Дисертації з теми "Sports healthcare"

Objective The goal of this dissertation was to identify evidence regarding potential means to reduce healthcare spending on youth injury while protecting and promoting the health of our youth. The first analysis estimated and analyzed both the financial costs and time lost from sports injuries among inpatient and ED youth patients to aid in identifying key populations, raising awareness to policy makers, and emphasizing the need of prevention programs for sports injury. The second analysis analyzed the effect of volume and trauma center (TC) ownership type on trauma alert response charges, which are billed to injured patients for a trauma team activation. The objectives of the third analysis were to evaluate associations of mechanism of injury in youth who have been misclassified as trauma alerts, and to analyze the effect of misclassified youth on healthcare costs. Methods The first study was a retrospective analysis of sports injuries identified in Florida’s Agency for Healthcare Administration (AHCA) 2010-2014 all-inclusive inpatient and ED datasets. The study population included all hospital patients, aged 5 to 18 years, with a recorded injury from sport. Fixed effects linear and negative binomial regression were used. In the second analysis, every inpatient who visited a TC in Florida and was billed a trauma response charge from 2012 to 2014 was included for a total of 45,993 observations. Multiple linear regression, controlling for patient and hospital factors, was used to find associations between volume and trauma response charges and hospital ownership type and charges. Severity elasticity of trauma response charges was calculated by ownership type. AHCA's 2012-2014 inpatient and financial data were used in the third analysis. The study population included patients, aged 5 to 18 years with no surgery, an ICISS score ≥ .90, a hospital stay less than 24 hours, discharged to home, with recorded mechanism and defined injury. Misclassified patients were those designated as a trauma alert in the field. Logistic and multivariable linear regression were used. Results Over the five year period, sports injuries in Florida youth cost $24,555,547 for inpatient care and $87,083,482 for ED care. Youth spent 10,397 days in the hospital and a total of 536,893 hours in the ED. Youth averaged $6,039 and 2.5 days for an inpatient visit and $439 and 2.3 hours for an ED visit in costs from sports injuries. Volume had a significant, inverse relationship with trauma response charges. For-profit TCs had statistically higher trauma response charges and government owned TCs had statistically lower trauma response charges than not-for-profits. For-profit TCs had an inelastic response to severity for trauma response charges. The mechanisms of injury of firearm, motor vehicle traffic, and transport were significantly, positively associated with misclassification as a trauma alert. Inpatient costs were associated with an 87% increase for patients who were misclassified as a trauma alert. Conclusion Older athletes and males consistently have high healthcare costs from sports. Baseball, basketball, bike riding, football, rollerskating/skateboarding, and soccer are sports with high costs for both ED patients and inpatients and would benefit from prevention programs. Injuries from noncontact sport participants are few but can have high costs. These athletes could benefit from prevention programs as well. Trauma response charges are higher when patient volume is reduced and at for-profit TCs. If injured youth had visited government or not-for-profit TCs, an estimated annual $6.5 to $8.3 million reduction in trauma response charges would have occurred. Reducing these charges are a potential way to reduce excessive healthcare spending without decreasing quality. Mechanism of injury is not a reliable predictor of trauma and was associated with misclassification of pediatric patients with minor injuries as trauma alerts. Costs were higher for mildly injured patients who were trauma alerted, in part due to the trauma alert charge.

Recent reductions in healthcare funding in the United States has pressured clinical laboratories to provide the same quality of diagnostic testing with fewer resources. Testing cascades have been developed to assist in the diagnosis of various illnesses, which use fewer tests and subsequently reduce costs. However, the cost effectiveness of a celiac disease (CD) testing cascade compared to a panel is currently unknown. Therefore, the purpose of this study was to determine if a CD testing cascade was equivalent to a panel in identifying patients deemed likely for CD, and to compare their cost effectiveness in a sample of symptomatic patients from Northeast Tennessee. A retrospective analysis using a CD testing cascade was performed on 933 outpatient samples referred to our laboratory from 2012 to 2017 with a request for a celiac disease serology panel. The seroprevalence of CD for the panel and the cascade were the same in this population (1.82%, 95% binomial confidence interval: 1.06% to 2.90%). The total cost of the CD cascade was 268% less than the cost of the panel resulting in a savings of $44,705, which translates to a savings of $47.92/patient. Based on these findings, we recommend utilization of the cascade to identify patients with likely CD. In the future, creative use of novel testing strategies can have significant contributions to healthcare reform and afford patients more cost-effective clinical diagnostic testing.

 

En hälsocoach kan arbeta på flera arenor i samhället. Exempel kan vara i företag, skolor, träningsinstitut. Dessa kan arbeta på olika sätt men oftast handlar deras arbete om att hjälpa människor med deras hälsoarbete. "Hälsovågen - Bölja och balans i vardagen" är ett projekt som syftar till att stärka friskvårdsinslaget på Karlstads universitet. Projektet startade våren 2005 och målet var att förbättra den fysiska och psykosociala hälsan hos de anställda och därigenom få ner sjuktalen. Vidare ville man öka de anställdas medvetenhet för att på så sätt skapa en möjlighet för dem att påverka sin egen livsstil. Projektet är nu i sitt slutskede och en redovisning av dessa hoppfulla mål skall göras.

 

Syftet vi har med denna uppsats är att undersöka om Hälsovågens specifika målsättning gällande den fysiska och psykosociala hälsan blivit förbättrad samt om de anställdas hälsomedvetenhet ökat. Vidare var ett delsyfte att studera vilken roll hälsocoacherna haft för individerna som deltagit i projektet Hälsovågen.

 

Vi har tagit stöd i en tidigare undersökning gällande hur hälsocoacher arbetar. Där intervjuer genomfördes vid en skola, länets friskvårds organisation samt Karlstad universitets samarbetspartner, Karlstads Medicinska Tränings Institut (KMTI), (Aristidou & Häljeskog, 2008). I nuvarande undersökning genomförde vi en intervju med en av de ledande för projektet vid KMTI. Vi tog del av Hälsovågens datainsamling som var gjord i form av två enkäter. Den första skickades ut 2005 och den andra, sen höst 2007.  

 

Det vi kom fram till i vår tidigare undersökning är att hälsocoacher arbetar på liknande sätt trots skilda miljöer. De arbetar utifrån vart individen i livet. Samtliga tar stöd i forskningsbaserad kunskap och bygger vidare med personliga erfarenheter. De finns som ett stöd för kunderna och försöker förmedla kunskaper på ett pedagogiskt sätt.

 

Resultaten inom projektet Hälsovågen tyder på att de anställda numer tänker på sin hälsa oftare och är mer aktiva på sin fritid. Tendensen pekar mot att upplevelsen av det allmänna hälsotillståndet har ökat. Långtidssjukskrivningarna har minskat med närmare 60 % och vad som upplevs, har en ökad hälsomedvetenhet bildats. Dock kan inga säkerställda svar ges på grund av bland annat stort bortfall. För att tydliggöra vissa delresultat genomfördes även en bortfallsanalys och en innehållsanalys.

 

You can find a healthcoach working in several arenas in the society. Some examples are companies, schools, and training faculties and so on. They are using different working methods when meeting people, but most of the time the work is about helping people with healthprevention and healthpromotion after the individual's lifesituation. "Healthwave - sense of balance in the daily life" is a project which purpose is to strengthen the healthcare at Karlstads University. The project started in spring 2005 and the purpose was to improve the physical and psychosocial health among the employees and through that, decrease the sickness rate. Further on, the projects intentions were to increase the workers health-awareness to create an opportunity for them to affect there lifestyle. The project is now in the final act and an annual report of the project is a pressing issue.

 

Our purpose with this essay is to investigate if the Healthwave mainly purpose involving the physical and psychosocial health been improved and if the employees health-awareness has increased. We have also chosen to investigate which role the healthcoaches had for the involved workforce in the project "Healthwave".

 

We have taken part of a previous investigation that involves how healthcoaches can work. There intervjues were carried out at school, the county's healthcare organization and Karlstads university's cooperative partner, Karlstads Medical Training Faculty (KMTI), (Aristidou & Häljeskog, 2008). In addition to this we also did one more interview with the one who has the managing position for the project at KMTI. We used information from Healthwaves two questionnaires. The first one was created 2005 and the second 2007.  

 

The results were showing that healthcoaches are using similar working methods even if the are on different arenas. They are working after every individuals life situation. Knowledge based fact is what they all are using in there work and this combined with there experience creates the working method. They are there as a support for the customers and are trying to express knowledge in an empowering way.

 

The results are showing that the employees at Karlstads University are presumably thinking on there health more often and are more active on their sparetime. The development shows that the experience of a general healthcondition has improved. The long during sickness rate has decreased with about 60 % and what it seems, a higher health-awareness had been real.  However we can't give any reliable results because of the anonymity and big losses of the questionnaires. We made a fall off analysis and a contet analysis to make our results more reliable.

The transmission of Clostridium difficile infection (CDI) is mediated by spores, which are highly resistant to heat and disinfectants. The healthcare laundry policy, Health Technical Memorandum 01-04 Decontamination of linen for health and social care, provides minimum disinfection conditions and microbiological standards for laundered linen: no bacteria on previously sterile de-sized textiles, > 5 log(10) reduction of a thermotolerant species of bacteria and < 100 cfu with no pathogenic bacteria on sampled linen. Quantification of the survival of spores, from hospital sheets (100% cotton) naturally contaminated with C. difficile spores were laundered in a washer extractor (WE) at a commercial laundry; they failed the microbiological standards. Similar results were achieved in a simulated healthcare WE cycle. The industrial detergent used failed the test for sporicidal activity (BS EN 13704), with a 2.81 log(10) reduction in spores. The method of recovering spores from swatches was important; in the presence of soiling, agitation by vortexing (4.48 log(10) cfu/25cm2) was more effective than stomaching (4.2 log(10) cfu/25cm2, p≤0.05). Spore adherence to cotton occurred over time, with 0% (0 hours) and 51% (24 hours) adherence; adherence decreased to 34% (24 hours) after exosporium removal, suggesting a role in spore adherence to cotton. The possibility cannot be discounted that low-level spore survival on processed linen may be contributing to environmental contamination and asymptomatic carriage.

Ganoderma lucidum spores (GLS) have attracted increasing attention for its versatile biological activities, particularly in cancer therapy. The resilient chitin bilayer of sporoderm is conventionally regarded as an obstacle in the exploitation of bioactive ingredients. Present study found that ethanol extract of broken GLS was able to inhibit cancer cells, however, water extract, especially medium extract (containing serum protein) from unprocessed GLS have also demonstrated anti-proliferative effects on cancer cells. The effectiveness of GLS extract on the inhibition of a series of human cancer cells, namely, osteosarcoma, neuroblastoma, myeloid leukaemia and breast cancer, has been compared, and DNA assays showed that the GLS extract is more efficient in inhibiting neuroblastoma but has less effect on osteosarcoma cell line. To overcome the limitations of the existing processing methods of GLS, the feasibility of sonication as a new way to break GLS has been tested. A series of processing parameters, such as sonication power and duration, have been compared to maximise the breaking efficiency. The preservation of bioactive components of GLS (e.g. polysaccharides and ganoderic acids) from sonication processing was revealed by Fourier Transform Infrared Spectroscopy (FTIR) and High Performance Liquid Chromatography (HPLC) analyses. In vitro study showed that sonication processed GLS were able to inhibit breast cancer cells, at dose and time dependent manner, particularly at low pH (6.5), favourable for cancerous cell growth. The inhibitory efficiency of sonication processed GLS on the growth of breast cancer cells was ranked the highest, compared with that of unprocessed GLS and commercially broken GLS. To preserve further the bioactive ingredients of GLS, broken GLS have been encapsulated with alginate by electrospraying (ES). The size of GLS encapsulated alginate (GLS/A) beads was found to affect the in vitro release profiles of bioactive ingredients of GLS, and can be controlled by varying the processing parameters (e.g. crosslinking time, infuse rates and applied voltage). A series of GLS/A beads with mean sizes ranging from 500 to 2500 µm have been produced by ES and the in vitro release profiles of GLS/A beads in simulated gastrointestinal mediums were found to be related to the pH, bead size and drying methods. In summary, an advanced method combining a customised sonication with ES has been developed by setting up a lab-scale production line from processing to encapsulation of GLS. This may pave the way to produce effective GLS products with desirable natural bioactive components for healthcare.

This thesis explores the general public s experiences of sport related injury (SRI) as they utilise Sport and Exercise Medicine services in NHS England. It focuses specifically on: the treatment pathways to, and utilisation of, one Sport and Exercise Medicine (SEM) clinic in NHS England; the social and economic costs incurred as a consequence of SRI; and the extent healthcare utilisation and costs coalesce to structure SRI experience. The study employs a qualitative methodology based on a two phase research design that retrospectively maps the pathways of patients (n=19) up until their treatment at the SEM clinic (focusing on social and economic costs ), and prospectively, as a number of patients (n=4) continue their treatment at the SEM clinic, thus illustrating how pathways and costs feed each other in problematic ways. Findings demonstrate that patient pathways to SEM are relatively lengthy and inefficient due to a lack of knowledge of SEM initiatives for SRI treatment amongst both GPs and patients. This leads to indirect referrals, increased workload in primary care and the utilisation of general orthopaedic secondary care services. It further highlights a number of social and economic costs incurred through SRI, such as diminished social wellbeing, increased emotional labour, poor health behaviours and workplace absenteeism, which are exacerbated through inefficient patient pathways and patient dissatisfaction with general orthopaedic treatment. The thesis is the first study to shed light on the pathways of SRI patients in the NHS and the treatment experience of SEM clinics in NHS England. It demonstrates the extent SEM initiatives justified on the basis of improving the efficiency of pathways and satisfaction of treatment for SRI patients could be more effectively implemented and identifies a number of important implications for the future sustainability of physical activity health promotion policy and the wider social and economic productivity of exercising public populations.

Healthcare-acquired infections (HAIs) cost the National Health Service (NHS) in England in excess of £1 billion per year. One of the main HAIs is caused by the endospore-forming bacterium Clostridium difficile. The most common cause of healthcare-acquired diarrhoea in the developed world, C. difficile was responsible for around 850 deaths in England and Wales in 2011. To help reduce the spread of the HAI-causing bacteria, terminal disinfection of isolation rooms and wards using hydrogen peroxide vapour is actively promoted. The key advantages of hydrogen peroxide vapour are its high oxidation potential which has been reported to inactivate bacteria, fungi and spores. An additional advantage of hydrogen peroxide vapour is that it is relatively environmentally friendly, breaking down into oxygen and water. Investigation into bacterial inactivation kinetics was undertaken at controlled, steady concentrations of hydrogen peroxide vapour in the range of 10 ppm to 90 ppm. An exposure chamber was designed whereby the bacterial spores could be exposed to constant concentrations of hydrogen peroxide for various exposure times. Bacterial spores (1-log10 to 8-log10 cfu) were filter deposited onto membranes to achieve an even layer for consistent exposure of the hydrogen peroxide vapour to the spores. Bacillus subtilis is often used for method development in bacterial studies; advantages are it has been shown to be highly resistant to hydrogen peroxide vapour and is not a human pathogen. Following the method development, different strains of C. difficile (ribotypes 014, 027, 103 and 220) were exposed to identify differences in resistance. Inactivation models (Chick-Watson, Series-Event, Weibull and Baranyi) were used to fit the data generated using the environmental chamber. Decimal reduction values (D-values) were calculated from the models for comparative studies regarding the inactivation achieved for the different bacteria and different hydrogen peroxide concentrations. The findings from this thesis revealed the Weibull model provides the best fit for most of the data. An initial shoulder period was identified for B. subtilis which was absent for C. difficile inactivation by hydrogen peroxide vapour; B. subtilis is therefore more resistant to hydrogen peroxide disinfection than C. difficile. Typical D-values for B. subtilis and C. difficile when exposed to hydrogen peroxide vapour at a concentration of 90 ppm were 140 and 1 min, respectively. C. difficile inactivation data were used to develop a model to estimate the log reduction that could be achieved during an inactivation cycle based on the concentration-time integral ( ). This model could be used to estimate the log reduction of commercially available hydrogen peroxide decontamination systems; these release a fixed amount of hydrogen peroxide into the room resulting in a peak concentration before decomposition to oxygen and water. Releasing the hydrogen peroxide into the room in this manner results in spatial and temporal variation; this could result in differences in bacterial inactivation in different areas within the room. Using the aforementioned regression model, the inactivation achieved at all locations within the room could be predicted, which could be used to optimise the current hydrogen peroxide decontamination cycles.

Includes abstract.
Includes bibliographical references (leaves 55-61).
To examine the association between 1) the levels of participation in an incentive based health promotion program (study1), 2) the level of engagement with the fitness related activities (Study2) and medical claims and hospital admission amongst adult members of a major health insurer.

With the rapid development of fitness industry, Internet of Things (IoT) technology is becoming one of the most popular trends for the health and fitness areas. IoT technologies have revolutionised the fitness and the sport industry by giving users the ability to monitor their health status and keep track of their training sessions. More and more sophisticated wearable devices, fitness trackers, smart watches and health mobile applications will appear in the near future. These systems do collect data non-stop from sensors and upload them to the Cloud. However, from a data-centric perspective the landscape of IoT fitness devices and wellness appliances is characterised by a plethora of representation and serialisation formats. The high heterogeneity of IoT data representations and the lack of common accepted standards, keep data isolated within each single system, preventing users and health professionals from having an integrated view of the various information collected. Moreover, in order to fully exploit the potential of the large amounts of data, it is also necessary to enable advanced analytics over it, thus achieving actionable knowledge. Therefore, due the above situation, the aim of this thesis project is to design and implement an ontology based system to (1) allow data interoperability among heterogeneous IoT fitness and wellness devices, (2) facilitate the integration and the sharing of information and (3) enable advanced analytics over the collected data (Cognitive Computing). The novelty of the proposed solution lies in exploiting Semantic Web technologies to formally describe the meaning of the data collected by the IoT devices and define a common communication strategy for information representation and exchange.

L’objectif de cette thèse est d’évaluer l’impact potentiel de l’activité physique de loisirs en milieu de travail sur la prévention du SM et sur la réduction des coûts médicaux que le système de santé destine au diabète de type 2 et à l’hypertension artérielle. Résultats : La prévalence du SM est de 24,4%. La proportion des individus qui ont un niveau d’activité physique de loisirs insuffisant est de 78,2%. Les hommes et les femmes qui effectuent ≥30 minutes d’activité physique de loisirs par jour montrent respectivement, 28% et 22% de moins de risque de présenter le SM. Par ailleurs, un investissement hypothétique de 25 852 dollars américains par an (≈ 18 096 euros) pour inciter 400 travailleurs d’une université publique à effectuer un niveau d’activité physique de loisirs recommandable pour la santé, pourrait nous apporter une réduction potentielle de 9% des cas de SM, 6,1% des cas de glucose altéré et 7,4% de cas de tension artérielle altérée ; ainsi que 138 880 dollars américains par an (≈ 97 216 euros) économisés sur le budget que la système de santé mexicain destine aux soins de santé du diabète et de l’hypertension artérielle. Ce qui génèrerait un ratio coût-bénéfice de 0,19 ; ce qui signifie, qu’un dollar investi dans l’organisation des activités physiques de loisirs, permettrait de réduire de 5,2 dollars les coûts médicaux liés au diabète et à l’hypertension artérielle. Conclusion : Nos résultats, nous apportent d’une part, plus d’éléments clefs pour fonder les décisions d’allocation des ressources dans le cadre de la prévention des maladies chroniques, et d’autre part, des éléments clefs pour la mise en œuvre de manière plus efficiente des programmes d’incitation à l’activité physique déjà existants au Mexique
Objective: This thesis assesses the potential impact of leisure-time physical activity on metabolic syndrome prevention and Mexican healthcare system expenditures on type 2 diabetes and hypertension treatment, in a sample of urban Mexican health workers. Results: The prevalence of MS was 24,4%. The proportion of participants who did not perform recommended levels of leisure time physical activity was 78,2%. MS risk was reduced at 28% in men and 22% in women who reported ≥30 minutes per day of physical activity during their leisure time. In addition, a hypothetical investment of $25 852 US dollars annually (≈ 18 096 euros) for engaging 400 workers in the recommended levels of physical activity at workplace, could decrease the prevalence of MS by 9%, cases of hyperglycemia by 6,1%, cases of hypertension by 7,4%, and reduce healthcare system expenditures for treatment of type 2 diabetes and hypertension by 138 880 of US dollars per year (≈ 97 216 euros). That would be a cost-benefit ratio of 0,19: one dollar invested might translate into a healthcare cost reduction of 5,2 dollars. Conclusion: Physical activity should be one of the most important strategies for chronic diseases prevention. Our findings may help to improve resource allocation decisions in the context of chronic disease prevention, as well to guide implementation of more efficient physical activity programs for Mexican workers

High-performance athletes are known to be at risk of adverse physical and mental health outcomes related to the extreme performance demands they face. Australian high-performance sport has traditionally been reactive to the healthcare needs of athletes who present having experienced compromised health, whether that be in the form of an illness, an injury, or a mental health challenge. Recently, there has been a move toward implementing limited health promotion approaches addressing identified health risks in the current athlete/sport environment. At present, there is no theoretical framework to help those working with this highly selective group to promote the development and maintenance of optimal holistic health. Moreover, the early and ongoing development of optimal holistic athlete health has not commonly been viewed as a performance requirement within sporting organisations. This research aimed to understand health and its determinants for Australian high-performance athletes from the perspective of a representative sample of expert health practitioners who currently work or have recently worked in high-performance sports healthcare. Determinants of health are factors that influence how likely we are to stay healthy or become ill/ injured. Understanding these determinants will help researchers and practitioners develop a theoretical health promotion framework that may be applied broadly across Australian high-performance sport. This study used a mixed-methods approach, including a Delphi survey and subsequent semi-structured one-to-one qualitative interviews to derive a consensus on athlete health determinants and the factors which influence these. The purpose of the qualitative interviews was to explore, more deeply, the experiences, beliefs and thinking behind participant responses to the questions posed in the Delphi survey, to add both nuance and context to those responses. The Delphi survey was conducted at two time points over a period of three months. Descriptive statistical analysis of the Delphi survey results demonstrated that there was general recognition of the relevance of the World Health Organisation definition of health and its determinants to the health of high-performance athletes, a finding that is not usually evident in the literature, nor reflected in the provision of health services to this population cohort. Thematic analysis of the Delphi survey data, using a socio-ecological theoretical lens, revealed a need to consider a broader range of influences on athlete health than those that relate specifically to participation in high-performance sport. These include geographic isolation, access to appropriate health services, ethnicity, and socio- economic status. The interview findings revealed that there is a need to apply additional consideration to factors that can be categorized as social determinants of health in healthcare planning for, and management of, Australian high-performance athletes. This study's findings will help form a theoretical framework for Australian high-performance athlete health. Specifically, this framework would address the need for sporting organisations to create and provide health-promoting environments for their athletes and to support athletes in developing their capacity to manage better the impact of the health stressors to which they are exposed, as identified by the high-performance healthcare experts surveyed in this study.

博士
臺北市立體育學院
競技運動訓練研究所
100
Purpose: This objectives of this study include the following: (1) Construct a map of the density of sports facilities by indices for each county in 2000; (2) construct a map of leisure-time physical activity by gender for each county in 2005; (3) construct a map of the mortality rates of the 10 leading causes of death by gender for each county between 2005 and 2007; (4) construct a map of healthcare expenditures by sex for each county between 2006 and 2009; and (5) examine geographic variations and investigate the causal relationship between the density of sports facilitiesy, leisure-time physical activity, mortality rates of the 10 leading causes of death, and health care expenditures. Methods: We use data obtained from the Sports Statistics of the Republic of China for 2000, monthly bulletins of the Interior Statistics for 2000, the National Health Interview Survey for 2005, the Death Registry System (2006 to 2009), and the National Health Insurance Research Database (2006 to 2009) in Taiwan. The maps are drawn and data are computed using Geographic Information System (GIS) ArcView 3.2 and SAS statistic package (version 9.12), respectively. Furthermore, we conducted a prospective ecological correlation study and used the Spearman partial rank correlation coefficient to discuss the relationship between the density of sports facilities in residential areas and the amount of leisure-time physical activities and between the mortality rates of the 10 leading causes of death and health care expenditures. Results: The results showed that sport facility density was inversely association with leisure physical activity, mortality rates of the all-cause and 10 leading causes of death and health care expenditures. Conclusion: Our results suggested that by providing information on the spatial-temporal distribution of sports facilities, leisure-time physical activity, health status, and health care expenditures, the map will become a powerful and significant tool for elucidating the risk factors of chronic disease and mortality.

Hypertension is among the leading preventable causes of cardiovascular diseases and deaths globally. Accumulating evidence suggested that the burden of hypertension is growing, particularly in low-and middle-income countries. Hypertension treatment and control remain challenging due to barriers associated with health system, healthcare providers, and patients. There is a lack of country-specific information on factors influencing hypertension treatment and control in Nepal, a South-Asian lower-middle-income country. Besides, in Nepalese primary care practice, the uptake of guidelines to use non-pharmacological interventions alongside the anti-hypertensive medications for optimum control of blood pressure is low. The aims of this thesis were: (1) to assess the gaps and associated barriers and enablers of hypertension treatment and control in Nepal; (2) synthesize the available evidence on non-pharmacological interventions for hypertension, including alcohol reduction, physical activity, salt reduction, potassium supplementation, weight control, and heart-healthy diet; and (3) explore the potential of yoga intervention, as one of promising non-pharmacological interventions, in the primary care setting in Nepal. This thesis includes five studies. The first study was a secondary analysis of data from two national surveys in Nepal which assessed the prevalence and associated factors of screening, awareness, treatment, and control of hypertension. The second study was a systematic review conducted to assess barriers, enablers, and strategies for hypertension treatment and control in Nepal. The third study narratively synthesised the evidence on nonpharmacological interventions for hypertension in primary care. The fourth study was a randomised control trial, testing the effectiveness of yoga, as a non-pharmacological intervention in primary care, on reducing blood pressure in patients with hypertension. The fifth study was a mixed-methods study exploring the implementation potential of the yoga intervention for hypertension control in the primary care setting. The findings of Study 1 suggested that the gap in cascade of hypertension care is prominent in Nepal, where the poor, the participants from remotely located provinces, those who received treatment from in primary health care centres and public hospitals, those who did not have health insurance coverage, and those under the age of 30 years were at a higher risk of inadequate hypertension care. Furthermore, Study 2 found several barriers to hypertension treatment and control associated with health governance, health service delivery, health financing, medication, technologies, human resources, individual health care providers, and patients, which are the major challenges for improving hypertension management in Nepal. The narrative review (Study 3) showed that previous evidence supports the use of alcohol reduction, sodium intake reduction, physical activity, and weight reduction as non-pharmacological interventions for blood pressure reduction in primary care, but more research is needed on other types of promising interventions, such as yoga. The intervention trial (Study 4) found that a health-worker led yoga intervention is effective for blood pressure reduction among patients with hypertension, while Study 5 showed that it is feasible to implement such an intervention in the primary care setting in Nepal. Overall, the thesis sheds light on imminent health care challenges related to hypertension treatment and control in Nepal. The findings may inform general practitioners, health administrators, and policymakers about the effectiveness, barriers, and facilitators of non-pharmacology interventions, including yoga. This may facilitate the implementation of such interventions in the standard primary care practice, and consequently improve the outcomes of hypertension treatment and control in Nepal.

Physician-rating websites (PRWs) are internet-based platforms that allow users to read or contribute to reviews of service performance about healthcare practitioners (HCPs). Healthcare consumers use PRWs to rate healthcare services; however, PRWs are not commonly embraced by HCPs, nor by professional associations. Nonetheless, in a competitive environment, HCPs could benefit their practice by attending to what clients publicly communicate about their services to align with the patient centred care (PCC) movement. The systematic literature review (SLR) revealed a paucity of research in the area. This research sought to understand what influences a HCP’s intention to adopt a PRW. In doing so, this research explored the relationship between HCPs’ motivation to adopt such websites and the role of their perceptions of a PRW’s characteristics. The motivation and system elements were assessed in terms of their relative influence on HCPs’ PRW adoption. This research conducted a narrative and SLR to inform a conceptual model to theoretically explain the relationship between motivation, system characteristics, and intention to adopt a PRW that was tested in a cross-sectional study. The research method and methodology included participants, 249 Australian allied healthcare professionals, who were surveyed using validated scales. Structural equation modelling estimated the model and the relative contribution of motivation and system characteristics on the adoption of PRWs. The Results chapter showed that HCPs’ motivation type external regulation—social had a direct negative effect on their intention to adopt a PRW (r = −.21, p < 0.01). In discussing the findings, they contrasted with the perceived system characteristics of relative advantage and ease of use, which were found to have a direct positive effect on intention to adopt a PRW (r = .88, p < .00) and (r = .24, p < .00), respectively. In conclusion, the results from this study, first, increase current understanding of HCP behavioural intention to adopt a PRW. Second, theoretical contributions are made through the integration of self-determination theory and diffusion of innovation applied to this unique context. Third, this study is the first to apply the Multidimensional Work Motivation Scale in Australia. The findings have implications for healthcare businesses and HCPs’ strategic development of PCC measures. Furthermore, translation of the findings could assist in the design of HCPs’ professional development to use online feedback, to manage patient onboarding, and to identify pathways to innovation adoption by HCPs.

The clinical directorate (CD) governance structure of contemporary tertiary healthcare facilities was introduced to Australian hospitals three decades ago. The principle reasons for the change from the previous traditional professional model were to streamline patient care, reduce the costs of providing healthcare, and to ensure a patient-centred approach to healthcare for all Australians. Thirty years on, hospital executives continue to refine structures while paying close attention to the strategic aims and goals of their organisations. However, the effect of these structures on communication between executives, and the likely impact on their managerial roles and relationships, has received limited attention. To address this problem, this study employed a mixed methods approach to understand the influence of the CD structure on executive communication behaviours. The focus of enquiry was the communication structures and networks of senior staff. The approach enabled an interactional view of executive communication networks in a tertiary healthcare facility in Melbourne. Three theories underpinned the study design that methodologically employed a social constructivist and social network analysis approach to answer the research questions. The constructivist position was taken because the focus was individuals’ understanding of processes. Internally generated understandings of the world are distinct from social constructionism where understanding processes is an interactive, collaborative domain (Raskin & Debany 2018). Ten members of the facility’s executive team provided data, which when analysed showed that communications were an intricately balanced phenomenon influenced by the structure of the organisation, their own agency, and that of their colleagues and peers. The project was undertaken in a time of change for the project organisation. The structure of the organisation was evolving under focused refinements by the executive team to create a fit for purpose. Findings suggest that apart from structural rebuilding, executives were personally challenged in establishing communication relationships with others in the context of a changing hospital structure. Noting the importance of wider hierarchical communication, this study focused on intra- executive team communication within the CD, the rationale being that if the executive team communicated well, a consistent message would be conveyed to reports (Keyton et al. 2013). Outcomes from the project demonstrated the importance of trust relationships to achieve effective communication and diffuse information. Effective communication is defined as having skills to transfer knowledge in a complex, cross-functional environment and to be competent in the transfer of knowledge to engage others (Waldeck et al. 2012). Enabling communication was dependent on established relationships, which were influenced by previous work collaborations, proximity, and familiarity. Hindrances to communication were excessive workloads, less time to establish and maintain contact between peers, geographical separation, presence of silos, and behavioural factors, which included limiting contact with other disciplines, exclusion from meetings, and limiting avenues for the development of long-term relationships. The findings contribute to the extant literature by developing the inchoate knowledge of agentive human behaviours within the CD. The emphasis on theoretical integration provides a robust account on which to build further research. Communication pathways and processes have implications for leadership effectiveness, which in turn affects the practice of teams and subsequent staff, system, and patient outcomes. Recommendations for action and future research are discussed.