Dissertations / Theses on the topic 'Community and primary care'
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Jones, Roger Hugh. "Self care and primary care of dyspepsia." Thesis, University of Southampton, 1990. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.241615.
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Welschhoff, Anja. "Community Participation and Primary Health Care in India." Diss., lmu, 2007. http://nbn-resolving.de/urn:nbn:de:bvb:19-69547.
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Meebunmak, Yaowaluck. "Community mental health care in Thailand: Care management in two primary care units." Thesis, Meebunmak, Yaowaluck (2009) Community mental health care in Thailand: Care management in two primary care units. PhD thesis, Murdoch University, 2009. https://researchrepository.murdoch.edu.au/id/eprint/6502/.
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Thailand faces increasing mental health problems, however mental health services are limited. In particular, mental health services provided in communities across the country are not clearly structured. Research in regard to community mental health care is rare.
The purpose of this study was to explore mental health care management in two primary care units (PCUs) in Thailand in order to understand the ways they operate within Thai communities. The specific objectives were to identify mental health care practices and roles of health providers, models of care and influences on mental health care practices in the two PCUs as case studies. An ethnographic approach using participant observation, semi-structured interview, quantitative questionnaire and document analysis was used in gathering data. The participants were seven nurses and three public health workers practising in the PCUs.
Findings enhanced understanding in the context of two PCUs located in communities of the Northern and Central Thailand. Both were local health centres providing a wide range of health services based on the principles of primary health care (PHC).
The PCUs were operated without mental health specialists, however nurses were the main resource in providing mental health care in terms of primary and secondary prevention. Primary prevention was provided through counselling sessions, drug prevention activities and seniors clubs. In addition, the health providers conducted activities of mental health promotion towards particular risk groups after assessing risks. They also gave support to mental health and normal cases that had possible mental health problems. Secondary prevention was provided in home visits, primarily in giving injections. The health providers played four main roles as educator, consultant, agent and manager in primary and secondary prevention.
There was no single model of mental health care practice provided in the PCUs. Information derived from the present study showed a variety of models underpinning care practices. The nursing process was clearly adopted, as well as integrated care, community participation, collaboration and consultation, and using standard guidelines.
Personal knowledge and interest in mental health were mentioned as an important factor in practising mental health care. Environmental factors such as adhering to policy, being family-oriented, being mindful of economic factors, using Buddhist Principles to guide interactions, guarding against occupational risks, maintaining a teamwork approach and the lack of specialists appeared to be factors influencing mental health care.
This study contributes to the body of knowledge of community mental health care management in Thailand. The findings suggest implications for practices, education, and policy making to improve quality of care.
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Muijrers, Paul Emile Marie. "Prescribing in primary care pharmacotherapy in primary care and the cooperation between general practitioners and community pharmacists /." Maastricht : Maastricht : Universiteit Maastricht ; University Library, Maastricht University [Host], 2005. http://arno.unimaas.nl/show.cgi?fid=5437.
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Hemphill, Jean Croce, and C. Macnee. "Community Partnership in Primary Care of Homeless and Indigent." Digital Commons @ East Tennessee State University, 1995. https://dc.etsu.edu/etsu-works/7589.
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Buys, Lüet Schraader. "Bridging the divide between primary health care and community." Master's thesis, University of Cape Town, 2016. http://hdl.handle.net/11427/22998.
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South African cities have a complex social and physical post-Apartheid layering. The historical legacy, referring here specifically to the inadequate roll-out of public facilities in areas and uprooting as well as separating of communities, have resulted in under serviced environments that can lack social cohesion and often struggle with poverty. Public institutions play a catalytic role within a community. To this end, health care portrays the government in a legible 'provider' role and is, in some ways, an obvious way to make citizens feel valued in comparison with other public institutions. Health care institutions impact the community in a unique way due to the combination of specificity of service and the emotive way it is experienced by the individual. This dissertation aims to research, define (and ultimately) test a strategy that aims to stitch together the fissure between community and institutions, by rethinking the urban interface of generic primary health care facilities. This research is structured around themes of theory, policy, the continuum of care and physical environments; each in order to better understand what and how the 'gap' between health care institution and community is constructed. Programmatic and/or spatial ideas that inform the architectural design. This dissertation asserts that providing 'traditional' generic institutions sustains rather than improves the life of the community. The research suggests that existing health care facilities can be more effective as public spaces by introducing new programmes, disaggregating the formal interface, redefining and activating a new urban threshold and providing meaningful open space. The design ultimately aims to act as a new skin or threshold through which institutions relate to the community.
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Poulton, Brenda Christine. "Effective multidisciplinary teamwork in primary health care." Thesis, University of Sheffield, 1995. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.339905.
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Temmers, Lynette. "Factors influencing the collaboration between community health workers and the public primary health care facilities in delivering primary health care services." University of Western Cape, 2019. http://hdl.handle.net/11394/7655.
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Master of Public Health - MPHCommunity health workers (CHWs) are integral to improve Primary health care (PHC) coverage, utilising their unique skills within the community to make services accessible and equitable. PHC is the cornerstone of the National Health Insurance (NHI) Bill for the provision of Universal Health Care (UHC). The Department of Health (DOH) in the Western Cape, South Africa, has set priorities and requirements for the provision of funding to Non-profit organisations (NPOs) for forming coalitions with the Health Department to deliver various aspects of health care. The post-2015 agenda of the Sustainable Development Goals (SDGs) are underscored by a strong sense of intersectoral collaboration to work together to attain sufficient and sustainable progress. Collaboration between CHWs and PHC facilities is important in aligning goals and activities to ensure a comprehensive and sustainable approach to ensuring UHC
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Johnston, Corrine W. "Whither the community in community health centres?, the limits of primary care reform." Thesis, National Library of Canada = Bibliothèque nationale du Canada, 1999. http://www.collectionscanada.ca/obj/s4/f2/dsk1/tape10/PQDD_0005/NQ41181.pdf.
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Achmat, Asma. "Professional health care workers' experiences of care at two Community Day Clinics on the Cape Flats." University of the Western Cape, 2016. http://hdl.handle.net/11394/4896.
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Magister Artium (Social Work) - MA(SW)Primary Health Care (PHC) is the cornerstone of health care globally, nationally and locally and, therefore, should be regarded as the foundation of health care provision. In South Africa, Community Day Clinics (CDCs) are part of the bouquet of services that is being offered at a PHC level. There are various factors that generate inconsistency in the provision of care to people accessing these CDCs. The purpose of this study was to identify and explore how these factors impact on the care practices that health care professional’s provide. Research suggests that the majority of health care workers are women, who play a double role as carers in their professional and private lives. Therefore, the political ethics of care, a feminist theoretical approach, was utilized to understand care practices in these health settings. The aim of the study was to develop an in-depth understanding of the care practices of health care workers at two CDC facilities on the Cape Flats. A qualitative research methodology was used to explore and identify the phenomenon under study. The research project followed an explorative and descriptive research design, as the researcher sought to understand the care practices of health care workers and how their values and ethics further influenced care practices at these two CDC settings. The data was gathered using semi-structured one-on-one interviews, and later analysed using qualitative thematic analysis. The research findings were grouped in terms of the values entrenched in the political ethics ofcare, which are attentiveness, responsibility, competence, responsiveness and trust. The research findings identified various aspects that, either negatively or positively, impact on these values. Finally, recommendations were made to management, as well as care workers. These recommendations were in terms of implementing care services that are attentive to service-users and care-workers; providing a service that takes into consideration the value of responsibility; the provision of competent services; and finally creating trusting relationships within the CDC.
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Yousuf, Hussein Shouneez. "Smartphone hearing screening in mHealth assisted community-based primary care." Diss., University of Pretoria, 2015. http://hdl.handle.net/2263/53477.
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Available ear and hearing health care services are not sufficient to meet the
burden of disabling hearing loss, particularly within developing countries such
as South Africa. Attempts to meet the needs of underserved populations may
require a move towards community-based primary care along with the
integration of recent mHealth approaches whereby primary health care
personnel facilitate ear and hearing health care. The objective of this study
was to determine the clinical utility of a community-based program for
identification of hearing loss, using smartphone hearing screening
(hearScreenTM) operated by community health care workers (CHWs), in a
developing South African community and to survey experiences of the CHWs.
An exploratory, descriptive cross-sectional research design was used. The
study comprised two phases. During phase one, 24 CHWs were trained to
conduct hearing screening in the underserved community of Mamelodi using
automated test protocols (sweep performed at 1, 2 and 4kHz bilaterally at an
intensity of 25dB HL for children and 35dB HL for adults), employed by the
hearScreenTM mHealth solution operating on low cost Android phones using
calibrated headphones (Sennheiser HD202 II). A total of 820 community
members were screened for hearing loss over a 12-week period. The results
were analyzed in terms of referral rates of the hearing screening program,
compliance of test environment noise during screening, and time proficiency
of the screenings. During phase 2, CHWs completed a questionnaire
regarding their perceptions and experiences of the hearing screening
program.
Data analysis was conducted on 108 children (2-15 years) and 598 adults
(16-85 years) screened. Referral rates for children and adults were 12% and
6.5% respectively. Noise levels only had a significant effect on referral results
at low intensities of 25dB HL at 1KHz (p<0.05). Age effects were significant
for adult referral rates (p<0.05) demonstrating a significantly lower referral
rate in younger (below 45 years) as opposed to older (45 years and above)
adults (4.3% compared to 13.2%). Majority of CHWs responded positively
regarding their involvement and experiences using the hearScreenTM tool in terms of usability, need for services, value to community members and time
efficiency.
Results of this study indicated that community-based hearing screening
programs can be successfully integrated into underserved contexts by CHWs
using an mHealth solution. The hearScreenTM smartphone application offers
benefits such as automated test protocols and interpretation, integrated noise
monitoring, data capturing and data sharing. Appointment of a program
coordinator, as well as the integration of informational counseling and minor
software changes were recommended towards an effective and sustainable
program.Dissertation (MCommPath)--University of Pretoria, 2015.
Speech-Language Pathology and Audiology
MCommPath
Unrestricted
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Feder, Gene. "Traveller gypsies and primary health care in East London." Thesis, King's College London (University of London), 1994. https://kclpure.kcl.ac.uk/portal/en/theses/traveller-gypsies-and-primary-health-care-in-east-london(f8d67b0e-b690-487d-b033-f9eebc6e678b).html.
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Roberts, Christopher. "Networked professional development : towards a model for primary care." Thesis, University of Sheffield, 2003. http://etheses.whiterose.ac.uk/14453/.
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Background. Although research has been carried out within higher education circles little is known about any educational benefits that may result from primary care professionals engaging in networked learning and what strategies may be used to overcome barriers to effective learning. Aim. This research was undertaken to identify specific educational strategies which may inform educators wishing to support continuing professional development for healthcare professionals within communication and information technology. Method. A model of networked learning was developed from the literature and using the experience of working models elsewhere. The model was implemented and evaluated over two case studies, and further refined in a third. The evaluation methodology used action research collecting data from surveys, interviews, observer participation, electronic text generated bye-mail discussions, and project documents. Results. Healthcare professionals were able to usefully communicate over a prolonged period with colleagues about clinical and professional matters, developing a number of process skills; using e-mail, web and on-line database searching. Compared to face -to-face small group learning, the added benefit of using e-mail discussions supported by web based learning resources was being able to use the method at a place, pace and time of their own choosing whilst still remaining committed to a shared educational experience. GPs were able to use the educational material to put to-wards a portfolio (personal learning plan) for accreditation for PGEA. Specific roles for an on-line facilitator in addition to small group learning skills were identified. However networked learning is acknowledged to have many obstacles, eg access, using software, lack of support which will need to be overcome. Managing a learning environment for CPO for healthcare professionals involves an integration of the teaching and learning strategy of the host organisation with a networked learning environment. Conclusion. A networked learning environment has the potential of supporting continuing professional development and its assessment with portfolios. For individual participants much depends on there own learning style, what they feel is relevant to learn at the time and their own preferences for a learning format. Much needs to be done to provide the necessary supporting infrastructure and integration of provision across traditional divides within healthcare education. This research describes a number of recommendations, which can inform action by educational stakeholders interested in healthcare education.
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Mukiapini, Shapi. "Baseline measures of Primary Health Care Team functioning and overall Primary Health Care performance at Du Noon Community Health Centre." Master's thesis, University of Cape Town, 2017. http://hdl.handle.net/11427/24504.
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Background: The importance of effective team work for improving quality of care has been demonstrated consistently in research. We conducted a baseline measure of team effectiveness and a baseline measure of primary health care performance. Aim: To improve Primary health care team effectiveness and ultimately the quality and user experience of primary care at Du Noon Community Health Centre. (CHC) Setting: Du Noon CHC in the southern/western substructure of the Cape Town Metro district services. Methods: A cross sectional study using a combination of Nominal Group Technique (NGT) method and a questionnaire survey to assess PHC team effectiveness and to obtain baseline measure for Primary Health Care (PHC) organization and performance. Results: Data from 20 providers from the primary health care team, showed that the PHC team members perceived their team as a well functioning team (70% agreement on the 7 items of the PHC team assessment tool, incorporated in the ZA PCAT. The NGT method reveals that communication and leadership are the main challenges to effective team functioning, The NGT also provides ideas on how to deal with these challenges. Data from 110 users and 12 providers using the ZA PCAT: 18.2% of users rated first contact-access as acceptable to good; 47,3% rated ongoing care as acceptable to good. The remaining subdomains of the ZA PCAT were rated as acceptable to good by at least 65% of the users. 33% of the providers (doctors and clinical nurse practitioners) rated first contact-access as acceptable to good; 25% rated ongoing care as acceptable to good, the remaining subdomains of the ZA PCAT were rated as acceptable to good by at least 50% of providers. First contact-access received the lowest acceptable to good score (18.2%) and comprehensiveness (service available) received the highest score (88.2%) from the users. For the providers the lowest acceptable to good score was for ongoing care (25%) and the highest acceptable to good score was for primary health care team (100%). The total primary scores are good (above 60%) for both users and providers but moderately higher for the providers. Conclusions: How teams perceive their effectiveness can motivate them to generate ideas for improvement. There were discrepancies between ZA PCAT (PHC team functioning) results and the NGT method results. The ZA PCAT (8 pre-existing domains) baseline results show a contrast between providers' and users' perceptions of the PHC system at Du Noon consistent with the finding of the Western Cape ZA PCAT study. We encourage Du Noon CHC to use these results to improve the user experience of primary health care services there.
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Walshe, Catherine. "What influences referrals in community palliative care services? : a case study." Thesis, University of Manchester, 2006. http://www.manchester.ac.uk/escholar/uk-ac-man-scw:77832.
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Equity of access to healthcare services is a concept which underpins current UK health policy. However evidence suggests that this is not achieved within community palliative care. Referrals can be tardy or not made at all. Most literature describes inequality in service utilisation, but does not aid understanding of why such inequalities exist. There is little research exploring the processes underpinning referral making rather than the outcomes of referrals such as service utilisation. The aim of this research was to investigate the influences on referral decisions made within community palliative care services. A qualitative case study strategy was chosen as the research approach as it provided a framework for facilitating the incorporation of multiple perspectives in a complex context, in a field where there has been little previous research, and where there is little theory to guide the investigation. Three cases (Primary Care Trusts) were studied. Data collection used multiple methods (interviews, observation and documentary analysis, as well as mapping and profiling the palliative care services provided within the cases) from multiple perspectives (general and specialist palliative care professionals, managers, commissioners and patients). Detailed data analysis followed a framework approach, comparing and contrasting patterns within and across cases with existing and developing theoretical propositions. Two core influences on the way health care professionals made referral decisions were found. First, their perception of their own role in providing palliative care. Autonomous professionals made independent judgements about referrals, influenced by their expertise, workload, the special nature of palliative care and the relationship they developed with patients. Second, their perception about those to whom they may refer. Professionals needed to know about services to refer, and then made a complex judgement about the professionals involved and what they could offer the referrer as well as the patient. These findings indicate that many more factors than an assessment of patients' clinical need affect referrals within community palliative care services. It appears that personal, inter-personal and inter-professional factors have the potential to shape referral practices. It may be that the combination of these factors has an influence on equitable access to community palliative care services. Practitioners could be more explicit about referral or non-referral rationales, and policy makers take account of these complex influences on referrals rather than just mandating change.
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Vaughan, David James. "Acceptability of primary care a study of one community in Montana /." Thesis, Montana State University, 2007. http://etd.lib.montana.edu/etd/2007/vaughan/VaughanD0507.pdf.
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Smith, Felicity Julia. "The contribution of community pharmacists to primary health care in London." Thesis, Queen Mary, University of London, 1989. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.389618.
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Oluyole, Alexander Bolarinwa. "Community involvement and needs assessment in primary health care in Nigeria." Thesis, Keele University, 1995. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.261479.
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Cornoc, N. S. "Quality improvement cycle for cardiac failure in primary health care : Elsies River community health centre, Cape Town." Thesis, Stellenbosch : University of Stellenbosch, 2015. http://hdl.handle.net/10019.1/97226.
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Abstract
Introduction
The study aimed to assess and improve the quality of care for congestive cardiac failure in a public sector, primary health care setting, in Cape Town. There is currently no literature available on the quality of care for the management of congestive cardiac failure in primary health care in South Africa.
Methods
A disease register was constructed by identifying patients prescribed Furosemide and checking the medical records. Altogether 95 patients with CCF were identified. The study followed the usual steps for a quality improvement cycle: Formation of an audit team; agreeing on criteria based on current CCF guidelines; collection of data from medical records to measure the criteria; analysis and feedback of results to the staff; critical reflection, planning and implementing change; re-audit of the medical records.
Results
There was a mean age of 63.4 years, 21% were male and 75% were females. The results of the initial audit revealed suboptimal management of patients diagnosed with CCF: 53% had an aetiological diagnosis recorded in the clinical notes, 24% had a documented functional capacity, 12% of patients had documented precipitating/exacerbating factors, 58% had fluid status documented, and 37% had documentation of their cardiac rate and rhythm.
The intervention consisted of feedback on the audit results and critical reflection with the relevant staff members. The doctors were provided with a printed protocol to refer to for the management of CCF. Clinicians were resistant to change and to taking on new tasks in relation to the management of patients with CCF and decided to only focus on improving the clinical assessment of patients.
The results of the re-audit after 5-months in 40 patients demonstrated improvement in the clinical assessment criteria: 95% of the patients had an aetiological diagnosis recorded in the notes, 50% had a documented functional capacity, 42% had documented precipitating/exacerbating factors documented, 72% had their fluid status documented, and 85% of patients had their cardiac rate and rhythm documented.
None of the five assessment criteria were met at baseline but post-intervention three of the five met the target set and all showed substantial improvement. There was no improvement noted in any of the other criteria, which were not specifically focused on in the plan to improve clinical practice.
Conclusion
The current quality of care for CCF in primary health care is poor and needs to be improved. The quality improvement cycle led to substantial improvement in the clinical assessment of patients with CCF. Recommendations are made regarding future criteria, which could be included in local audit tools.
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Hepburn, Mary Patricia. "An exploration of environmental understanding among primary health care providers in an Eastern Cape community." Thesis, Rhodes University, 1999. http://hdl.handle.net/10962/d1003415.
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This study explores environmental understanding among the health care practitioners serving a rural community in the Eastern Cape Province in South Africa. During the preliminary phases of the research, the decision was made to adopt a participatory approach to the inquiry as far as was possible. Semi-structured interviews, participant observation and focus group discussions were the techniques chosen to focus the participants' thinking about: the meaning of environment, environmental issues and problems which impact on health, and, environmental education in practice. Comparisons between the recently transformed health education idea proposed by the World Health Organization (WHO), known as "health promotion", and a popular environmental education model are made. It is argued that many of the obstacles to effective health education described by the participants in the study can be overcome by using environmental educationlhealth promotion approaches. The findings show that the health practitioners studied relate to a wide range of environmental issues with varying levels of engagement. They are influenced by changing values, their feelings about indigenous knowledge, and their notions about how people should respond to the environment. An urgent need for more and better communication among the different levels of health practitioners is identified. Finally, it is recommended that health care practitioners be supported with opportunities for professional development which can lead to a confident, seIfreflective approach to health education.
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Nickson, Patricia Jane. "The implementation of primary health care in North Eastern Zaire." Thesis, University of Liverpool, 1989. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.291717.
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Hepburn, Robert Cameron. "Environmental epidemiology in primary care using a geographic information system." Thesis, University of Aberdeen, 2001. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.268876.
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Rahman, Shams-Ur. "Location-allocation modelling for primary health care provision in Bangladesh." Thesis, University of Exeter, 1991. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.280652.
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Gilley, Margaret Mary. "Bridging the boundaries? : collaboration and community care, Sunderland 1990-1994." Thesis, Durham University, 1997. http://etheses.dur.ac.uk/5083/.
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The independence of the health and social care agencies makes the coordinated delivery of inter-related and inter-dependent services very difficult. Collaboration in health and social care has been a goal of policy makers for many decades, but it has not been achieved to the degree or to the extent of the aspiration. This thesis examines collaboration in the context of the NHS and Community Care Act 1990, which marked a new stage in the development of community care policy and in collaborative working between health and social services. The thesis takes the form of a case study set in Sunderland during 1990-1994, from the passing of the Act to the first anniversary of the implementation of its community care elements. It considers firstly, collaboration at a strategic planning level between Sunderland Health Authority and the Local Authority Social Services Department in the development and implementation of community care policy; secondly, the evaluation of a collaborative project at an operational level, in the attachment of a social worker to a general medical practice; and thirdly, the evaluation of a project which tried to strengthen collaborative working within the health service, among district nurses, health visitors and general practitioners. The thesis sets these three pieces of work in a number of contexts: the political setting of the NHS and Community Care Act and the changes it introduced; the literature of collaboration; and a description of Sunderland and its need for health and social care. The case study showed how difficult it is for organisations to work together. Relationships between individuals tended to be more collaborative than relationships between corporate bodies, but it is important to see the relationship between those individuals in the context of relationships between organisations. The study also found that for the success of joint projects to be sustainable and generalisable, collaboration needs to be present at all levels of the organisations. The thesis also showed that there is as much need for collaboration within the health service as between the health and social services. The thesis used as a measure a framework of factors which promote collaboration, and found that many elements were lacking in Sunderland. However, in the real world it is necessary to settle for a notion of "pragmatic collaboration" in which joint working is possible even when full collaboration is absent.
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Sapsford, Lesley Eliaine. "The professional development of primary health care nurses in integrated self managing teams." Thesis, Bucks New University, 1998. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.270297.
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Gillam, Stephen. "Community-oriented primary care : an evaluation of the King's Fund pilot programme." Thesis, Imperial College London, 1998. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.417784.
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Horrocks, Susan. "Evaluation of health services in primary care and the community (1995-2008)." Thesis, University of the West of England, Bristol, 2009. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.522545.
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Melton, Tyler C., Nicholas E. Hagemeier, Kelly N. Foster, Jesse Arnold, Billy Brooks, Arsham Alamian, and Robert P. Pack. "Primary Care Physician and Community Pharmacist Opioid-Related Communication and Screening Behaviors." Digital Commons @ East Tennessee State University, 2019. https://dc.etsu.edu/etsu-works/7743.
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Tweedie, Allen McCaskill. "Repositioning independent community pharmacy in the National Health Service primary care sector." Thesis, University of Portsmouth, 2003. https://researchportal.port.ac.uk/portal/en/theses/repositioning-independent-community-pharmacy-in-the-national-health-service-primary-care-sector(38ead6a5-a01a-4cd5-ab1f-2911befb2942).html.
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In 1994 the author of this thesis proposed a new role of medicines management (MM)for dispensing community pharmacists, requiring systematic collaboration with GPs. In1998 the Minister for Health approved the proposal and commissioned pilot trials which are currently proceeding. This thesis explores cultural, inter-professional and operational factors which may impede or facilitate service roll-out nationally. A review of management literature explored two areas, marketing and change management theory, which could be applied to a community pharmacy context. This review revealed innovative ways of presenting new services to target audiences and novel means of engineering organisational change. 'Culture~; 'leadership~; 'motivation"; 'communications"; and, 'competitive force~ were studied alongside the psychology of 'attitudes'; 'needs'; and, 'wants'. The BurkeLitwin change model was selected as the most applicable to pharmacy service change. Triangulated field research has revealed forces which impede and facilitate change. A series of key informant interviews and focus groups helped identify crucial issues which informed the content and structure of national postal surveys to GPs (1000) and pharmacists (750). Key 'attitudes'; 'needs'; and, '~ants of both professions were revealed: i. 75% of GPs and 81 % of pharmacists wish to engage in MM; ii. 36% of GPs already receive pharmacist assistance at varying levels; iii. 58% and 48% of GPs respectively, do not support pharmacist involvement with medication selection or identification of sub-therapeutic dosage; and, iv. 89% of pharmacists do not have the ability and 81% do not have time to do MM. The literature research fmdings were theoretically applied to these issues and suggestions made for managing the proposed transformation of pharmacy service. This thesis recommends cultural support of the GP by styling and branding the MM service accordingly with the GP as the lead figure, directing the programme of work. It further recommends urgent action by pharmacy leadership, to provide the framework for dispensing pharmacists to acquire the knowledge and time to undertake this transformational service.
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Sokar-Todd, Hanan Benjamin Mansour. "The contribution of community pharmacists to primary healthcare in Alexandria." Thesis, University College London (University of London), 2000. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.342282.
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Tsoabisi, Sello. "Investigating the extent and efficiency of community participation in primary health care in Khayelitsha, Cape Town." Thesis, Cape Technikon, 2004. http://hdl.handle.net/20.500.11838/1669.
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Thesis (MTech (Public management))--Cape Technikon, Cape Town, 2004The evolution of the South African health system has been characterised by inequities, imbalances as well as fragmentation. The unification of South Africa in 1910 did not consolidate public health administration, which was characterised by increasing institutionalisation, professionalism and organisation. This was the status-quo up until after 1990, whereby there were marked efforts and endeavours to effect defragmentation. In the context of the dramatic political changes that the country has seen over recent years, many aspects of local health care have been upgraded. Issues such as policy making and planning, the development of human resources and training for health care and the establishment of health systems and structures requires a different approach from the previous. Effective human resources development and management in consultation with communities, can contribute towards improvement of service delivery around health issues. Personnel matters and skills development should be considered in the exercise to boost employee morale and job satisfaction. The challenge facing South Africa has been to design a comprehensive programme to redress social and economic injustices, to eradicate poverty, increase efficiency and reduce waste. In the health sector this has been ongoing to involve the complete transformation of the national health care delivery system and the relevant institutions. Health care workers jointly, require the right skills, knowledge and expertise with attitude in their duties and obligation to serve the community.
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El-Sanady, Magdy Latif. "Performance analysis of Egyptian non-governmental organisations in primary health care." Thesis, Keele University, 2001. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.341301.
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Despite recent phenomenal growth of non-governmental organisations (NGOs) in the developing world, especially in the field of primary health care (PHC), their performance currently witnesses many paradoxes. For example, a paradox between their growth in size and diversity, yet increasing concerns about their impact; another paradox is that of the intense questioning of their performance in development and health, and yet the increasing flow of support from most international agencies; and, a third paradox, is that of the increasing pressures for, and acceptance of the need for, performance evaluation, and yet a lack of institutionalisation within NGOs themselves, and the scarcity of models that can guide/help NGOs in that direction. Many explanations have been suggested for these paradoxes, and are likely to include the following: first, an NGO may lack the performance system which enables it to look at its own performance and analyse in a systematic way; second, an NGO, when undertaking a selfevaluation exercise, may confine itself solely to the project level (for accountability reasons) and overlook the other levels of analysis (namely, the organisation, service delivery, and individual levels); and, third, an NGO may not hold an holistic view as to what areas should be analysed, nor may it have the analytical tools readily available which help it to undertake such an analysis. Evidence from different literature supports each of these possible explanations. Accordingly, within this thesis, to help an NGO self-analyse its performance, a performance analysis framework (PAF) has been developed. This framework is structured to analyse the performance of an NGO service provider at three main levels: organisational; project; and, service delivery. Each level addresses an area for analysis, drawing upon a set of criteria for each area, raising a group of relevant questions for each criterion, and casting light on a cluster of possible investigative tools largely, but not exclusively, qualitative in nature. Theunderlying hypothesis of this framework is that the performance of an NGO in health and social development is the outcome of an interaction of many factors within both its external and internal environments. Hence, in the PHC setting, an NGO is confronted with an external environment composed of contextual elements (political, economic, legal, and socio-cultural), as well as a cluster of relationships with different stakeholders (donors, beneficiaries, government bodies, and other NGOs). On the other hand, the internal environment of an NGO is formed of a four-fold set of inter-related elements: its identity, its strategy, its operations, and its resources. Thus, the kinds of interactions taking place in both these environments are key determinants of the overall performance of the NGO. The PAF was then field tested in Egypt through a series of investigations, including focus group interviews as well as instrumental case studies. Four cases were selected from a pool of Egyptian NGOs (ENGOs) with different histories and geographic locations, but all being Community Development Associations (CDAs); participants in umbrella capacity building (CB) programmes sponsored by intermediary NGOs and funded by one bilateral donor; and, having service provision in the area of Maternal and Child Health (MCH). While the PAF was applied at the project level, the four PHC/MCH projects have also served as entry points to the analysis of the four organisations through a participatory self-assessment approach. The PAF, therefore, served as both research tool and conceptual frame of reference against all four cases, relying upon various triangulation techniques, in pursuit of research validation and quality control. The outcome is that of robustly testing the framework: by so doing, important lessons and insights have emerged both about the external and internal environment of ENGOs; and about the levels and kinds of performance CDAs operating in health currently attain, and can attain in the future. The research concludes with recommendations for a proposed capacity-building programme for CDAs guided by the PAF
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Gamiet, Shamila. "Health professionals' perceptions of rehabilitation care workers." Thesis, University of the Western Cape, 2015. http://hdl.handle.net/11394/5246.
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Magister Scientiae (Physiotherapy) - MSc(Physio)People with disabilities (PWD) often come from disadvantaged communities and struggle to access health and rehabilitation, education and employment. This leads to poorer health outcomes, lower education achievements, and higher rate of unemployment in comparison to people without disabilities. Therefore there is a need to empower PWD to remove all barriers which prevent them from participating in all aspects of their communities. In South Africa, 5% of the population is disabled and in a worldwide review conducted on access to rehabilitation services, it was reported that South Africa provided 21% to 40% of the disabled population with rehabilitation services. In 2012 the Department of Health (DOH) trained a new cadre of community health worker (CHW) in the field of rehabilitation in order to improve PWDs‘ access to health services. As a result, health professionals in the Western Cape became concerned about the role of this new cadre of rehabilitation care worker in PHC and CBS. The aim of this study was therefore to explore health professionals‘ perceptions of the newly trained rehabilitation care workers (RCWs). Q methodology was selected as an appropriate research design to meet the objectives of this study as it can be used to analyse opinions, perceptions and attitudes. The study population consisted of all the health professionals who engaged with the RCWs in the clinical workplace during their clinical practice module. A convenient sample of sixteen health professionals participated in this study. Ethics approval was obtained to conduct this study and all participants gave written consent to participate in this study. The researcher gathered all the viewpoints of the health professionals regarding the new rehabilitation care workers (RCWs) by conducting focus group discussions and document analysis. Statements were then drawn up based on the health professionals' viewpoints. The participants then ranked these statements from strongly agree to strongly disagree on a Q data score grid, in a process called Q sorting. The completed Q data score grids, called Q sorts, were then entered into PQMethod software programme for statistical and factor analysis. From the results of this Q analysis, two factors emerged which were analysed and interpreted. A factor is representative of participants with similar opinions. The participants loading onto Factor one and Factor two shared similar opinions of the RCWs. The results indicated that the participants were of the opinion that RCWs‘ role would be to strengthen primary health care (PHC) and community-based rehabilitation (CBR) and promote the participation of PWD in society. The results suggested that the RCWs were capable of improving the quality of life of PWD by empowering PWD to become actively involved in all aspects of community life. The participants felt that the RCWs would be included in the health system by working at intermediate care centres (facility-based) and in the community (home-based). However, the participants agreed that the RCWs must work under the direct supervision of qualified health professionals. Participants loading onto Factor one and Factor two further agreed that RCWs worked well in the structured environment of intermediate care health facilities. They felt that it would be beneficial for RCWs to be employed at these health facilities as the RCWs reduced the workload of the health professionals. From the results, it was also found that health professionals were of the opinion that the RCWs displayed positive attitudes and good professional behaviour in the clinical environment. Health professionals however identified gaps in the knowledge of the RCWs and a lack of skills to perform certain tasks. However, health professionals agreed that the RCWs' skills will develop and improve with time and exposure. This study showed that health professionals had positive perceptions of the RCWs and this could indicate that RCWs will be well accepted by health professionals as part of the PHC team. This could lead to the effective utilisation of RCWs in community-based rehabilitation. Recommendations can be made to the developers and implementers of the RCW training curriculum to make adjustments to the curriculum so as to address the lack of knowledge and skills in certain aspects of health and disability. It can further be recommended that South Africa's National DOH capitalise on these positive perceptions and train more RCWs to extend rehabilitation and health services to more underserved communities. This will assist the South African Government in ensuring that more PWD receive rehabilitation and become included in all aspects of their communities as is envisaged in the 2020/2030 health plan.
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Eneh, Ann. "Access to Primary Care in Pennsylvanian Rural Townships." ScholarWorks, 2018. https://scholarworks.waldenu.edu/dissertations/5075.
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Access to primary care is limited in rural communities across the United States. Evidence supports primary care as the cornerstone of healthcare. The purpose of this project was to explore community perceptions of barriers to primary care access with the aim of learning about ideas for possible interventions that could improve primary care access for Mifflin County residents. Penchansky and Thomas's model of healthcare access provided the theoretical framework for this qualitative phenomenological study. Using a community-based research approach, semistructured, open-ended telephone interviews and qualitative surveys were conducted with 26 participants, including physicians, nurses, and residents. Data were analyzed using Edward and Welch's extension of Colaizzi's 7-step method for qualitative data analysis. Key findings included perceptions that (a) primary care access is limited in Mifflin County due to inadequate health services emanating from insufficient community health centers, provider shortages, health insurance issues; (b) high cost and poor choice of services discourage residents from seeking preventative care; (c) distance from services reduce residents' ability to access primary care; (d) service problems impact the quality of care received, such as a lack of provider training in opiate addiction; and (e) providers and residents should be involved in primary care service planning since they can provide valuable information to help improve access to services. Positive social change could occur through improvement in access to primary care using a collaborative approach and community involvement, in policy formation and service planning.
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Wangombe, Joseph Kibuchi. "Economic evaluation in primary health care : the case of the western Kenya community based health care project." Thesis, Swansea University, 1985. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.639341.
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Dale, Jeremy. "Primary care in accident and emergency departments : the cost effectiveness and applicability of a new model of care." Thesis, London School of Hygiene and Tropical Medicine (University of London), 1998. http://researchonline.lshtm.ac.uk/682264/.
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The thesis describes the development, research and evaluation of the applicability of a new model of care that involves GPs being employed on a sessional basis in A&E departments to treat patients attending with primary care needs. The main aim of the study was to research its cost and clinical effectiveness. A multi-faceted approach was taken to include consideration of patients' needs and preferences, professional concerns, organisational and structural issues within the health service, and planning and policy issues. Clinical, sociological, epidemiological, and economic perspectives are drawn upon, reflecting the context of the service development and to provide a firm base for discussion about the generalisability and applicability of the findings. The first two chapters provide a detailed review of the epidemiological, sociological, clinical, and organisational literature relating to the primary care/A&E interface. The incentives and disincentives that may act to increase or reduce demand and supply are explored, in addition to issues relating to the 'appropriateness' of demand, the organisational culture of A&E departments, and strategies used to curtail or cope with demand. The demand for primary care at A&E departments appears to cross national boundaries and hence, literature from other countries (particularly the USA) is included and its applicability to the UK considered. Relevant literature relating to the quality of A&E care, patient satisfaction, and the costing of care is also discussed. The main study was a prospective controlled trial that was conducted at King's College Hospital. This compared process variables, clinical outcome and costs of 'primary care' consultations performed by senior house officers (SHOs), registrars, and general practitioners working three-hour sessions in A&E. A new system of nurse triage was implemented to allow the prospective identification of patients presenting with primary care needs. A total of 27 SHOs, three registrars and one senior registrar were included, and the patient sample comprised 1702 patients seen by GPs, 2382 by SHOs, and 557 by registrars or the senior registrar. GPs were found to practice considerably less interventionist care than A&E medical staff, and the resource implications were substantial. The findings are discussed critically, and their applicability is considered drawing on empirical data from recent evaluations of A&E Primary Care Service developments in other parts of London. The policy and service implications of the study are considered and further research needs identified.
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Fabricant, Stephen Joel. "Community financing in Sierra Leone : affordability and equity of primary health care costs." Thesis, London School of Hygiene and Tropical Medicine (University of London), 1992. http://researchonline.lshtm.ac.uk/682247/.
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Critics of user charges for government primary health care have focussed on the deterrent effect these charges might have on the poor, but there is little convincing empirical evidence that supports or contradicts these claims. The main research aims were to assess the equity effects of user charges for curative PHC services on households in 2 rural districts of Sierra Leone, a country that has suffered severe economic hardship in the last decade. Secondary objectives were to assess the feasibility of using objective means-testing to identify patients for exemption, and to recoimiend a simple methodology for acquiring the same information for local, operational purposes. A survey of 1156 households was carried out in the dry post-harvest season, and covered a range of household economic factors in addition to the actions taken in response to all reported illness episodes. A followup survey was made the following rainy season to assess seasonal effects. Supplementary information was obtained through focus groups and case studies. The data were analyzed within the framework of a conceptual model which assumed that preferences, access, and ability to pay were the main factors (or groups of factors) that determined which of several medical and non-medical treatment options would be used. Multiple regression models were used to assess the effects of each group of factors. The main findings were that, while wealthier households used cheap market drugs and expensive medical treatment options more than the poor, there was little difference in use of medium-priced PHC treatment. Household wealth and income factors correlated weakly with amounts actually paid for treatment. The immediate availability of money in the household appeared to be the economic factor most affecting utilization, with wealthier households nearly as likely = to have the amounts needed for PHC treatment on hand as poorer ones. Distance was a much more important determinant of choice of treatment than was income or assets, as were certain preference factors. However, the poor spent a much higher proportion of household income on treatment than the wealthy, so a way of limiting total expenditures for the poor would be more important than limiting their deterrence. Several readily-ascertained household factors correlated well with household income, but means-testing was concluded to be an inefficient way to accomplish the objective of selectively limiting expenditures unless incorporated into a prepayment scheme.
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Selbie, Hilary L. "Chronic pain in the community : its impact and management needs in primary care." Thesis, University of Aberdeen, 2006. http://digitool.abdn.ac.uk/R?func=search-advanced-go&find_code1=WSN&request1=AAIU213905.
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One of the key findings of this thesis was the participants' perception of chronic pain impact. Participants' social-situational contexts, coping activities and help seeking approaches determined the degree of impact perceived in the experience of chronic pain. Experience of chronic pain impact was modified to varying degrees by engagement in coping activities e.g. physical and environmental and/or psychological and emotional, modifications and activities. Differences existed between those coping successfully or unsuccessfully as reflected in their overall coping approaches and/or strategies e.g. "active" or "passive". These approaches had positive or negative consequences for the process of adjustment. Expectations of GPs and primary care services were low. Actual experiences of consultations often contrasted with the ideal. Unmet needs and increasing frustration over repeated failed treatments was reported. Many participants moved on to seek help outwith the NHS e.g. CAM, and/or developed personal coping approaches and strategies. Others continued to consult whilst still believing that their GPs' neither did not care nor could not help them. These participants were amongst the most dependent and least evolved in their personal coping. Several typologies emerged from the thematic inductive analysis e.g. coping and consultations styles. Within these typologies, important socioeconomic differences were identified in the participants' ability to adapt e.g. to modify pain impact by developing successful coping strategies, gaining satisfactory health care treatment and obtaining health professional cooperation in or outwith the NHS. Thus, inequalities in pain experience and access to effective treatments were identified.
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Dlatu, Ntandazo. "The integration of mental health care services into primary health care system at King Sabata Dalindyebo Municipality Clinics." Thesis, Walter Sisulu University, 2012. http://hdl.handle.net/11260/d1008290.
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Introduction: Primary Health care refers to care which is based on the needs of population. Mental health care provided within general primary care services is the first level of care within the formal health system. There is no research in King Sabata Dalindyebo, carried out on issues around integration of mental health with primary health care. The present study is initiated to overcome this gap. Aim of the study: The aim of the study was to investigate the level of knowledge, implementation and barriers of integrating mental health care services into primary health care system at King Sabata Dalindyebo clinics, in Mthatha region. Methods: This descriptive cross-sectional study was conducted at King Sabata Dalindyebo Clinics, between January 2010 and December 2011. A 10% random sample of all health professionals from King Sabata Dalindyebo was interviewed concerning their demographic characteristics, education/ qualifications, general and further training in psychiatry, awareness about Mental Health Care Act 17 of 2002 and mental health care services characteristic related to the integration of mental health care services into primary health care system. For data analysis, the means of continuous variables across 2 groups were compared using Student-t test. The proportions (%) of the categorical variable across 2 groups were compared using Chi-square test. Results: A total of 52 health professionals (40.4% males, 59.6 females, 59.6 married, 3 doctors, 49 nurses, mean age 36.9± 8 years range 23 years-52 years), were surveyed. The participants were characterized by low level of qualification in specialization, further training in psychiatry, and by very low awareness about Mental Health Care Act 17 of 2002. Furthermore, there was no implication of expects (Regional psychiatrist, psychologist, social worker) and co-ordination of mental health care services. Working in remote and disadvantaged area, health workers with lower education qualification, absence of a coordinator for mental health care services and absence of workshop on Mental Health Care Act 17 of 2002 were determinants of lower awareness about Mental Health Care Act 17 of 2002. However, there was a good to excellent framework for potential implementation of mental health care services into primary health care system. The government support in infrastructures, drugs availability, transport and equipment was evident. Patients were helped within abroad based ethical, human rights and psycho-social framework. Conclusion: There is a lack of improving human capacity for mental health in terms of continuous training in mental health issues, policies, organisation and development. Globally, the integration of mental health care service in King Sabata Dalindyebo is non-optimal.
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McAteer, Anne. "Symptoms in the community : prevalence, management and preferences for care in a UK working-age population." Thesis, University of Aberdeen, 2011. http://digitool.abdn.ac.uk:80/webclient/DeliveryManager?pid=167793.
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Introduction: Symptom prevalence and management have important implications for the use of healthcare services, as well as the health of individuals. Aim: To describe symptom prevalence and management in the UK and to investigate decision-making and preferences for care. Methods: Two questionnaire surveys were undertaken: 1) a symptom survey of 8,000 working-age adults in the UK, 2) a discrete choice experiment (DCE) with 1,370 respondents to the symptom survey. Results: Symptom survey - Over 75% of respondents experienced at least one symptom in the last two weeks (mean 3.7). The two-week prevalence of symptoms varied from 0.2% for coughing-up blood to 41.3% for feeling tired/run down. Prevalence of specific symptoms was associated with a number of participant characteristics. The most common response to symptoms was doing nothing at all (49%) followed by over-the-counter medicine use (25%). Approximately 8% consulted a GP, while use of other members of the primary-care team (pharmacist, nurse, complementary practitioner and NHS24/NHSDirect) was very small (<2%). Symptom characteristics were more commonly associated with actions taken than participant characteristics. DCE - Significant differences were found for three symptom scenarios of increasing seriousness (diarrhoea, dizziness and chest pain). Self-care was the preferred option for diarrhoea. Consulting a GP was the preferred option for dizziness and chest pain. For all symptom scenarios there was a preference for less waiting time, less cost, greater convenience/availability and a very good chance of a satisfactory outcome. These preferences were valued more highly as the seriousness of the symptom scenario increased. Respondents were willing to trade between different attributes, with waiting time and chance of a satisfactory outcome being the attributes most likely to influence preferences for different actions. Conclusion: Further research is required to examine the public’s knowledge and perceptions of the services offered by different members of the primary care team for managing symptoms.
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Kali, Julia Mamosiuoa. "Understanding women’s involvement in primary health care: a case study of Khayelitsha (Cape Town)." Thesis, University of the Western Cape, 2012. http://hdl.handle.net/11394/4095.
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Magister Artium (Medical Anthropology) - MA(Med Ant)Women are the principle providers of their families when it comes to issues of health care, even though their health needs and efforts are neglected. The contributions that they make to health development seem to be undervalued, and their working conditions ignored. Societies depend heavily on women as role players in the welfare of their families and of national economics together with their physical well-being which determines the ability to be productive. The study has provided an overview of the experiences of women concerning primary health care and the quality of service in Nolungile PHC Khayelitsha, Cape Town. Primary health care (PHC) forms an integral part both of the country‘s health system and the overall social and economic development of the community. Central to the PHC approach is full community participation in the planning, provision, control and monitoring of services. Priority has to be given to the improvement of women‘s social and economic status.A much neglected perspective in health issues is that, a number of questions arise from the provision of PHC. Does PHC rely on the contribution of women and if so, why women? Women in their communities have joined their hands together as community health workers, educating community members on issues of health. The study has provided an insight of the work that women are doing in their communities, and how do they give meaning to their experiences in PHC. The study also answered questions that raise fundamental issues on gender stereotyping and disparities in PHC. The study gave me an opportunity to work closely with the women while observing the challenges that they are facing and how to they overcome them in the daily lives.Changes are called towards the attitudes of health care providers working in the formal and nonformal sectors. The provision of health education for women ultimately empowers them as health educators for the community.
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Zainy, Zainy M. Ali. "Primary care health centres : exploring the interface between patients' overall satisfaction with the primary health care environment, environmental factors, and non-environmental factors: case study Arriyadah City, Saudi Arabia." Thesis, University of Strathclyde, 1993. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.287913.
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Algaman, Abrahim Hamad. "TQM implementation in a health care setting : a case study of a Saudi Arabia National Guard primary care setting." Thesis, Manchester Metropolitan University, 1999. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.311074.
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Hagemeier, Nicholas E. "Let’s Talk About It: Communication Research in Pharmacy and Primary Care Settings." Digital Commons @ East Tennessee State University, 2018. https://dc.etsu.edu/etsu-works/5419.
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This session will describe research approaches that have led to innovations in pharmacy practice. Specifically, the program will identify effective strategies to assess the impact of academic partnerships on advancing practicebased research at professional practice sites. This session will utilize a roundtable format to foster discussion and engagement among participants.
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Davis, Kierrynn Miriam Davis. "Cartographies of rural community nursing and primary health care : mapping the in-between spaces /." [Richmond, N.S.W.] : University of Western Sydney, Hawkesbury, 1998. http://library.uws.edu.au/adt-NUWS/public/adt-NUWS20030509.135659/index.html.
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Li, Jun. "The use of child health computing systems in primary preventive care : an evaluation." Thesis, University College London (University of London), 1993. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.274686.
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Humphrey, Charlotte Miranda. "Promoting audit in primary care : a qualitative evaluation of medical audit advisory groups." Thesis, University College London (University of London), 1996. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.338849.
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Cantoro, Maria. "The role of the Community Psychiatric Nurse in counselling within the Primary Care Team." Thesis, Roehampton University, 2010. http://hdl.handle.net/10142/90340.
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A literature search was carried out on the role of the Community Psychiatric Nurse (CPN) in counselling within the Primary Health Care Team (PHCT) which highlighted a lack of theoretical knowledge for the psycho-social issues and that CPNs were not trained to provide counselling. The aim of this thesis was centred around the role in counselling the CPNs in Mid-Surrey Health District had in PHCTs, and whether General Practitioners (GPs) perceived CPNs as CPNs or counsellors. Two hypotheses were devised at the beginning of the study and a methodology was pursued in proving or disproving these hypotheses. Results indicated that CPNs were aware of the meaning of the term ‘counselling’ and that all but one felt they had not enough knowledge to carry out more in depth counselling/psychotherapeutic interventions. They all felt that counselling training was inherent to their work as CPNs within the PHCT. This therefore supported the hypothesis that CPN counselling in the PHCT needs to be trained. The GPs result was that they were unaware of qualifications held by CPNs or counsellors. They felt that CPN was invaluable and it would be an advantage if CPNs had counselling training. However, some felt that CPNs needed to retrain the ‘multipurpose’ aspect of their work. From the results it was apparent that there was a misperception of the role of CPN and counsellor as some GPs felt that CPNs were already counsellors. However, the result was inconclusive in proving or disproving the hypothesis. Most GPs introduced the CPN as a CPN and not as a counsellor, although some GPs believed that CPNs were also trained in counselling. It is argued that although these findings indicate that CPNs need counselling training and counselling was perceived as an important part of their work, in depth counselling training was not regarded as necessary to carry out their work as CPN.
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Kawaya, Hilda. "Challenges Community Health Workers perceived regarding home visits in the Tshwane district." Diss., University of Pretoria, 2020. http://hdl.handle.net/2263/78359.
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ABSTRACT
Background: Community Health Workers are faced with challenges in the community when conducting home visits. The re-engineering of Primary Health Care services in South Africa brought a new cadre of Community Health Workers. The role of Community Health Workers relieved the workload and activities which were done by Primary Health Care nurses. Community Health Workers had to conduct home visits as one of the activities. The Community Health Workers experienced challenged during home visits.
Aim: This study was conducted to describe and explore the challenges Community Health Workers perceived regarding home visits in the Tshwane district
Method: Semi-structured interviews were undertaken with a purposive sample of fourteen Community Health Workers conducting home visits. The individual face to face interviews concentrated on the challenges perceived regarding home visits. All the interviews were transcribed verbatim and analysed using the tesch method.
Findings: The challenges perceived were that of the community, logistical, occupational, human resource and managerial. The participants expressed the need for respect and acceptance by the community during home visits. Improved planning related to delegation of households by Outreach Leaders and provision of material resources. The support by managers for career development through training and education for various disease prevention.
Conclusion: the findings suggest that training of Community Health Workers need to be formalised and in-service education related to home visits should be planned, structured and supported by the Department of Health.
Key words
Challenges, Perceived, Community Health Workers, Home visit.Dissertation (MNurs)--University of Pretoria 2020.
Nursing Science
MNurs
Unrestricted
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Kagee, Shaheen Ashraf. "Treatment adherence among primary care patients in a historically disadvantaged community in the Western Cape : a qualititative study." Master's thesis, University of Cape Town, 2005. http://hdl.handle.net/11427/9389.
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Includes bibliographical references.The question of treatment adherence remains a concern that affects the health outcomes of patients attending public health clinics in South Africa. Patients with chronic illnesses who reside in impoverished communities face particular challenges in terms of managing the often complex aspects of their treatment. The sample for the study was selected from patients diagnosed with diabetes or hypertension attending public health clinics in the Boland area of the Western Cape. A total of 23 patients between the ages of 32 and 80 participated in the study. All participants were Afrikaans-speaking had been classified as Black or "Coloured" under the apartheid system and as such were all historically disadvantaged. Participants were selected by means of convenience sampling and were asked to participate in qualitative interviews under confidential conditions. The interviews addressed various aspects of the participants' experience of their illness and treatment and were conducted by two trained interviewers. Interviews were recorded, transcribed, and entered into Atlas.ti, a computer programme that assists in the analysis of textual data. The analysis of the data focused on the content of participants' concerns and difficulties associated with adhering to treatment recommendations. The themes that emerged from the study included participants' attribution of the origin of their illness, their experience of their illness and of the health care system, their own concerns about the consequences of poor adherence, financial and problems, psychosocial support, spirituality, alternative medicine, and patients' own understanding of the symptoms of poor adherence. The results of the study are discussed in terms of the often hierarchical relationship between health care workers and patients. Public health care workers often hold sceptical and suspicious views about their patients regarding their illness, symptoms, and level of adherence. As such, patients may be regarded in a paternalistic manner and in some cases even be admonished by health care workers for poor adherence. Yet, competing social realities often inhibit patient adherence. These include financial constraints, being labelled a patient, side effects of medication and family opposition to treatment. Adherence may also be related to the notion of responsibility for the causes of and solutions to medical problems. The results of the study were considered in terms of four models of attribution of responsibility for the origin of and solution to the medical problem as identified by Brickman, Rabinovits, Karuza, Coates, Cohn, and Kidder (1982). These models are the moral model, the compensatory model, the medical model, and the enlightenment model. The medical model is the most dominant in the South African public health system. Yet, in many instances, participants appeared to adopt other models of engaging with the causes and solutions to their illness conditions. The question of participants' understanding of the consequences of adherence is discussed in terms of the theoretical work by Pepper's (1942), who proposed four possible perspectives with which people may view the world. These world-views are formism, mechanism, contextualism, and organicism. In many instances adherence as a means of controlling somatic symptoms occurs as part of a logical and mechanistic understanding of health. However, in terms of an organismic worldview, adherence may represent an effort to restore equilibrium to the patient's constitution that has spiralled into disequilibrium as a result of disease.