays, comme la France, utilisent alors des listes explicites définissant les produits pris en charge ou non pris en charge par le biais de financements publics. L'idée sous-jacente d'un tel procédé est de concentrer la prise en charge publique sur des produits dits « utiles », c'est-à-dire qui non seulement participent au traitement de pathologies jugées importantes, mais qui se montrent également efficaces et, le cas échéant, les moins onéreux. Si cette idée est simple, l'élaboration en pratique de telles listes reste complexe. La définition des critères adoptés pour déterminer les contours d'un panier de médicaments remboursables ainsi que les méthodes utilisées pour évaluer si un produit répond à ces critères, représentent des enjeux importants pour les décideurs publics et peuvent avoir des répercussions directes sur la qualité et les coûts des prescriptions médicamenteuses. Dans l'absolu, la décision de prendre en charge un médicament peut s'appuyer sur de nombreux critères : efficacité, rapport coût-efficacité, gravité de la pathologie, symptômes traités, impact sur les budgets consacrés à la santé, etc. De plus, les évaluations présentent toute une série de difficultés méthodologiques et techniques auxquelles viennent s'additionner le contexte politique et le pouvoir de négociation des laboratoires pharmaceutiques, qui influencent également les décisions de prise en charge. La présente étude s'organise autour de la présentation de la notion de médicament, des modalités de prise en charge de ces derniers et de la procédure de leur mise sur le marché sous un angle comparé entre le droit français et divers autres systèmes juridiques relevant du cadre communautaire. Une telle analyse soulève certaines interrogations dont la mise en cause du système actuel de régulation des médicaments. À travers ce travail de recherches, il est permis de constater plusieurs défaillances non seulement dans le mécanisme de régulation des dépenses, mais aussi dans le système de prise en charge lui-même. Si la question d'un réajustement de la politique de régulation des médicaments est alors au cœur du débat, des perspectives d'évolution se dessinent néanmoinsWhile the European countries face increasing spending regarding medicine, the coverage of a new product of health by the public financiers appears as an essential stake in the control of these spending. Most of the countries, as France, use then explicit lists defining products taken care or not taken care by means of public financing. The underlying idea of such a process is to concentrate the public coverage on "useful" said products, that is which not only participate in the treatment of pathologies considered important, but which show themselves also effective and, where necessary, the least expensive. If this idea is simple, the elaboration in practice of such lists remains complex. The definition of the criteria adopted to determine the outlines of a basket of refundable medicine as well as the methods used to estimate if a product answers these criteria, represent stakes important for the public decision-makers and can have direct repercussions on the quality and the costs of the medicinal prescriptions. Theoretically, the decision to take care of a medicine can lean on numerous criteria: efficiency, cost efficiency ratio, revolved by the pathology, the handled symptoms, the impact on the budgets dedicated to the health, etc. Furthermore, the evaluations present a whole series of methodological and technical difficulties to which come to add up the political context and the bargaining power of pharmaceutical companies, which also influence the decisions of care. The present study gets organized around the display of the notion of medicine, modalities of care of the latter and the procedure of their launch on the market under a compared angle enter the French and diverse law other legal systems being a matter of the community frame. Such an analysis lifts certain questioning of which the questioning of the current system of regulation of medicine. Through this research work, it is allowed to notice several failures not only in the mechanism of regulation of the spending, but also in the system of care itself. If the question of an adjustment of the policy of regulation of medicine is then at the heart of the debate, perspectives of evolution take shape nevertheless
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Haenssgen, Marco Johannes. "Mobile phone diffusion and rural heathcare access in India and China." Thesis, University of Oxford, 2015. https://ora.ox.ac.uk/objects/uuid:3f48fc8b-5414-4851-926b-07a57eed6cfe.
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Three decades of mobile phone diffusion, thousands of mobile-phone-based health projects worldwide ("mHealth"), and tens of thousands of health applications in Apple's iTunes store, but fundamental questions about the effect of phone diffusion on people's healthcare behaviour remain unanswered. Empirical, theoretical, and methodological gaps in the study of mobile phones and health reinforce each other and lead to simplifying assumptions that mobile phones are a ubiquitous and neutral platform for interventions to improve health and healthcare. This contradicts what we know from the technology adoption literature. This thesis explores the theoretical link between mobile phone diffusion and healthcare access; develops and tests a new multidimensional indicator of mobile phone adoption; and analyses the effects of phone use on people's healthcare-seeking behaviour. My mixed methods research design - implemented in rural Rajasthan (India) and Gansu (China) - involves qualitative research with 231 participants and primary survey data from 800 persons. My research yields a qualitatively grounded framework that describes the accessibility and suitability of mobile phones in healthcare-seeking processes, the heterogeneous outcomes of phone use and non-use on healthcare access, and the uneven equity consequences in this process. Quantitative analysis based on the framework finds that mobile phone use in rural India and China increases access to healthcare, but it also invites more complex and delayed health behaviours and the over-use of scarce healthcare resources. Moreover, increasing phone-aided health action threatens to marginalise socio-economically disadvantaged groups further. I present here the first quantitative evidence on how mobile phone adoption influences healthcare-seeking behaviour. This challenges the common view that mHealth interventions operate on a neutral platform and draws attention to potential targeting, user acceptance, and sustainability problems. The framework and tools developed in this thesis can support policy considerations for health systems to evaluate and address the healthcare implications of mobile phone diffusion.
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Lemar, Susan. "Control, compulsion and controversy: venereal diseases in Adelaide and Edinburgh 1910-1947." Title page, contents and abstract only, 2001. http://web4.library.adelaide.edu.au/theses/09PH/09phl548.pdf.
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Includes bibliographical references (leaves 280-305). Argues that despite the liberal use of social control theory in the literature on the social history of venereal diseases, rationale discourses do not necessarily lead to government intervention. Comparative analysis reveals that culturally similar locations can experience similar impulses and constraints to the development of social policy under differing constitutional arrangements.
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Uridge, Lynsey. "The identity of the heart patient in the context of the gift economy: HeartNET and media framing." Thesis, Edith Cowan University, Research Online, Perth, Western Australia, 2014. https://ro.ecu.edu.au/theses/1578.
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This health communication research examines the identity levels of the heart patient on a therapeutic website HeartNET through an empirical investigation of site interactions as manifestations of a gift economy. The thesis also explores the media’s representation of heart health in both television and print.
This research utilised a longitudinal qualitative ethnographic and netnographic approach involving twenty-six participants who completed two in-depth interviews. The first one-on-one interview occurred during the early stages of the participants’ heart journey, explored their heart story and use of interactive technology for heart health support. The second interview occurred six to twelve months later, and investigated changes in the participants’ heart health status and their media awareness. Data obtained through onsite postings, in-depth interviews, and asynchronous and synchronous interactions on HeartNET, resulted in an analysis of the rich insights into the lived experiences of people affected by heart disease.
The heart patient has to cope with an unknown and disrupted future which may be complicated by a lack of understanding by their significant other and extended network. Interactions on HeartNET indicated a change in participants’ attitudes toward their heart disease. The gift of time, information and support were commodities that were shared freely. Over time however, a change in focus was evident. As members became more independent their posts would shift to a focus on independence and healing (or wellbeing) rather than focusing on the disease.
Another key finding among the non-HeartNET members was the importance of volunteering and how it became an integral aspect of many recovering heart patients’ lives. As peer supporters this volunteering role appears to support the extension of social networks and complements professional health services.
Findings from this research have shown that the media often portrays heart disease as a lifestyle issue and the participants of this research felt the media considered they were ‘to blame’, even though the majority of them had a healthy, well-balanced lifestyle prior to their heart event. An analysis of newspaper articles indicates that the use of the Heart Foundation brand name, or a passing mention of heart disease, was often used to raise the salience of the newspaper article, particularly in terms of its title.
This research provides valuable insights into the heart patient’s journey as each individual recreates and re-identifies as a heart patient. Most importantly, this research allows participants’ voices to be heard.
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Horn, Lynette (Lynette Margaret). "Theories of justice and an HIV/AIDS health care policy for South Africa : a comparative analysis." Thesis, Stellenbosch : Stellenbosch University, 2003. http://hdl.handle.net/10019.1/53662.
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Thesis (MPhil)--University of Stellenbosch, 2003.ENGLISH ABSTRACT: On The io" of May 1994 Nelson Mandela was inaugurated as the first democratically elected black president of South Africa. The occasion was regarded, both nationally and internationally, as a triumph for humanity and perfused with a widespread optimism for the future of South Africa. Mandela proclaimed in his inaugural speech that "Never, never and never again shall it be that this beautiful land will experience oppression of one by another .... The sun shall never set on so glorious an achievement." However, now, less than 10 years later the rapidly accelerating and devastating HIV/AIDS epidemic is again 'obscuring the sun'. Those people affected so negatively by the racial, economic and gender injustices of the apartheid past, seem again to be suffering a possible injustice, because of a health and welfare system that is struggling to meet the needs of the HIV affected population. The purpose of this dissertation is to examine the concept of distributive justice in South Africa, within the context of this devastating epidemic. I begin by discussing the Bill of Rights in the South African Constitution. I argue that an acceptable framework for a theory of justice for health care in South Africa, must be worked out against the background of this egalitarian Bill of Rights. I then consider the extent of the HIV epidemic, the effect it is having on the people of South Africa and the consequent implications for health care needs. It is within this context that I examine and compare three theories of distributive justice, namely utilitarianism, John Rawls' theory of "Justice as Fairness" and a libertarian concept of justice, as proposed by Robert Nozick. Utilitarianism is a consequentialist theory that focuses on producing the 'greatest happiness for the greatest number'. I argue that many health policy decisions in South Africa are in fact guided by this principle. However utilitarianism has both strengths and weaknesses which are critically examined. Within the framework of health care policy making, utilitarian justice dictates that rights are derivative and that the welfare of the majority usually takes precedence over the pressing needs of a minority. This issue in particular is discussed. Rawls' theory of "Justice as fairness" is critically discussed next. This theory has been adapted to health care by Norman Daniels, who argues that the Rawlsian principle of "fair equality of opportunity" is a suitable founding principle for health care institutions. Apartheid entrenched a system of 'inequality of opportunity'. Consequently, a theory that focuses on equality of opportunity, has many advantages within the South African context. I examine this theory in detail and provide justification for my assertion that it could be usefully adapted to South African healthcare and the HIV/AIDS epidemic. Finally, I discuss a Libertarian (Nozickian) theory of justice and examine both the strengths and weaknesses of this theory. I attempt to demonstrate why a libertarian system, with it vigorous commitment to moral and economic individualism and belief that one is only entitled to that share of healthcare that can be paid for, would be unjust, if rigorously applied within the post-apartheid South African context. I conclude my dissertation by reiterating my assertion that "Justice as Fair Equality of Opportunity" could be used as a just foundation for a theory of justice for health care in current day, HIV/AIDS affected South Africa.
AFRIKAANSE OPSOMMING: Teorieë van geregtigheid en 'n gesondheidsbeleid vir die VIGS epidemie in Suid Afrika: 'n vergelykende ontleding. Op die 10de Mei 1994 is Nelson Mandela ingehuldig as die eerste demokraties verkose swart president van Suid- Afrika. Die geleentheid is in beide Suid-Afrika en in die buiteland beskou as 'n oorwinning vir humaniteit. Optimisme oor Suid-Afrika se toekoms was oral tasbaar. Mandela het in sy inhuldigingstoespraak verkondig dat dit nooit weer sal gebeur dat hierdie pragtige land sal lyonder die onderdrukking van een oor die ander nie. Hy het gesê dat die son nooit salondergaan op so 'n wonderlike prestasie nie. Nou, minder as tien jaar later, is die verwoestende VIGS epidemie besig om weer die 'son te laat ondergaan'. Dieselffde mense wat alreeds onder apartheid se rasisme en ekonomiese en geslagsongeregtighede gely het, blyk nou weer verontreg te word; hierde keer omdat die gesondheids- en welsynsisteem sukkel om in die behoeftes van die VIGS-geaffekteerde populasie te voorsien. Die doel van hierdie verhandeling is om die konsep van distributiewe geregtigheid in die konteks van die dreigende VIGS epidemie te bespreek. Ek begin met 'n bespreking van die Verklaring van Regte soos vervat in die Suid-Afrikaanse Grondwet. Ek voer aan dat enige aanvaarbare teorie oor geregtigheid in die Suid-Afrikaanse gesondheidsisteem gegrond moet word op hierdie egalitêre Verklaring van Regte. Tweedens kyk ek na die omvang van die VIGS epidemie, die effek wat dit op die HIV-positiewe populasie en hulle familielede het, en die gevolglike implikasies vir gesondheidsbehoeftes. Dit is binne hierdie konteks dat ek drie teorieë van distributiewe geregtigheid ondersoek en vergelyk; naamlik utilitarisme, John Rawls se teorie van "Justice as Fairness", en 'n libertynse konsep van geregtigheid soos voorgestel deur Robert Nozick. Utilitarisme is 'n konsekwensialistise teorie wat beteken dat die regte daad die een is wat in enige situasie die grootste geluk vir die meeste persone sal meebring. Ek voer aan dat baie van die beleidsrigtings wat 'n gesondheidsorg in Suid-Afrika gevolg is, deur hierdie teorie beïnvloed is. Utilitarisme het uiteraard sterk en swak punte en beide kante word krities ondersoek. In 'n gesondheidsorg konteks beteken utilitarisme dat regte altyd afgelei is en dat die welsyn van die meerderheid gewoonlik belangriker is as die van 'n minderheid, selfs wanneer die probleme van die minderheid ernstig en dringend is. Rawls se teorie van geregtigheid word vervolgens krities bespreek. Hierdie teorie is deur Norman Daniels aangepas vir gesondheidsorg. Hy stel voor dat Rawls se beginsel van 'regverdige gelykheid van geleentheid' baie effektief aangepas kan word vir gesondheidsorginstellings. Apartheid het 'n sisteem van ongelyke geleentheids verskans; gevolglik hou 'n teorie wat gelykheid van geleentheid verseker baie voordele vir die Suid- Afrikanse situasie in. Ek bespreek hierdie teorie in detail en poog om my standpunt dat die teorie besonder geskik is vir Suid-Afrikaanse gesondheidsisteem - veral in die konteks van die VIGS epidemie - te regverdig. Laastens bespreek ek die libertynse teorie van geregtigheid soos voorgestel deur Robert Nozick. Ek probeer aantoon waarom hierdie teorie, wat gebaseer is op morele en ekonomiese individualisme en gevolglik aanvoer dat mense geregtig is op gesondheidsorg alleenlik as hulle daarvoor kan betaal, onregverdig is in die Suid-Afrikaanse post-apartheid konteks. Ek sluit hierdie. verhandeling af deur weer te argumenteerdat Rawls se teorie en die beginsel van 'geregtigheid as gelyke geleentheide' uiters geskik is as 'n grondslag vir gesondheidsorg in Suid-Afrika vandag.