Dissertations / Theses: 'Community health centres'

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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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Rankin, David. "Sustainability processes in community-level health initiatives : the experiences of Scottish healthy living centres." Thesis, University of Edinburgh, 2010. http://hdl.handle.net/1842/4820.

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Background This thesis explores processes involved in stakeholders’ attempts to secure sustainability of three short-term funded community health initiatives known as healthy living centres (HLCs). The overall aim was to identify and examine development of sustainability strategies in Scottish HLC organisations. In contrast to retrospective accounts examining influences on extent of sustainability little is known about how this concept is considered by organisations approaching the end of funding. Organisational development theorising has focused on organisational change, with no attention given to sustainability processes in short-term funded organisations. Building on a concurrent longitudinal evaluation of a larger sample of HLCs, the temporal nature of this PhD study offered scope to explore development of, influences on and changes to stakeholders’ sustainability strategies over time. Methods The study used a qualitative evaluation methodology. A case study approach framed the HLCs, permitting comparison between sites. An ethnographic approach using observations and in-depth interviews was employed. Interviews were undertaken with stakeholders (comprising managers, staff, partners and board members) from each HLC. Managers were interviewed on several occasions. Latterly, interviews were undertaken with respondents holding policy, practice and funding posts. A thematic analysis, informed by grounded theory, was carried out. This used a constant comparative methodology to understand the data against the backdrop of the PhD study aims and wider literature. Findings Findings examine stakeholders’ accounts of the impact of a range of issues on HLC sustainability strategies. These are located in the context of health and community sector restructuring. Especially challenging were: efforts to secure local partners and further lottery funding; consideration of new funding criteria and models of service delivery; and limitations in demonstrating effectiveness. Addressing such challenges, managers’ strategic positioning signified attempts to influence HLCs’ fit within local health structures. Stakeholders’ accounts highlighted attempts to secure continuation of HLCs’ original identity; ensuring continued accessibility of Centres to local communities; and, seeking continuation of developmental methods of work. External respondents’ perspectives illuminated how policy-driven changes restricted system-wide attention to HLC sustainability. Latterly, Government-provided funding offered a short-term fix, enabling continuation of attempts to secure sustainability. Conclusions and implications This study offers new perspectives on the temporal exploration of sustainability of shortterm funded health initiatives. Analysis of stakeholders’ accounts over time provides insight into the effects of restructuring and ways in which system-wide flux impacted on influences known to enhance the likelihood of sustainability. Recommendations address programme design and wider responsibilities of health system actors in positioning and considering a future for such organisations after short-term funding ends.

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Bresick, Graham. "A study of continuity in Cape Town community health centres." Master's thesis, University of Cape Town, 2005. http://hdl.handle.net/11427/9358.

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Includes bibliographical references.
This study sought to determine: i) the extent of continuity in Cape Town public sector clinics; ii) patients' views of continuity; iii) senior managers ideas of how continuity can be improved; iv) clinical managers' views of a proposed practice team model to improve continuity. Continuity, defined as present if patients saw the same doctor for at least 80% of visits in a 2 year period, was present for less than 9% of patients.

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Gordon, Roberta June. "Pregnant women's perception and application of health promotion messages at community health centres." Thesis, University of the Western Cape, 2005. http://etd.uwc.ac.za/index.php?module=etd&amp.

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Studies have shown that pregnant women do understand and value information of their unborn child. However, those providing health promotion services often focus on medical procedures and health education messages, ignoring the cultural, socio-economic and psychological dimensions that impact on women's health. This research aimed to look at a specific component of health promotion, i.e. health promotion messages shared with pregnant women attending Stellenbosch and Klapmuts Community Health Centre Antenatal Health Promotion Programme and their perceptions of how they apply messages in their daily lives.

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Higuchi, Michiyo. "Improving the use of medicines in community health centres, Timor-Leste." Thesis, London School of Hygiene and Tropical Medicine (University of London), 2008. http://researchonline.lshtm.ac.uk/1300445/.

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While access to essential medicines has become recognised as a human right, problems concerning the inappropriate use of medicines have emerged. Medicines lose their therapeutic value and can impair both individual health and public health if inappropriately used. Inappropriate use of medicines diminishes the quality of healthcare and causes resources to be wasted, which is especially serious in under-resourced countries. To improve the use of medicines, the introduction of standard treatment guidelines (STGs) is suggested as a potential strategy. The aim of this DrPH thesis is to study the use of medicines, focusing on adherence to new STGs in Community Health Centers (CHCs) in Timor-Leste. The country is now trying to establish an equitable and sustainable healthcare system under extremely resource-limited conditions. The study used mixed research methods, collecting data from randomly selected 20 rural CHCs, 1,799 retrospective samples from patient registration books, 583 prospective observations, and 55 semi-structured interviews of health personnel were collected. Timor-Leste's medicine use was found, in general, to be acceptable. For example, use of injections was extremely low. Training, especially clinical nurse training, influenced knowledge of, attitudes to, and practical use of medicines and also prescribing adherence to STGs. Other factors that influenced the use of STGs were: health personnel's agreement with the policy concept and contents of STGs; health personnel's positive perception of the changes brought about by the introduction of STGs; development of STGs in a health policy framework: the fact that their STGs were easy to use repeatedly; and a supportive environment and systems to use STGs. Constant socialisation and timely updates of STGs are necessary. Interrelation and consistency across policies and programs should be maintained. The position of training within the health policy framework should be clearly understood by the all people concerned. Follow-up supervision is needed both for individuals and the CHC. Anticipated support should be well functioning.

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Rhoda, Anthea. "The rehabilitation of stroke patients at community health centres in the Western Cape." Thesis, University of the Western Cape, 2010. http://etd.uwc.ac.za/index.php?module=etd&action=viewtitle&id=gen8Srv25Nme4_5654_1318838292.

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The rehabilitation of stroke patients can occur at different settings. These include in-patient settings, such as stroke units or general rehabilitation wards and out-patient settings, such as out-patient departments attached to hospitals, day hospital departments and the patientsâ home. In South-Africa, day hospitals have been upgraded and are now referred to as Community Health Centres which provide comprehensive health services to the population. In the Western Cape these centres are faced with the rehabilitation of stroke patients who have been discharged early from hospital during the acute stage or who have never been admitted to hospitals. To date there is a lack of best practice guidelines and formal evaluations in terms of efficacy and effectiveness of rehabilitation at these centres. The aim of the study was therefore to investigate the rehabilitation of stroke patients at Community Health Centres in the Metropole Region of the Western Cape. The structure, process and outcomes (SPO) model was used as a conceptual framework in this study.

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Yi, Sang-il. "Responsiveness, equity and decentralisation : the example of community health centres of Seoul, South Korea." Thesis, University College London (University of London), 2002. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.272123.

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Greathead, Erica. "Role competencies of first-line nurse managers in community health centres : a delphi study." Master's thesis, University of Cape Town, 2000. http://hdl.handle.net/11427/2951.

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Bibliography: leaves 166-194.
This study was conducted to determine the role competencies required of first-line nurse managers of Community Health Centres (CHC) in South Africa with the implementation of the district health system and the corresponding delegation of authority and responsibility to lower levels of management. A Delphi technique was utilised, which involved a panel of 24 senior nurse managers.

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Biggs, Debbie Lynn. "Health promotion needs of stroke patients accessing community health centres in the metropole region of the Western Cape." Thesis, University of the Western Cape, 2005. http://etd.uwc.ac.za/index.php?module=etd&amp.

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Stroke is the third leading cause of death and a major cause of disability in most societies. Individuals with physical disabilities are at risk of secondary complications due to the impact of the disability, which may be exacerbated by poor lifestyle choices. Although disabled persons desire to engage in wellnessenhancing activities, limited programmes based on their health promotion needs&rsquo
assessment have been developed. The aim of the present study is to determine the health promotion needs of stroke patients accessing selected Community Health Centres in the Metropole region of the Western Cape. A cross-sectional survey, utilizing a self-administered questionnaire and in depth interviews with a purposively selected sample was used to collect the data. The quantitative data was analysed using Microsoft Excel ®
. Means, standard deviations and percentages were calculated for descriptive purposes and the chi-square test was used to test for associations between socio-demographic and health-related variables. Audiotape interviews were transcribed verbatim, the emerging ideas were reduced to topics, categories and themes and finally interpreted. In order to qualify for between-method triangulation used in the study, complementary strengths were identified by comparing textual qualitative data with numerical quantitative results and vice versa. The quantitative analysis revealed that the participants were engaging in health risk behaviours such as physical inactivity, substance usage, non-compliance to medication use and inappropriate diet modification. Lack of financial resources, facilities and access to information predisposed them to involvement in risky health behaviours. In-depth interviews supported the quantitative findings and revealed that numerous participants&rsquo
suffered from depression and frustration as a result of having a stroke. The necessary ethical considerations were upheld. The outcome of the study could contribute to the need to develop, encourage and promote wellness-enhancing behaviours and activities to improve the participants&rsquo
health status and ultimate quality of life.

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Sebeh, Alaa Galal. "Evaluation of community based rehabilitation for disabled children in urban slums in Egypt." Thesis, University College London (University of London), 1996. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.362828.

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Abdulqadir, Ayiman Husayn Khalleefah. "Rehabilitation professionals' views on the experiences of patients with physical disabilities accessing community health centres." University of the Western Cape, 2018. http://hdl.handle.net/11394/6409.

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Masters of Science - Msc (Physiotherapy)
Rehabilitation services have been described as being necessary to maximize patient independence in order to enable them to participate fully in their communities. The Aim of the study was based on the problem statement and the research question, this study aims at exploring rehabilitation professionals' views on the experiences of patients with physical disabilities accessing CHCs in the Western. The objectives of the study were to explore the views of rehabilitation professionals regarding experiences by patients accessing rehabilitation services at the Community Health Centres (CHCs) in the Western Cape and to reach health experts consensus on how rehabilitation services should be provided at the CHCs based on the outcomes of objective 1. Methodology: This study used an exploratory design that used qualitative methods for data collection (workshops and focus group discussions (FGDs) and a Delphi study. The study was conducted at purposively selected CHCs in the Western Cape. The population in this study included all rehabilitation professionals who provide rehabilitation services in the CHCs, who were invited to participate in the study. Data collection: In the qualitative and the Delphi study, data was collected through workshops, focus group discussions and emails respectively. Data analysis: The workshops and the FGDs were audio recorded and then transcribed verbatim for content analysis.

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Matsika, Callista Kanganwiro. "Persons with physical disabilities' experiences of rehabilitation services at community health centres in Cape Town." University of the Western Cape, 2009. http://hdl.handle.net/11394/2932.

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Magister Scientiae (Physiotherapy) - MSc(Physio)
According to the United Nations, more than half a billion people (about 650 million) worldwide are disabled. Disability can have a vast impact on both the individual and the family. Rehabilitation is therefore a fundamental need for the persons with disability to achieve functional independence and have an improved quality of life. To enhance the effectiveness of rehabilitation, it is important to seek clients perspectives of the rehabilitation services and to incorporate these perspectives into the planning and delivery of rehabilitation services. In areas where rehabilitation services are available in South Africa, minimal research has been done to explore the clients experiences regarding provision of these services. The aim of this study therefore was to explore the persons with physical disabilities experiences of the rehabilitation services they received at community health centres (CHCs) in the Cape Town Metro Health District. Data was collected using a mixed methods design in the form of a sequential exploratory strategy. Qualitative data collection was done using in-depth interviews and this was followed by administration of an interview questionnaire. The questionnaire was developed using results from the in-depth interviews together with information from literature. Ten persons with physical isabilities, who had received rehabilitation services at participated in the in-depth interviews and 95 responded to the interview questionnaire. The interviews were tape-recorded and transcribed verbatim and they were analysed using predetermined themes. The SPSS version 16.0 was used to analyse the quantitative data which was presented in frequencies, medians, quartiles and percentages. The results of the study revealed that the participants experienced problems with getting transport to travel to the community health centres and getting adequate information from the service providers particularly information regarding disability and support services available for them. Experiences regarding participants involvement in their rehabilitation were generally positive. Generally, the participants reported positive experiences regarding their interaction with service providers and family support and involvement and this study recommends the staff to maintain their standards regarding these two dimensions of rehabilitation. However most of the participants were not concerned about whether the service providers gave them an opportunity to express their preferences or not. The results indicate the need to improve transport services for persons with physical disabilities and to give them more information regarding support services. The service providers should also give the clients more opportunities to get involved in their rehabilitation and educate them about the benefits of them getting involved.
South Africa

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Arowoiya, Ayorinde Ibukun. "Participation restrictions of stroke patients living in the community at selected community health centres in the Metropole Districts in the Western Cape, South Africa." University of the Western Cape, 2014. http://hdl.handle.net/11394/4680.

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Magister Scientiae (Physiotherapy) - MSc(Physio)
Stroke is the second leading cause of death globally and the consequences on human and economic health are of major concern. The aim of this study was to determine and explore the participation restrictions experienced by stroke patients. The study populations were stroke patients living within the community in Western Cape, South Africa. A mixed methods approach was used to collect data in this study which consisted of two phases. For the first phase, the descriptive, observational cross sectional design was used to determine the participation restrictions of stroke patients living within the community and the factors associated with community with respect to integration. In this phase, an interviewer- administered questionnaire was used to collect data; the instrument for this study is the standard World Health Disability Assessment Schedule 2.0 (WHODAS 2.0) for disability assessment which includes the International Classification of Functioning Health and Disability (ICF) concept in disability assessment which has been tested and found to be reliable and valid, to determine various participation restrictions among stroke patients living in the society. While in the second phase of this study, two focus group discussions were conducted at the selected community health centre; these participants were conveniently selected from those who participated in the first phase of the study. This was conducted to retrieve in-depth information on difficulties encountered in participating in daily life situations. The Statistical Package for Social Sciences (SPSS) was used for descriptive and inferential statistics. Chi square and Anova t-test was used to determine the association between the demographics statistic and participation restrictions. Alpha level was set at 0.05. For qualitative findings, audiotaped interviews and note taken were transcribed and translated into English; the expressed ideas were coded and reduced into subthemes, themes and categories. Ethical clearance and permission to conduct study was sought, consents from participants were sought, clearly stating the right to participate and withdraw from the study was respected and anonymity and confidentiality has been ensured. The result of the study showed that participants encountered difficulty with cognition, (23.3% of participants reported severe difficulty in learning a new task; 20% reported severe difficulty analyzing and finding solution to day to day activities), mobility (34% acknowledged difficulty walking a long distance like one kilometer after stroke), self-care ( 44% indicated difficulty staying alone for few days after stroke, while the majority, 61% complaints of difficulty with getting dressed by self), getting along with people with the majority of the difficulties (36%) are sexual activities, household activities with major complaints (46.6% and 31.4%, for severity and exemption respectively) in getting needed household work done, severe difficulty (51.7%) reported in relaxation and pleasure after stroke, 50.8% been financially restrained after stroke, 40% with difficulty in joining in the community activities, 39.2% severely affected by people perception towards them and 25.8% of the participants indicated extreme time spent on health; all difficulties investigated within the society 30 days after the incidence of stroke. However, the result of the qualitative phase reported the participation restrictions experienced by the participants. Difficulty in cognition was reported, which promotes indiscipline among family members. Limitation in activity level such as in mobility (walking for a long distance, standing from a sitting position), in self-care (washing the whole body, eating, staying alone after stroke), in getting along (maintaining friendship, sexual activities), in household activities and work activities was reported. Participants experienced difficulty in joining in community activities, emotional fluctuations, poor perception of attitudes of others after stroke, excessive use of time on health conditions, increased financial impact of health condition and burden impact on family was reported. Environmental barriers such as transportation and toilet facilities were reported. The current study findings suggest appropriate and specific programmes should be aimed at improving participation among stroke survivors in the community.

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Rabie, Tinda. "Positive practice environments in community health centres of the North West Province: a case study / Tinda Rabie." Thesis, North-West University, 2012. http://hdl.handle.net/10394/9196.

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The practice environment of nurses plays a very important role in the delivery of quality health care. However, there is limited knowledge on what positive practice environments entail with specific reference to the primary health context of the public health care sector of South Africa. Nurses in this context are the frontline health personnel and are affected not only by nursing shortages, but also high workloads as the public health care sector serves 83% of the South African population and the private health care sector only 17%. In this study the researcher decided to conduct a study to explore the practice environment of nurses in the primary health care context as no studies have previously been undertaken in this regard. The researcher used a case study design with quantitative and qualitative approaches and implemented descriptive, explanatory and contextual strategies. This design, together with the findings of objectives one, two and three, the World Health Organization Strengthening of Health Systems and Fourteen Forces of Magnetism Frameworks and inductive and deductive logic enabled the researcher to achieve the overarching aim, which is objective four, of this study. Descriptive statistics, confirmatory factor analysis and Cronbach’s alpha assisted the researcher in assessing the demographic profile (objective 1) and the status of the practice environment of community health centres in North West Province (objective 2). Thereafter, the researcher was also able to identify the community health centre with the most favourable practice environment in order to conduct semi-structured individual interviews (objective 3). The descriptive data of objective 1 revealed that community health centres in the North West Province are located on average 36 km from the nearest referral hospital to which an average of five patients per day are referred. The average number of patients consulted per month is 3 545 of which the nurse consults an average of 40 and the physician 15 patients per day. In the community health centres the average age of nurses is 40, with 10 years of nursing experience. There were more female than male nurses of which 65% of the registered nurses had a diploma in nursing and had only started their careers at 31 years of age. There is an average of eleven registered nurses, five auxiliary and one enrolled nurse in the community health centres of which only four of the registered nurses (36%) had a qualification in Clinical Health Assessment, Treatment and Care. The overall staff turnover rates were very low and the satisfaction levels were high. The factor analysis of objective 2 revealed that the Practice Environment Scale of the Nursing Work Index’s sub-scales staffing and resource adequacy and nurse participation in primary health care/community health centre affairs had means below 2.5, indicating that nurses were not in agreement with these sub-scales. However, nurse manager ability, leadership and support; collegial nurse-physician relationships and nursing foundations for quality of care had a mean above 2.5 indicating that the nurses were in agreement with these sub-scales. Lastly, the qualitative findings indicated that although the community health centres with the most favourable practice environment were affected by factors that decrease quality of care which included a lack of resources, limited infrastructure, limited support from pharmacy and staff shortages. These mentioned factors were not in the control of the community health centres. Although the community health centres were affected by the above-mentioned factors these community health centres excelled in support, leadership and governance, collegial nurse-physician relationships and factors influencing quality of care which were in the control of the community health centre.
Thesis (PhD (Nursing))--North-West University, Potchefstroom Campus, 2013.

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Adamson, Kaashiefah. "Are we ready for an emergency." Thesis, Stellenbosch : University of Stellenbosch, 2015. http://hdl.handle.net/10019.1/97212.

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Introduction Trauma and emergencies contribute to the quadruple burden of disease in South Africa and being prepared for an emergency requires rapid access to emergency equipment, drugs and emergency trolleys to optimally manage an emergency. This is the first descriptive study looking specifically at essential emergency equipment, drugs and the emergency trolley required for the provision of optimal emergency care at Community Health Centres (CHCs) in the Western Cape Metropole. Aims and Objectives The aim of the study was to evaluate whether eight 24 hour emergency units at CHCs in the Western Cape Metropole had the appropriate and essential emergency equipment, drugs and emergency trolleys necessary for the delivery of optimal emergency care, using the Emergency Medicine Society of South Africa (EMSSA) guidelines as the audit tool. Objectives included: 1. To assess availability of essential emergency equipment 2. To assess availability of essential emergency drugs 3. To assess the functionality of existing emergency trolleys Methodology EMSSA guidelines were used as the evaluation audit tool to perform a survey of emergency equipment, drugs and emergency trolleys at eight 24 hour CHCs in the Western Cape Metro pole. Data collection for the study was conducted at the eight 24 hour CHCs over a 3 month period during the months of June 2012 to August 2012. The data was analyzed using the Statistical Package for Health Sciences (Statistica, version 10 of 2012) and Microsoft Excel. Results A total of 81 emergency equipment items, 43 emergency drug items (37 emergency drugs, 6 intravenous fluids) and 78 emergency trolley items were required to be in each emergency unit. An average of 62% of all recommended emergency equipment items, 80% of all emergency drugs and 52.4% of all emergency trolley items were found to be present in this survey. Essential emergency paediatric equipment including bag ventilation devices, Magill’s forceps, masks, intraosseous needles and appropriate blood pressure cuffs were found to be absent at 2 CHCs. All CHCs had access to a defibrillator and ECG machine but these were found to be dysfunctional at 2 CHCs due to expired batteries and no tracing paper being available. Expired first line emergency drugs (adrenaline and atropine) were found at certain CHCs. The recording of emergency trolley checklists and stocking of essential emergency items were found to be incongruent, inconsistent and not up to the recommended standard. Conclusion Essential emergency equipment and drugs and the functionality of emergency trolleys were found to be generally inadequate. Considerable deficiencies of essential emergency items were found, particularly paediatric equipment and drugs and this may negatively impact on resuscitative efforts and outcome in both paediatric and adult emergency care at CHCs in the Western Cape Metropole.

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Major-Helsloot, Mel. "Low back pain and associated factors among users of community health centres in South Africa : a prevalence study." Thesis, Stellenbosch : University of Stellenbosch, 2010. http://hdl.handle.net/10019.1/5439.

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Thesis (MScPhysio (Interdisciplinary Health Sciences. Physiotherapy))--University of Stellenobosch, 2010.
Background: Low back pain (LBP) has a high prevalence worldwide. LBP is significantly associated with a range of poor socio-demographic circumstances which should be addressed in preventive programs. Despite this there is a dearth of information about the prevalence and associated factors among low-income communities in South Africa. It is speculated that the burden of LBP may be most significant in these underprivileged communities. Objective: The objective of this study was to assess the prevalence of LBP among the lowincome communities in the Cape Town Metropole and to establish associated factors in order to make recommendations for management. Study design: A cross-sectional study was conducted among the visitors of eight community health centres (CHCs) in the Cape Town Metropole. Methodology: A new measurement tool was developed based on existing validated outcome measures and initial testing of the psychometric properties of the questionnaire was conducted. The questionnaire was administered to 489 eligible subjects. Descriptive analysis was used to describe the sample and logistic regression analytical techniques were applied to determine associated factors. Main findings: Lifetime prevalence for LBP was 76.49% (n=358). About 37% (n=133) suffered from chronic LBP. LBP was significantly associated with belonging to the black ethnic group, any co-morbidity, poor perceived general health, and any type of pain medication. Lifting weights > 20 kg and kneeling and squatting were physical factors significantly associated with LBP. Severe psychological distress was significantly associated with acute and chronic LBP. Having a better or same perceived general health compared to a year ago, was protective for LBP. Conclusion: LBP has a high prevalence among the low income communities, visiting the CHCs, in the Cape Town Metropole. Multiple factors were associated with LBP, which imply that a tailormade multidisciplinary program addressing lifestyle issues, self management strategies, medication use, chronic diseases and psychosocial factors may be required for this population to combat LBP.

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Majikela-Dlangamandla, Buyelwa. "An evaluation of health promoters' adherence to a planned diabetes educational intervention that includes motivational interviewing at community health centres in Cape Town." Master's thesis, University of Cape Town, 2014. http://hdl.handle.net/11427/6059.

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Jantjies, Monalisa Ayabulela. "A discursive exploration of managers’ competencies at community health centres in low socio-economic status communities in Cape Town." University of Western Cape, 2019. http://hdl.handle.net/11394/7427.

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Magister Artium (Development Studies) - MA(DVS)
South African health professionals’ competencies, especially those of managers have been placed under the spotlight. In the community health centres (CHCs) situated in low socio-economic status areas in Cape Town, a shortage of human resources has been an area of importance, as it exacerbates the impact of competence and service delivery by the healthcare managers.

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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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Yu, Chuan. "Breastfeeding and health outcomes in infants who receive continuing care from hospitals or community health centres in Chengdu Sichuan Province, People’s Republic of China." Thesis, Curtin University, 2013. http://hdl.handle.net/20.500.11937/544.

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Introduction. The child health is one of the most important indicators of population health and the development of society. The health of children in China has improved in the past decades. The child health care system has been established and improved. The child health care service is one of the most important ways to improve child health and protect child from illness and growth failure. Infant feeding consultation, especially advice on breastfeeding practices, is one of the major parts of child health care services. The ongoing health system reform in China provides opportunity for the further development of child health care services. Besides hospital outpatient clinics, infants can receive child health care from community health centres with the development of more community health services in China.The aims of this study are to determine infant feeding practices in the city of Chengdu in Sichuan Province and the factors associated with breastfeeding practices, and explore the differences of child health care outcomes, including breastfeeding rates and health outcomes, of infants receiving their health care at a hospital or a community health centre. The maternal perceptions of quality of the child health care services provided will also be assessed.Method. A cohort study of 845 mothers and infants (417 in the hospital group and 428 in the community health group) who received continuing child health care from hospital or community health centre, was undertaken to explore the infant feeding practices in Chengdu and associated factors between April 2010 and January 2012. Mothers were interviewed face to face within 15 days after their infants" birth and followed up through phone interviews at one, three and six months using structured questionnaires. A client perception study was undertaken at six and half months postpartum to study the quality of the continuing child health care services provided by the hospital outpatient clinic and child health care section of community health centre.Descriptive and univariate analysis were used to describe the socio-demographic characteristics of the observations and facilities, the breastfeeding related variables and the prevalence of breastfeeding at one, three and six months between community health centre and hospital groups. Logistic regression analyses were used to examine the factors associated with infant feeding practices. Survival analysis was performed to describe the duration of breastfeeding and the factors associated with the breastfeeding duration. The factors relating to health outcomes including infants‟ growth and illnesses were analysed using ANOVA, Chi-square test, and a logistic regression model. The clients perceptions of the child health care from community health centres and hospitals were assessed by descriptive and univariate analyses. All analyses were undertaken using PASW Statistics version 18.0.Results In this study, 93% of mothers initiated any breastfeeding within 15 days postpartum. The any breastfeeding rate was 88.0%, 73.4% and 55.4% at one, three and six months. The full breastfeeding rate was 63.9% at baseline, and dropped to 60.5% and 52.9% at one and three months and was only 3.2% at six months. Most mothers introduced solid foods to their infants after four months. The exclusive breastfeeding rate was 12.5% within 15 days, 5.7% at one month and 1.7% at three month postpartum due to the high rates of usage of prelacteal feeds. Only one mother was still exclusively breastfeeding her baby at six months. The median duration of any breastfeeding in this study was 6.50 months.In this study, the second objective was to determine the health status of infants up to six months and the relationship with breastfeeding practices. The male and female infants had an average weight of 8.45±0.87 kg and 7.91±0.80 kg and average height of 68.4±2.05 cm and 66.9±1.95 cm at six months. Half of infants in the study had experienced health problem within six months after birth. About 89% of the infants who reported having a health problem were taken to see doctors and 9.8% of them were admitted to hospital. Any breastfeeding for less than one month and early introduction of solid food before four months were associated with a higher prevalence of lower respiratory tract infection in the study.A high rate of use of prelacteal feeds was found in this study. Only 24% of infants were given breastmilk as their first feed and more than 65% were given a first feed of infant formula. Five infants received cow milk as their first feed. About 9.6% of infants were given water, including plain water, sugar water and water with herbs as their first feed. Several factors were found to be associated with the use of prelacteal feeds in this study, including delivery method, the length of time for infant-to-breast contact after birth, teaching by hospital staff about positioning and attachment of infant at breast, health problems of mother during pregnancy, paternal education level and paternal preference of feeding method.The factors that were identified to be associated with the initiation of full breastfeeding in the study were mothers had a job, paternal education level was at least high school or occupational school, caesarean delivery, intended to go back work within six months, first feed with breastmilk, and most of mothers friends breastfed their babies. The determinants that were found to be associated with establishment of any breastfeeding were higher paternal education level, paternal job was office job, staff did not encourage early infant-to-breast contact, staff encouraged and supported breastfeeding, father did not care infants feeding method or preferred infant formula, maternal grandmother breastfed at least one infant. The predictors that showed an association with discontinuing any breastfeeding before 12 months in cox regression model were paternal smoking, mother back to work within six months, first feed with breastmilk, introduction of complementary food before four months, mother had experienced health problems by six months, health staff had any conflict opinion on breastfeeding, mother was satisfied with her breastfeeding experience at one month.Comparison of breastfeeding rate and health outcomes in infants received child health care from community health centre and hospital is another important aim of the study. The any breastfeeding rate was higher in infants who received child health care from a community health centre compared to the infants who received child health care from a hospital outpatient department at one and three months. The prevalence of lower respiratory tract infection was found to be higher in the hospital group than the community health centre group.Mothers' perceptions of child health care services were investigated using a structured client perception questionnaire. The average total perception scores of child health care services were 54.23 (95% CI 53.79-54.68) and 46.50 (95% CI 45.79-47.21) for community health centre group and hospital group. The level of approval was significant higher in the community health centre group. Significantly higher scores for the community health centre attendees were found in all four subscales. Mothers' evaluation showed that the child health care services in community health centre were preferred to the hospital outpatient services.Conclusion. This study provided information on breastfeeding rates and health status of infants in Chengdu. But more importantly, it provided evidence to support the continued development of child health care services in community health centres. The breastfeeding rate was found to be higher in infants who received child health care from community health centre in comparison with infants who received child health care from hospital outpatient clinics. There was no difference in the growth rates of infants in community health centre group compared to those infants from the hospital group. Compared with infants who received their child health care in hospital outpatient clinic, the prevalence of lower respiratory tract infection was lower in infants who received child health care in community health centres. The maternal perception score on child health care services and facility was higher in community health centre group than hospital group. These results provide support for the continuing support and expansion of child health care services in community health centre in preference to receiving regular child health care services from hospital outpatient departments. The promotion of child health care services in community health centres by the government will be beneficial to residents and their children.

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Tembon, Chi Andy. "The demand for outpatient care in a health district in the North West Province of Cameroon : an empirical investigation into the potential effects of introducing community financing in public health centres." Thesis, London School of Hygiene and Tropical Medicine (University of London), 1994. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.286412.

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Dumisani-Ndlovu, Sidumisile Charity, Balandeli S. I. Sonti, and S. James. "Knowledge of midwives at Community Health Centres and Midwife Obstetrics Units in the Nelson Mandela Bay regarding the use of the Road-to-Health Chart." Thesis, Nelson Mandela Metropolitan University, 2017. http://hdl.handle.net/10948/21692.

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The challenge of child mortality between the ages of 0 and 5 years has extensively increased over the past few years. Furthermore, the ever-evolving and complex consequences of ineffective monitoring of children’s growth and development have been identified as one of the reasons for this increase in child mortality. The Road-to-Health Chart was developed and redesigned for use by child nurses and midwives to monitor children’s growth and development. The purpose of this study was to investigate whether the midwives at community healthcare centres in the Nelson Mandela Bay area had the necessary knowledge to utilise the Road-to-Health Chart effectively. Permission to conduct the study was sought from the Nelson Mandela Metropolitan University, the Department of Health and the participants. A quantitative, non-experimental descriptive survey was used in this research. The population consisted of all the midwives working in the Midwife Obstetric Unit and community healthcare centres within the Nelson Mandela Bay Municipal area. The sample was extracted from the targeted population but from willing participants that met the inclusion criteria. The research data-collection method was a self-developed questionnaire with closed-ended statements to measure the knowledge of how effectively the midwives in the Nelson Mandela Bay area were using the RTHC. The researcher ensured the validity of the questionnaire by focusing on the instrument’s validity, construct validity, content validity and face validity. Ethical considerations, including permission, informed consent, confidentiality and anonymity, were adhered to. The most significant findings showed that midwives at CHCs and MOUs in the Nelson Mandel Bay area were knowledgeable about the importance of the RTHC to the mother and child and the use of the RTHC. These findings may assist in the identification of measures to enhance the knowledge of midwives about the use of the RTHC thus ultimately facilitating the use of the RTHC by mothers as intended.

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Mfundisi, Nokwamkela Pearl. "Client satisfaction with midwifery services rendered at Empilweni Gompo and Nontyuatyambo community health centres in the Eastern Cape, South Africa." Thesis, University of Fort Hare, 2013. http://hdl.handle.net/10353/d1006902.

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The aim of this study was to investigate whether patients were satisfied with midwifery services rendered at the two Community Health Centres in the Eastern Cape Province.The study sites were Empilweni Gompo and Nontyatyambo Community Health Centres. Descriptive quantitative study design was employed, using a questionnaire with closed and open ended questions as the data collecting tool. Likert Scale was used to measure the following variables: quality care variables to measure level of satisfaction with midwifery services rendered and to determine positive and negative perceptions regarding quality of care received during antenatal, labour and postnatal period. Non-random convenience sampling of sixty pregnant women, thirty from each Community Health Centre, with two or more antenatal subsequent visits and forty postpartum women, twenty from each health facility, six hours after delivery if there were no complications. Out of 60 participants interviewed n=60 (100 percent) agreed that individual counseling and importance of HIV testing was explained.The majority of participants n=53(88 percent) disagreed that they were educated about focused antenatal visits. Out of 60 participants interviewed n=41(68 percent) agreed that delivery plan formed part of their ANC visits and n=18 (30 percent) disagreed. Of the 60 participants interviewed n=11(18 percent) agreed that they were told that they had the right to choose labour companions and n=48 (80 percent) disagreed.Out of 60 participants interviewed n=23 (38 percent) stated that they waited a long period of time without being attended to by midwives. In general, the study revealed high satisfaction level with intrapartum and postnatal care due to functional accessibility of both Community Health Centres. Both health centres delivered normal healthy babies and mothers. However, the participants were dissatisfied with antenatal care rendered at the two facilities. The researcher’s recommendations were based on the closing of gaps that were identified with regard to the implementation of Basic Antenatal Care; birth companions: health education deficiency; community involvement and participation.

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Govender, Indira. "An evaluation of the clinical audit of diabetes management at community health centres in the metro district of the Western Cape Province." Master's thesis, University of Cape Town, 2011. http://hdl.handle.net/11427/10543.

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Duffy, Marina. "The impact of Ireland’s current Mental Health Policy on the profile of community mental Health Services." Master's thesis, Faculdade de Ciências Médicas, 2013. http://hdl.handle.net/10362/10861.

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RESUMO: Em 2006, foi aprovada uma nova política governamental para a saúde mental intitulada “Uma Visão para a Mudança”, a qual está neste momento no sétimo ano de implementação. A política descreve um enquadramento para o desenvolvimento e promoção da saúde mental positiva para toda a Comunidade e para a prestação de serviços acessíveis, baseados na comunidade, serviços especializados para pessoas com doença mental. A implementação da política e o tornar a “Vision for Change” uma realidade têm sido problemáticos, com críticas consideráveis por parte dos intervenientes, relativas à lenta e desconexa implementação. Este estudo fornece informação sobre as características dos serviços de três importantes tipos de instituições de saúde mental comunitária a nível nacional, nomeadamente Hospitais de Dia, Centros de Dia e residências comunitárias operantes 24 horas. A pesquisa analisa objetivos e funções, perfis dos pacientes, atividades terapêuticas, a eficácia das redes de comunicação e beneficia da perspectiva dos funcionários sobre o que mudou no terreno ao longo dos últimos sete anos. As questões identificadas a partir das características dos três serviços dizem respeito a todos. Os participantes indicaram que o ethos da recuperação parece ter alcançado um papel mais central no tratamento do paciente na comunidade mas reconheceram que o desafio de integrar os princípios de recuperação na prática clínica se mantém presente. Parece ser reconhecida a importância da planificação do cuidado individual nos serviços comunitários e os entrevistados indicaram que existe um empenho para garantir o envolvimento do usuário do serviço. Há diferenças entre os „pontos de vista do pessoal‟ e os „pontos de vista dos representantes‟ sobre uma série de aspetos da prestação de serviços. Este é o primeiro estudo irlandês deste género a examinar a prestação de serviços das três principais instituições comunitárias de saúde mental num só estudo. Estes serviços representam um enorme investimento em recursos, quer a nível monetário, quer humano. O estudo examinou os desafios e as questões fundamentais que lhe são aplicáveis e que têm impacto nestes três tipos de prestação de serviços. Também forneceu informações sobre os elementos de mudança positiva, os quais se começam a focar lentamente na prestação do serviço, assim como na importância da centralidade do utilizador do serviço e na promoção de um ethos da recuperação.----------ABSTRACT: In 2006, a new Government policy for mental health “A Vision for Change” was endorsed and is currently in the seventh year of implementation. The policy describes a comprehensive framework for building and fostering positive mental health across the entire community and for providing accessible, community based, specialist services for people with mental illness. The implementation of the policy and turning “Vision for Change” into reality has been problematic with considerable criticism from stakeholders concerning slow and disjointed implementation. This study provides information on three key community mental health service settings, namely Day Hospitals, Day Centres and 24 Hour Community Residences at a national level. The research looks at aims and functions, patient profiles, therapeutic activities, effectiveness of key communication networks and gains an insight from staff on what has changed on the ground over the past seven years. Issues identified from the three service settings pertain to all. Participants indicated that the recovery ethos appears to have moved to a more central role in patient care in the community but acknowledged that the challenge of integrating recovery principles in clinical practice remains present. The importance of individual care planning appears to be recognised in community services and respondents indicated that efforts are being made to ensure service user involvement. There were differences between „staff views‟ and „advocate views‟ on a number of aspects of service provision. This is the first Irish study of its kind to examine service provision across the three main community mental health settings in one study. These services represent a huge investment in resources both on a monetary and human level. This study has examined the challenges and key issues which are applicable and impacting on all three types of service provision. It has also provided information on the elements of positive change, which are slowly embedding themselves in service provision such as the importance of the centricity of the service user and the promotion of a recovery ethos.

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Ellsahli, Lutfia Ali. "The management of Bell’s palsy at selected community health centres in the Cape Metropolitan District of the Western Cape, South Africa." University of the Western Cape, 2015. http://hdl.handle.net/11394/4733.

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Magister Scientiae (Physiotherapy) - MSc(Physio)
Bell’s palsy (BP), a fairly common disorder predominantly prevalent in the adult age group, affects nerves and muscles in the face causing paralysis or dropping of one side of the face. Clients with Bell’s palsy face many challenges, including psychological, physical and emotional. A long recovery period and/or delayed complete healing could lead to a negative effect on many aspects of an individual's life. How society perceives the person could negatively influence the client’s self-confidence. The management of Bell’s palsy depends on the individual case and may include medication, physiotherapy and as a last option, surgery. The aim of the study was to investigate the management of Bell’s palsy at primary health care level in the Cape Metropolitan District of the Western Cape. The study specific objectives was to investigate the management or treatment protocol of clients with Bell’s palsy, to determine the tendency for referral for physiotherapy, to determine whether an association exists between the type of management or treatment received and the recovery of clients with Bell’s palsy and to explore the impact Bell's Palsy has on the clients. The over-arching design of the study was the sequential explanatory mixed methods design where qualitative data was used to assist in explaining and interpreting the findings of a primarily quantitative study. Stratified random sampling was done proportionately to ensure equal representation. A self-administered questionnaire, comprising of four sections, was used to collect quantitative data that was analysed using SPSS version 21. Descriptive statistics was employed to summarise the data on the socio-demographic information of the clients. Inferential statistics was used to determine the distributions of cases in the various groups. Significant differences tested for using the Chisquare test and effect size through Cramer’s V tests. A semi-structured interview guide was developed based on the results of the analysis of the quantitative data. Focus group discussions were employed to a sub-sample of the clients with Bell’s palsy. Permission an ethical clearance will be obtained from Senate Higher Degrees Committee at the University of the Western Cape (UWC), the Western Cape Department of Health and the facility managers of the participating CHCs.

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Li, Zelin. "A socio-technical approach for mobile health informatics together with organisational change : case studies in community healthcare service centres in China." Thesis, Kingston University, 2011. http://eprints.kingston.ac.uk/22965/.

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This thesis addresses the theory of Socio-Technical Systems (STS) within the context of Information Systems (IS), a complicated field combining Information Technology and social shaping impacts. IS have been changing our society for some decades. From Office Automation (OA) to E-Commerce and E-government, IS are creating a new era of Mobilisation. Different industries have all been adopting Information Technology to enhance their business, from enterprises to public sectors. All these changes bring dramatic impacts for organisational behaviour and people's living, which need to be studied. According to academic literature, health informatics, being one of the important and complex fields in IS, started to employ mobile technical systems to improve healthcare service delivery for citizens at the start of the new Millennium. Comparing with other theoretical models in IS, the author argues that the Socio-Technical approach can explain comprehensively the new changes to organisations and society. Following the theories of STS, these case studies were decided by the researchers as field work in Chinese Community Healthcare Service Centres, where there are various mobile services for the citizens. Through multiple case studies, the author found that Leader Emphasis is one new social element in the field of the IS, while Participation, as another social element is essential to the context of this research project. These two social shaping elements, combining together within a model of STS, provide new decision making process, which is vital to a successful development of Mobile Health Information Systems (MHIS). The model has affected organisational behaviour, organisational structure, culture and society, following the usage of Mobile IS. Based on the result of the field work and the relevant literature of E-govemment, this research also concludes that M-govemment can be the transformation of E-govemment, as public service can be delivered efficiently by Mobile IS. A developing model is presented in this thesis.

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Nygaard, Bjørn. "WHO CC Affiliate Safe Community Support Centres og deres rolle i Safe-Community bevegelsen : En studie av organisering, utvikling og framtid." Thesis, Nordic School of Public Health NHV, 2007. http://urn.kb.se/resolve?urn=urn:nbn:se:norden:org:diva-3225.

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Den internasjonale Safe-Community (SC) bevegelsen vokser stadig. Denne studien setter søkelyset på de såkalte Affiliate Safe Community Support Centres (ASC) og deres rolle i bevegelsen. SC-begrepet blir behandlet både som en innovasjon og som en organisasjons- modell som utbres etter Rogers og Røviks teorier. ASCene ses på som ”forandrings-agenturer” i følge disse teoriene. Studien er en case-study i følge Yin, og dekker 9 av ialt 15 ASCer. Tre av dem har mistet sin status som ASC, seks av dem har sin status i behold. De følgende fem påstander blir studert: 1)Det er ingen forskjell i hvordan sentrene har utøvet sin rolle som årsak til at noen mister sin status og andre ikke. 2)Årsakene til at noen mister sin status ligger i interne organisasjonsmessige, personalmessige eller økonomiske forhold. 3) ASC’ene og deres oppgaver er ikke særlig godt kjent blant ”brukerne” 4)ASC’ene har et svakt eller lite bevisst forhold til det teoretiske og vitenskapelige grunnlag for spredningsprosesser 5)SC-begrepet oppfattes i liten grad som en organisasjonsmodell på linje med andre organisasjonsmodeller. Data ble samlet inn fra spørreskjemaundersøkelser, skriftlig materiale og intervju. Materialet omfatter alle ”nivåer” i SC-bevegelsen. Alle fem påstander ble styrket av materialet. Studien har ledet til følgende konklusjoner og anbefalinger som forhåpentligvis kan styrke både renommé og effektivitet i SC-bevegelsen og lette arbeidet i ASCene: Organisasjonsteori og organisasjonsspørsmål må i langt større grad settes på dagsorden i bevegelsen. Vekst og utbredelse av SC-”ideén” får for stor plass i forhold til konsolidering. Det forekommer konflikter mellom ASC-arbeidet og andre arbeidsoppgaver. Det gjelder særlig når det gjelder prioriteringen mellom forsking og arbeidet med å utbre SC-modellen. ASCene har ikke tilstrekkelig kapasitet til å følge opp veksten i SC-bevegelsen. Begge disse forhold synes hovedsakelig å bunne i mangel på finansiering og mangel på planmessig utbygging. Mangel på planmessig organisering av bevegelsen er foruroligende. Dersom det ikke blir tatt tak i denne manglende organiseringen, vil det kunne være til hinder for videre utbredelse og i verste fall virke ødeleggende for bevegelsen. Det må også pekes på kvinnenes sterke, til dels dominerende stilling
The international Safe-Community (SC) movement is steadily growing. This study highlights the so-called Affiliate Safe Community Support Centres (ASC) and their role in the movement. The concept of SC is treated as an innovation and an organisational model diffusing according to the theories of Rogers and Røvik. The ASCs are looked upon as ”change agencies” according to these theories. This is a case-study according to Yin of 9 out of 15 ASCs. Three of them have lost their status as ASC, six still have their status. The following five propositions are examined: 1.There are no differences in how the ASCs have executed their role that can explain why some have lost their status and some not. 2.The reason why some have lost their status can be explained by internal organisational, personal or economic conditions. 3.The ASCs and their tasks are not well known by the ”users”. 4.The ASCs have a weak or little conscious relations to the theoretical and scientific foundation of diffusion processes. 5.The SC-concept is to a very little degree considered as an organisational model. Data was collected from surveys and interviews with people at all ”levels” of the SC-movement as well as written material. All five propositions were strengthened by the material. The study leads to the following conclusions and recommendations which hopefully can improve the reputation and efficiency of the SC-movement and ease the work of the ASCs: The ASCs have an important role in the movement, but they are too few to serve an increasing number of SCs. The development of new ASCs should go on simultaneously with the increase of SCs. It is also necessary with a geographical distribution corresponding with the distribution of the SCs. The economy of the ASC-work has a very weak foundation, and this should be taken more seriously. There are conflicts between ASC-work and other tasks. There are no indications that certain models of internal organisation or company construction are more functional than others. Organisational matters are not considered sufficiently important. This is alarming, and may threaten the existence of the whole movement if not taken more seriously. It must be a responsibility of the WHO Collaborating Centre to bring these matters to discussion. There are few other arenas for these discussions than the regional and world-wide conferences. But in addition the institutions teaching SC-issues have a responsibility for taking up these topics in their education programmes. Women have a very strong position in the ASC. But it is not possible from this material to draw conclusions as to whether their position has influenced the priorities or choice of topics in the ASC-work.

ISBN 978-9185721-08-5

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Mtwana, N. B. "The exploration of health seeking behaviour of clients presenting with minor ailments attending community health centres in Khayelitsha (Michael Mapongwana, Site B) and Phillipi (Inzame Zabantu, Mzamomhle)." Master's thesis, University of Cape Town, 2005. http://hdl.handle.net/11427/3436.

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Includes bibliographical references.
CHCs in Khayelitsha and Phillipi are overcrowded and overburdened with clients who tend to present with minor ailments. The problem of overcrowding of the CHCs with such clients poses a problem to the health professional as they do not have sufficient time to manage clients with more serious ailments and to educate those with minor health ailments. This problem of overcrowding of CHCs in Khayelitsha and Phillipi with clients presenting with minor health ailments was brough to a community health forum meeting that constituted the management of CHCs, clinical facilitators from the University of Cape Town (UCT) and elderly persons from Khayelitsha and Phillipi in 2001. At this meeting questions were raised regarding the health seeking behaviour of the clients that are presenting with minor health ailments and overcrowding the CHCs.

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Larkin, Christine M. A., and N/A. "Social work and racism : a case study in ACT Health." University of Canberra. Education, 1994. http://erl.canberra.edu.au./public/adt-AUC20060815.160708.

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A Feminist Action Research methodology was used as a collaborative process with five ACT Health social workers based at the Community Health Centres and four at the Woden Valley Hospital. The primary purpose of the study was to investigate, both through critical reflection and action in their work setting, the participants' relevance or otherwise to Aboriginal people in the ACT and region. Behind this is the question of how encapsulated social work is by racism. The impetus for the study arose from my unresolved concerns regarding these issues, having been a social worker in ACT Health for 6 years, to 1990. Decisions on how to proceed involved a process of ongoing consultation between the participant social workers and myself. Exploratory meetings were held in March and April, with an ongoing program being held 2-3 weekly from June to September, followed by a review in December. Most gatherings were specific to the Woden Valley Hospital or Community Health settings. However two half-day workshops were held for all the participants. All the sessions from June were taped. Aboriginal leaders were consulted, as were several managers in ACT Health. The phenomena of institutional, cultural and personal racism were addressed by the social workers through discussion, exercises, and anti-racist initiatives in their work setting. They found that significant time restraints presented an example of institutional racism working against their good intentions. Another dimension arose from implicitly racist education in social work courses when most of the participants undertook their undergraduate courses in the 1960s and 1970s. Aspects related to professionalism such as its language and separation of a personal and professional self were indicative of cultural racism. Stories of personal racism were shared, in the context of raised awareness leading to changing those attitudes and behaviours. The fact that the study took place in 1993 - a watershed year for Aboriginal/white relations in Australia - seemed to lead to greater momentum for the project. The social workers found that participation in this study increased their knowledge of, and their confidence - both actual and potential - in interaction with Aboriginal people. However, they also understood these to be just small steps towards greater justice for the indigenous people. An outcome of the project has been involving some colleagues in similar anti-racist actions to those the social workers participated in during the time of the study. The action research project has continued on in different ways, beyond 1993, despite my withdrawal as 'the researcher' who took the initiative.

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Malise, Nthabeleng. "The role of a quality assurance programme in promoting patient satisfaction and safety in community health centres of Emfuleni Local Municipality / Nthabeleng Malise." Thesis, North-West University, 2013. http://hdl.handle.net/10394/10642.

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This study concentrates on the strategic framework of quality assurance in the South African health sector. The study focused the Community Health Centres (CHCs) situated in the Emfuleni Local Municipality (ELM). The study aimed to analyse the administrative issues of a quality assurance programme for promoting patient satisfaction and safety in the CHCs of the ELM. The position of patients in the health services emanates from the provision made by the Constitution of the Republic of South Africa Act of 1996 (hereafter „the Constitution‟). Two of the objectives of the Constitution are to “provide services that are sustainable” and to “promote a safe and healthy environment”. In addition the health care sector in South Africa also places patients at the forefront. The Constitution also makes provision whereby municipalities are required to encourage the involvement of communities in the affairs of the local government. Patient satisfaction represents intense interest in giving voice to the patients in the developed world, whereas patients in the developing countries have very little voice. Quality assurance is defined as a process which ensures that any product or service meets a required standard which has been set. Quality assurance as a process can be compared to the framework of a house and the foundation is always linked to customer needs. Quality Assurance as a tool strives to establish and maintain quality improvement activities which are integral and sustainable part in any organization. The main objective of this study was to evaluate main models, approaches and indicators used to implement a quality assurance programme within the CHC‟s. The study also provides ecommendations of how quality could be improved, based on the perception of the service users. For this study, a qualitative technique was used for data collection. A qualitative method was also used to report statistical data provided in Chapter 4. The objectives were realised by means of literature reviews, interviews and field work. The study found that a quality assurance programme is meaningful and has reached the needs of the patients. Access to the CHCs was impressive as the services offered were generally of good quality. However, the participants still does not understand the role of the CHCs. The CHCs was established to offer services which are closer to the people as compared to public hospitals. The hospitals provide chronic patient treatment with specialised resources (staff and equipment) whereas the CHCs offer acute treatment. The staff complement was assuring whereby there is a medical doctor allocated to each facility. Many community members still need to be educated about the services offered in the CHCs. Such awareness would empower the health service users about the benefits of the CHCs and to retain public trust for improved health service delivery.
M Development and Management (Public Management and Governance), North-West University, Vaal Triangle Campus, 2014

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Tana, Vuyiswa Veronica. "Experiences of chronic patients about long waiting time at a community health care centre in the Western Cape." Thesis, Stellenbosch : Stellenbosch University, 2013. http://hdl.handle.net/10019.1/80332.

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Thesis (MCurr)--Stellenbosch University, 2013.
ENGLISH ABSTRACT: The objectives of this study were to explore patients’ experiences about long waiting time at the Vanguard Community Health Care Centre in the Western Cape and to explore possible solutions for this problem from the patients’ perspective. A qualitative research approach was applied. A sample size of (n=12) was drawn from a total population of 2829 (N=2829) using a non-random convenient sampling technique. A semi-structured interview guide was designed based on the objectives of the study and validated by experts in the field before data collection took place. Approval for the study was obtained from the Ethics Committee at the faculty of Health Sciences, Stellenbosch University and from the facility manager of health centre where the study was to be undertaken. The presentation of the results was categorised into themes and sub-themes that emerged from the data analysis. According to the findings in chapter 4 the themes that emerged were: Causes of long waiting time Areas of concern where waiting occurs most Emotions experienced when waiting long for service Possible solutions to waiting long for service The findings support the conceptual framework developed for the purpose of this study which includes the Patient’s Bill of Rights, the Principles of Batho Pele, Quality Care, Patients’ Representation and Patient satisfaction. The results of the study suggests that the conceptual framework needs to be implemented as a guideline to address the problems of long waiting time with the input from the participants’ opinions about possible solutions to be incorporated to the problem of long waiting time at the community health centre.
AFRIKAANSE OPSOMMING: Die doelwitte van die studie was om pasiente se gevoelens oor lang wagtye by Vanguard Gemeenskapsgesondheidsentrum in die Wes-Kaap te ondersoek en om moontlike oplossings vir hierdie probleem vanaf die pasient se perspektief te bepaal ‘n Kwalitatiewe navorsingsbenadering is gebruik. ‘n Steekproefgrootte van (n=12) is verkry vanaf ‘n totale bevolking van 2829 (N= 2829) deur die gebruik van ‘n nie-ewekansige gerieflike steekproefneming tegniek. ‘n Semi-gestruktureerde onderhoudgids is ontwerp gebaseer op die doelwitte van die studie. Die onderhoudgids is geldig bevind deur spesialiste in die gebied voor data insameling plaasgevind het. Goedkeuring vir die studie is verkry van die Etiese Komitee by die Fakulteit Gesondheidswetenskappe, Stellenbosch Universiteit en van die bestuurder van die gesondheidsentrum waar die studie uitgevoer sou word. Resultate is rangskik in temas en subtemas wat afgelei is van die data analise. Die volgende temas is bepaal vanuit Hoofstuk 4 se bevindinge: Redes vir lang wagtye Areas waar lang wagtye voorkom Emosies ondervind wanneer lank gewag moet word vir diens Moontlike oplossings vir lang wagtye Die bevindinge ondersteun die konseptuele raamwerk ontwikkel vir die doel van die studie wat die Handves van Regte vir pasiente, die beginsels van Batho Pele, Kwaliteitsorg, Pasient verteenwoordiging en Pasienttevredenheid insluit. Die bevindinge van die studie dui aan dat die konseptuele raamwerk geimplementeer moet word as riglyn om die probleme wat ervaar word met lang wagtye aan te spreek. Die deelnemers se menings oor moontlike oplossings moet deel moet wees van die aanspreek van die probleem van lang wagtye in die gemeenskapsgesondheidsentrum.

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Leach, Sarah Elizabeth, and kimg@deakin edu au. "Nursing Work and Nursing Knowledge: Exploring the Work of Womens' Health Nurses Patterns of Power and Praxis." Deakin University. Nursing, 1998. http://tux.lib.deakin.edu.au./adt-VDU/public/adt-VDU20031126.084144.

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The majority of women's health nurses in this study work in generalist community health centres. They have developed their praxis within the philosophy and policies of the broader women's health movement and primary health care principles in Australia. The fundamental assumption underlying this study is that women's health nurses possess a unique body of knowledge and clinical wisdom that has not been previously documented and explored. The epistemological base from which these nurses' operate offers important insights into the substantive issues that create and continually shape the practice world of nurses and their clients. Whether this represents a (re)construction of the dominant forms of health care service delivery for women is examined in this study. The study specifically aims at exploring the practice issues and experience of women's health service provision by women's health nurses in the context of the provision of cervical cancer screening services. In mapping this particular group of nurses practice, it sets out to examine the professional and theoretical issues in contemporary nursing and women's health care. In critically analysing the powerful discourses that shape and reshape nursing work, the study raises the concern that previous analyses of pursing work tend to universalise the structural and social subordination of nurses and nursing knowledge. This universalism is most often based on examples of midwifery and nursing work in hospital settings, and subsequently, because of these conceptualisations, all of nursing is too often deemed as a dependent occupation, with little agency, and is analysed as always in relation to medicine, to hospitals, to other knowledge forms. Denoting certain discourses as dominant proposes a relationship of power and knowledge and the thesis argues that all work relations and practices in health are structured by certain power/knowledge relations. This analysis reveals that there IX are many competing and complimentary power/knowledge relations that structure nursing, but that nursing, and in particular women's health nurses, also challenge the power/knowledge relations around them. Through examining theories of power and knowledge the analysis, argues that theoretical eclecticism is necessary to address the complex and varied nature of nursing work. In particular it identifies that postmodern and radical feminist theorising provide the most appropriate framework to further analyse and interpret the work of women's health nurses. Fundamental to the position argued in this thesis is a feminist perspective. This position creates important theoretical and methodological links throughout the whole study. Feminist methodology was employed to guide the design, the collection and the analysis. Intrinsic to this process was the use of the 'voices' of women's health nurses as the basis for theorising. The 'voices' of these nurses are highlighted in the chapters as italicised bold script. A constant companion along the way in examining women's health nurses' work, was the reflexivity with feminist research processes, the theoretical discussions and their 'voices'. Capturing and analysing descriptive accounts of nursing praxis is seen in this thesis as providing a way to theorise about nursing work. This methodology is able to demonstrate the knowledge forms embedded in clinical nursing praxis. Three conceptual threads emerge throughout the discussions: one focuses on nursing praxis as a distinct process, with its own distinct epistemological base rather than in relation to 'other' knowledge forms; another describes the medical restriction and opposition as experienced by this group of nurses, but also of their resistance to medical opposition. The third theme apparent from the interviews, and which was conceptualised as beyond resistance, was the description of the alternative discourses evident in nursing work, and this focused on notions of being a professional and on autonomous nursing praxis. This study concludes that rather than accepting the totalising discourses about nursing there are examples within nursing of resistanceboth ideologically and X in practiceto these dominant discourses. Women's health nurses represent an important model of women's health service delivery, an analysis of which can contribute to critically reflecting on the 'paradigm of oppression' cited in nursing and about nursing more generally. Reflecting on women's health service delivery also has relevance in today's policy environment, where structural shifts in Commonwealth/State funding arrangements in community based care, may undermine women's health programs. In summary this study identifies three important propositions for nursing: nursing praxis can reconstruct traditional models of health care; nursing praxis is powerful and able to 'resist' dominant discourses; and nursing praxis can be transformative. Joining feminist perspectives and alternative analyses of power provides a pluralistic and emancipatory politics for viewing, describing and analysing 'other' nursing work. At the micro sites of power and knowledge relationsin the everyday practice worlds of nurses, of negotiation and renegotiation, of work on the margins and at the centrewomen's health nurses' praxis operates as a positive, productive and reconstructive force in health care.

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Werfalli, Mahmoud. "Informing the development of a self-management care programme for older people with type 2 diabetes attending community health centres in Cape Town, South Africa." Doctoral thesis, Faculty of Health Sciences, 2019. http://hdl.handle.net/11427/30420.

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Diabetes is a growing problem globally, with the major impact being experienced in low and middle-income countries. In 2017, there were an estimated 122.8 million people over the age of 65 years living with diabetes globally, with a prevalence of 18.8% and 3.2 million deaths at this age. If the trends continue, the number of people living with diabetes over the age of 65 years will be 253.4 million in 2045.This is being driven by demographic changes including the ageing of the population. In South Africa, diabetes is a major cause of morbidity and mortality and a burden to the overstretched health services, community, family and people with the disease. Self- care management is a cornerstone of diabetes care. The purpose of this thesis is to inform the development of a self-care management programme for older people attending public sector primary health care services in Cape Town, South Africa by using the PRECEDE planning model. This model provides an eight-phase framework for health care professionals to determine, develop, implement and assess health promotion programmes, as well as the application of health promotion theories systematically within such programmes. The thesis incorporates five interlinked studies, presented as five publications, two published and three in review: The first was a systematic review of studies that assessed the prevalence of type 2 diabetes mellitus among older people in African countries conducted between 2000 and 2015 with the objective of providing data for the monitoring of future trends. This demonstrates that type 2 diabetes is not rare in individuals aged 55 years and older across Africa – the overall prevalence of diabetes was 13.7% (95% CI 11·3–16·3) and was twofold higher in studies based on the oral glucose tolerance test than in those using fasting plasma blood glucose. The second is a secondary analysis of the Study on global AGEing and adult health (SAGE) South Africa Wave 1 data that examined the prevalence of self-reported diabetes and the association between diabetes and each of health-related quality of life and disability amongst South Africa’s older adults. The results were that diabetes was associated with lower quality of life and greater disability: it represented not only a risk factor for disability but was associated with a range of impairments and co-morbidities predisposing to loss of autonomy. The third, a cross-sectional survey, examines the knowledge of older people with diabetes attending primary care clinics in Cape Town, South Africa, about living with and managing their diabetes; and aims to determine the relationship of social support, especially that of family and friends with their self-management. Its major finding is that there was a lack of knowledge about the complications of diabetes, suggesting that the available diabetes educational opportunities have not been effective. Importantly, however, social support was positively associated with both knowledge and a number of self-care aspects. The fourth is a qualitative study consisting of documentary review and individual interviews with key informants to investigate the current policies, programmes and any other interventions as they relate to older people with diabetes. This found that generally older persons face numerous barriers in managing their condition. Further, there are multiple efforts to re-orientate the healthcare system to focus more effectively on non-communicable diseases for the population which would benefit older patients with diabetes. Finally, the study includes a systematic review of peer and non-professional health worker-led diabetes self-management programmes (COMP-DSMP) in low and middle-income country primary health care settings, and also examines the implementation strategies and associated diabetes-related health outcomes This found equivocal evidence supporting the use of COMP-DSMP for people with diabetes in these countries and suggested that the models of a peer/CHW-led programme need to be further explored, especially given the inevitability of a professional healthcare workforce shortage in LMICs. In conclusion, this research study has described the extent of the need for developing and evaluating education programmes that focus on older people with diabetes and emphasises the role of family and friends. Whilst there have been some significant policy interventions pertaining to the protection of the health and welfare of older persons in SA, the needs of this vulnerable group remain relatively low on the list of priorities in terms of focus and resource allocation. In this context, older people, as a distinct group, are also not a strong focus in current health policy relating to the provision of NCD care. This thesis alerts policymakers and clinicians to some of the specific issues considered to be pertinent and important in the care and management of older persons with diabetes. Many of these would also be applicable to older individuals with other chronic conditions.

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Mkhencele, Nontando Precious. "Evaluation of the role of support groups in the lives of HIV positive people at Nontyatyambo and Empilweni Gompo Community Health Centres in East London, Eastern Cape." Thesis, University of Fort Hare, 2011. http://hdl.handle.net/10353/d1001094.

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South Africa has the highest number of people living with HIV/AIDS in the world. The estimated 5,7 million South Africans that are living with HIV need comprehensive and holistic care. Psychosocial support is a vital aspect of care for HIV positive people. Support groups have been identified as a basic form of psychosocial support. The aim of this study was to evaluate the role of support groups in the lives of HIV positive people in East London, Eastern Cape. A qualitative study design was implemented using focus group interviews to explore the role of HIV support groups. The research questions were designed to elicit responses pertaining to the needs, expectations and experiences of HIV positive support group attendees. Activities conducted in support groups as well as the attitude of support group members towards recruiting other HIV positive people to join the group were also explored. Findings revealed that the benefits of attending a support group included emotional and psychological support, sense of belonging to a “family”, assistance with disclosure issues, gaining information about HIV and treatment as well as material benefits such as food parcels and job opportunities. The greatest need of support group attendees was assistance in obtaining a Social Support or Disability Grant. A few negative experiences were reported which included: unfulfilled promises by people outside of the group, unfair allocation of grants and food parcels, as well as negative group dynamics at times. Support group members agreed that even though there were few negative experiences, the benefits clearly outweighed the negative experiences. Most participants agreed that they would recommend the support group to other HIV positive people so that they could also enjoy the stated benefits. In summary, the study concluded that support groups are very helpful in the lives of HIV positive people.

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Holst, Martina, and Jenny Ankarstrand. "Ge egenvårdsråd till föräldrar : En intervjustudie om distriktssköterskors erfarenheter i telefonrådgivning." Thesis, Jönköping University, Hälsohögskolan, 2021. http://urn.kb.se/resolve?urn=urn:nbn:se:hj:diva-51619.

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Bakgrund: Av alla telefonsamtal från föräldrar till vårdcentralen får hälften av dessa egenvårdsråd till sina barn, vilket kan främja hälsa, förhindra och förebygga sjukdom. Om förmågan till egenvård sviktar hos föräldrarna har distriktssköterskorna en viktig roll i att stötta och undervisa. Syfte: Att beskriva distriktssköterskors erfarenheter av att ge egenvårdsråd till föräldrar i telefonrådgivning på vårdcentral. Metod: Studien genomfördes med kvalitativ metod med induktiv ansats. Datainsamlingen bestod av 12 semistrukturerade intervjuer med distriktssköterskor på vårdcentral. Materialet analyserades med hjälp av en kvalitativ innehållsanalys och tre kategorier och nio subkategorier framkom. Resultat: Tre kategorier framkom i resultatet. Verktyg för samtalet med underkategorierna kommunikation, undervisning, stöd och hjälpmedel. Nyttan med egenvårdsråd med underkategorierna stärkt föräldraroll, tillgänglig som samtalskontakt och färre vårdbesök. Utmaningen med egenvårdsråd med underkategorierna komplexiteten i telefon, föräldrar är olika och kulturella olikheter och språksvårigheter. Distriktssköterskorna erfor att föräldrarna fick stöttning, råd och hjälp med sin oro i telefonsamtalen. Det fanns svårigheter i telefonsamtalet som att inte kunna se barnet och stressen när samtal drog ut på tiden. Slutsats: Distriktssköterskorna arbetade personcentrerat och stöttade föräldrarna till egenvård så att de kunde verka för god hälsa och förebygga sjukdom hos sina barn. Undervisning i egenvårdsråd stärkte föräldrarollen samt minskade deras oro.
Background: Of all telephone calls to the health care centres, half come from parents’ who receive self-care advice for their children, which can promote health and prevent illness in children. If the parents’ ability to self-care fails, the district nurse has an important role in supporting and teaching. Aim: To describe district nurses’ experiences to provide self-care advice to parents in telephone counselling in health care centrals. Method: The study was implemented with a qualitative method with an inductive approach. The data collection consisted of 12 semi-structured interviews with district nurses at health care centres. The material was analysed with a qualitative content analysis that resulted in three categories and nine subcategories. Results: Three categories emerged in the result. Tools for the conversation with the subcategories communication, teaching, support and aids. The benefit of self-care advice with the subcategories strengthened parenting role, available as a conversational contact and fewer care visits. The challenge with self-care advice with the subcategories of the complexity of the telephone, parents are different and cultural differences and language difficulties. The district nurses experienced that the parents received support, advice and help with their concerns in the telephone conversations. There were difficulties in the phone call such as not being able to see the child and the stress when the call dragged on. Conclusion: District nurses worked person-centered and supported parents in self-care so they could work for good health and prevent illness in their children. Teaching in self-care advice strengthened the parental role and reduced their worries.

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Marathe, Shriram. "BENCHMARKING COMMUNITY HEALTH CENTERS' EFFICIENCY:MULTIVARIATE ANALYSIS." Doctoral diss., University of Central Florida, 2006. http://digital.library.ucf.edu/cdm/ref/collection/ETD/id/2671.

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Community Health Centers (CHCs), designed to provide accessible and affordable health care services to low-income families, were first funded by the Federal Government as part of the War on Poverty in the mid-1960s. Improving healthcare organizational performance efficiency is paramount. It is an especially pressing need for CHCs' because they carry a disproportionate burden of caring for the uninsured within limited budgets. Prior studies suffer from conceptual and methodological limitations. A longitudinal multivariate analysis of factors influencing the performance of CHCs is needed. The purpose of this study is to benchmark CHC performance in terms of technical and cost efficiency, and examine factors that affect its variation. A theoretically grounded non-experimental study design is used, with five waves of panel data from 493 CHCs for the years 2000 through 2004. This study found that data mining and predictor tree analysis of factors influencing the variation in CHCs' technical and cost efficiency yielded inconsistent results. A declining trend in technical efficiency scores over the five-year study period was observed. Based on growth curve modeling, the three factors that influenced technical efficiency at the initial period of the study are: the percentages of Medicare, Medicaid, and Hispanic population being served by the CHCs. The five factors that positively influenced the variation in cost efficiency at the initial period were: the initial score of technical efficiency, the percentage of Hispanic patient population, staffing mix (ratio of providers to total staff), pay mix (ratio of federal grant dollars to total revenue), and percentage of Medicare-eligible. The initial cost-efficiency score and the initial technical efficiency score are negatively associated with the growth trend of technical efficiency. The initial level of technical efficiency is not statistically significantly associated with the growth trend of cost efficiency. The two factors influencing the growth trend of cost efficiency are the growth trend of technical efficiency (with a positive influence) and the initial level of cost efficiency (with a negative influence). Analysis of the effects of contextual and organizational-structural variables on the technical efficiency and cost efficiency of community health centers found that the explanatory power of the predictors is much greater for cost efficiency than for technical efficiency. The study lends support to contingency theory and confirms the independent and additive influences of contextual and organizational predictors on efficiency. Irrespective of the efficiency measures, contextual factors have much more influence on CHCs' efficiency than design (organizational structural) factors do. The three study hypotheses supported by multivariate analysis are: technical efficiency is associated with contextual factors and organizational factors; cost efficiency is associated with contextual factors and organizational factors; and technical efficiency positively affects cost efficiency.
Ph.D.
Department of Public Administration
Health and Public Affairs
Public Affairs: Ph.D.

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Wood, Judith E. (Judith Ellen) Carleton University Dissertation Sociology. "Hygeia vs. panakeia; the community health centre in Canada." Ottawa, 1986.

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Johnson, Danielle. "Quantifying the Effects of Community Health Center Access on Health for Medically-Vulnerable Populations." Diss., Temple University Libraries, 2016. http://cdm16002.contentdm.oclc.org/cdm/ref/collection/p245801coll10/id/373453.

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Sociology
Ph.D.
Established in 1965 as a part of President Johnson’s War on Poverty effort, the federal community health center (CHC) program is a primary source of federally-subsidized quality health care services for medically-vulnerable populations in the United States. Despite its current role as a medical safety-net for the nation’s health care system, the CHC program did not begin as a public health program, but rather as a social justice program. Since its formalization, the CHC program has enjoyed relatively consistent Congressional support as a cost-effective means of providing primary healthcare to indigent populations; however, the narrative of the program has shifted overtime from a focus of empowerment and lifting communities out of poverty, to the fortification of the national health care system as a cost-effective provider of quality healthcare care for all. In this manuscript, I argue that this transition from community empowerment and the mitigation of fundamental causes of disease to a more risk-based emphasis on the issue of access, has diminished the urgency around the engagement of the structural effects of poverty on health in favor of a “one size fits all” approach to the provision of basic health care. In an effort to objectively quantify the effects of geographic access on health as a means for evaluating the success of the contemporary program, this research project explores the extent to which proximal access to a CHC is significantly associated with various self-reported indicators of positive health outcomes. My primary research method is multivariable regression utilizing secondary data from the 2012 Southeastern Pennsylvania Household Health Survey, the 2008-2012 5-year American Community Survey Estimate, and the Health Resources and Services Administration Data Warehouse. Using statistical modeling, I test the effect of CHC access on three distinct measures of individual health: (1) self-reported health status, (2) the likelihood of having pain lasting 6 months or more, and (3) the likelihood of having a usual source of health care. Within each model, I also test a series of interaction terms through nested sub-models to uncover any conditional effects of access for selected social groups. This statistical design offers the opportunity to explore whether the main association between access to a CHC and health varies based on the social characteristics and/or social environment of the individual. The findings of my analysis suggest that the effect of CHC access varies for different social groups, with less disadvantaged groups, such as poor non-Hispanic whites with high social capital, and poor individuals living in areas of low disadvantage, receiving the greatest benefit from proximal CHC access. However, individuals at the extremes of social disadvantage benefit least from CHC access alone. I argue that while the provision of CHC access is a noble and necessary tactic for fighting the persistence of health disparities in our medically-vulnerable communities, focusing on access alone is insufficient to solve the problem. The pendulum must switch back to community empowerment and the eradication of structural threats to health to initiate real change for medically-vulnerable populations.
Temple University--Theses

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Drevdahl, Denise J. "Constructing the meaning of community in a community-based clinic : a postmodern feminist analysis /." Thesis, Connect to this title online; UW restricted, 1996. http://hdl.handle.net/1773/7369.

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Wernick, Shoshana. "Evaluating a community health centre's diabetes project: A strategy to reduce health disparities." Diss., Wichita State University, 2009. http://hdl.handle.net/10057/2375.

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Diabetes is a senous health problem in the African American community. African Americans experience significantly higher rates of diabetes, diabetes complications, and premature mortality compared to Caucasians. The current study examined a Diabetes Project implemented by a local community health care center that serves predominantly low income and underserved populations. The goal of this research was to detennine the usefulness, feasibility, and potential effectiveness of the Diabetes Project. There were 216 participants (147 females and 69 males) of mean age 53.56 (SD = 14.71) consisting of 143 (66.2%) African Americans, 55 (25.5%) Caucasians, and 18 (8.3%) Other. The average time patients were enrolled in the Diabetes Project was 2.59 years. The HbAlc (blood glucose), blood pressure (BP) -- systolic and diastolic, LDL cholesterol, and body mass index (BMI) was measured at baseline and at the date of the last visit. Three of the five pairwise comparisons were significant - HbAlc, and BP (systolic and diastolic). Although there were no statistically significant differences between gender, race/etlmic groups, and age, there were several statistically significant within group differences. An unexpected fmding was the significant improvements in self-management behaviors of patients at the CHW. Limitations included the fact that this research was not developed at the time of implementing the Diabetes Project. As such, the available data was limited and lacking in details. Recommendations include more effective record keeping and conducting process and impact evaluations on a regular basis. Overall, the results were promising and it appeared that African Americans benefitted the most from the Diabetes Project, which may be serving as a strategy to reduce health disparities.
Thesis (Ph.D.)--Wichita State University, College of Liberal Arts and Sciences, Dept. of Psychology

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Guzman-Lopez, Mayra. "Appropriateness and Use of Medications by Patients with Persistent Asthma in a Community Health Center." The University of Arizona, 2017. http://hdl.handle.net/10150/624180.

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Class of 2017 Abstract
Objectives: A chart will be used to assess the need for the asthma education program. The chart review aims to: analyze the refill history of asthma medications along with verifying adherence via electronic health record and assess if patients are getting appropriate asthma therapy per 2007 NHLBI asthma guidelines. Methods: The patient’s MHC Healthcare electronic record profile and pharmacy refill record will be accessed. The information that will be obtained from the electronic health record will be: ethnicity, age, sex, allergic rhinitis diagnosis, flu vaccine status, pneumonia vaccine status, GERD diagnosis, spirometry measure if available, use of prednisone for exacerbation, prescribed asthma therapy, and provider’s (MD, NP, PA, etc)’s notes that might indicate nonadherence. The information that will be obtained from the pharmacy record are controller and rescue medication refill history. The information will be recorded in paper data collection forms and electronic versions will be saved to the secure college of pharmacy workgroup. The raw physical information described above will be stored in a locked cabinet at MHC healthcare pharmacy inside the pharmacy director’s office and the de-identified information will be stored in the secure workgroup. Results: Conclusions:

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West, Christopher E. "Technical limitations of electronic health records in community health centers: Implications on ambulatory care quality." Diss., Search in ProQuest Dissertations & Theses. UC Only, 2010. http://gateway.proquest.com/openurl?url_ver=Z39.88-2004&rft_val_fmt=info:ofi/fmt:kev:mtx:dissertation&res_dat=xri:pqdiss&rft_dat=xri:pqdiss:3398890.

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Hanson, Brittany Minnick. "Growing Health: Community Gardens and their Effects on Diet, Physical and Mental Health and Community." Master's thesis, University of Central Florida, 2012. http://digital.library.ucf.edu/cdm/ref/collection/ETD/id/5237.

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Recently, research on community gardens and their benefits to health and community has become very popular. However, this influx of research has failed to investigate challenges to successful community gardening. Some articles examine issues between community gardeners and the land owners, but other than these conflicts community garden challenges, like lack of participation and quality leadership, have not been discussed in the literature (Draper and Freedman, 2010). To allow future gardens to be as successful as possible it is important to identify potential obstacles. Additionally, it is just as important to continue to examine possible benefits, for example, physical activity and health benefits of community gardening and the breadth of community issues possibly addressed by community gardeners. Continuing to research on community will allow for more successful gardens and encourage funding for these programs. This study examines how food insecurity, health and community cohesion issues can be affected by community gardens in Central Florida. It also investigates challenges community gardens often face. To do this I conducted structured interviews with community gardeners and semi-structured interviews with community garden leaders at several gardens throughout Orange County, Florida. The results show that community gardens have several benefits including increased consumption of fresh produce, improved physical activity, mental health and community cohesion. However, gardens are not without difficulties. About a third of the gardeners and the majority of the leaders said that lack of participation was a challenge they faced.
ID: 031001542; System requirements: World Wide Web browser and PDF reader.; Mode of access: World Wide Web.; Adviser: James Wright.; Title from PDF title page (viewed August 21, 2013).; Thesis (M.A.)--University of Central Florida, 2012.; Includes bibliographical references (p. 65-68).
M.A.
Masters
Sociology
Sciences
Applied Sociology

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Gagnon, Kristy J. MPH, Mary Ann PhD Littleton, Amy M. MSc Poole, Cynthia J. BA Blair, Timir K. MD PhD Paul, Ginny MA Kidwell, Liang MD PhD Wang, et al. "Perceptions of Community-dwelling Patients and Caregivers of Patient-Centered Care in Central Appalachia: An Exploratory Study." Digital Commons @ East Tennessee State University, 2019. https://dc.etsu.edu/asrf/2019/schedule/88.

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Introduction: Cardiovascular diseases (CVD) remain the leading cause of death in the United States (U.S.), accounting for one in three deaths annually. Within the U.S., disparities in CVD outcomes and risk factors exist across demographic groups and geographic areas, such as the Central Appalachian region where the burden is higher than state and national rates. Patient-centered care (PCC), is a model of health care delivery that has been shown to improves disease outcomes and quality of life, and is critical in addressing disparities in health care. However, little is known about how high-risk Central Appalachian populations understand or perceive such a model. As such, the objective of this study was to examine the perceptions of PCC among community-dwelling CVD patients/caregivers in the region. Methods: A qualitative study design applying thematic analysis was utilized for data collection and analysis. Seven focus group discussions across six states in Central Appalachia were conducted, and comprised of 78 middle-aged participants selected through purposive sampling. Sessions were guided by standardized instrument regarding current efforts in their communities concerning CVD; challenges and needs; appropriate approaches to their cardiovascular issues; understanding and views about patient-centeredness; and related priorities. The discussions were audio-recorded, transcribed, and then coded for thematic analysis using NVivo qualitative data analysis software. Dependability of data analysis was achieved through an audit trail tracking the NVivo process. Results: Data analysis identified interpersonal relationships with health care providers (HCPs) as the most important aspect of PCC among participants. When asked what PCC meant to them, each group discussed the interpersonal relationship they wanted from HCPs, barriers that kept them from achieving this relationship, and how it impacted their care. Within this theme, two overarching subthemes emerged: (1) developing long-term relationships with HCPs, and (2) developing partnerships with HCPs. The first theme had subthemes that included: turnover of HCPs in their geographical location, the disappearance of family physicians, and preferences related to seeing a physician versus a physician’s assistant or nurse practitioner. The second theme’s subthemes included: communication, feeling cared for as an individual, and input into care. Conclusion: Patients/caregivers stressed the importance of interpersonal relationships with providers in the delivery of PCC. However, patients recognized when PCC was not being provided, provided examples of interactions that were not conducive to providing PCC, and reported feeling disempowered as a person and a patient. The results of this research can be utilized to understand patient/caregiver perceptions of PCC, and indicates the need for further research to reconcile these viewpoints with those of providers to improve the delivery of care, and health outcomes.

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McKague, Meredith. "Assessing individual determinants of health, the development of a health determinant instrument for use in a Community Health Centre." Thesis, National Library of Canada = Bibliothèque nationale du Canada, 2000. http://www.collectionscanada.ca/obj/s4/f2/dsk1/tape4/PQDD_0019/MQ55285.pdf.

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Banderker, Shahida. "The use of low dose tricyclic antidepressants at Heideveld Community Health Centre." Master's thesis, University of Cape Town, 2004. http://hdl.handle.net/11427/8630.

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Includes bibliographical references.
AIM OF THIS STUDY: To describe how doctors are prescribing low dose antidepressants at Heideveld Community Health Centre. OBJECTIVES: 1. To determine how many patients are being prescribed low dose antidepressants at Heideveld Community Health Centre. 2. To see what sort of dosages are being prescribed as low dose most frequently. 3. To see if indications for the use of low dose tricyclic antidepressants are being recorded. 4. To identify the indications for the use of low dose tricyclic antidepressant. METHOD: A total of 500 patient folders were reviewed. 50 patient folders, (10 folders each from five medical officers), were systematically sampled, per day, for ten days over a two week period. Records were reviewed and data was captured on a data capture sheet. Demographic data: age and gender was recorded. The dose of the antidepressant per patient was recorded. The indication for its use was recorded. Where the indication of its use was not recorded, this was also documented. RESULTS: 1. Of the 500 folders reviewed, a total of 153 (30,6%) of the patients were prescribed low dose tricyclic antidepressants at the consultation, during the time that the study took place. 2. The minimum dose used was 10mg and the maximum dose used was 75mg of tricyclic antidepressant. The median dose used was 25mg. 3. 83% of the folders had reasons for the use of low dose tricyclic antidepressant recorded. 17% of the folders had no reason recorded. 4. The reasons for using low dose tricyclic antidepressants, were for chronic pain syndromes, insomnia, somatic symptoms and for psychological or psychiatric reasons (anxiety or depression related symptoms). CONCLUSION: Low dose tricyclic antidepressants were justifiably prescribed for the many non-psychiatric and psychiatric conditions that respond to it, at Heideveld Community Health Centre.

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Ball, Roger. "Healthy marriage initiative| A community centered religious educational analysis." Thesis, Fordham University, 2016. http://pqdtopen.proquest.com/#viewpdf?dispub=10113659.

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This research looks at HMI through the context of marriage and family life of Pentecostal faith communities and how a religious educative and ministerial lens can strengthen such programs in local churches. Through historical and secondary analyses, the researcher examines the history, evolution and examples of recent HMI evaluations. The study is informed by, recent sociological studies, feminist theology and religious education experts. The work proposes how Healthy Marriage Initiatives within congregational settings can be strengthened through religious educative, spiritual, and pastoral responses to marriage and family life within faith communities.

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HAMAJIMA, NOBUYUKI, KOUTARO TOMITA, YUKAKO HINOHARA, and NOBUYUKI KATSUDA. "STRUCTURE AND ROLES OF PUBLIC HEALTH CENTERS (HOKENJO) IN JAPAN." Nagoya University School of Medicine, 2011. http://hdl.handle.net/2237/14916.

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Hendricks, Michelle. "Assessing the attitude of nursing staff working at a community health centre towards the mental health care user." University of the Western Cape, 2018. http://hdl.handle.net/11394/6855.

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Abstract:

Magister Curationis - MCur
The South African health care system shifted the focus of treating psychiatric disorders from institutional care level mental health services to facilitate this process of integration into the Primary Health Care (PHC) settings. All the provinces were thus engaged in improving mental health care services at community level by providing training for professional nurses in mental health at PHC settings. Consequently, mental health nursing has also changed considerably by shifting the focus of mental health care to the primary care level. It is however, suggested that the current revolving door syndrome experienced at psychiatric institutions was partly due to inadequate community-based psychiatric services. It was also suggested that the attitudes and knowledge of health professionals towards mental illness has a major impact on service delivery, treatment and outcome of mental illness. The aim of this research study was to assess the attitude of nursing staff working at a Community Health Centre (CHC) towards the mental health care user. A CHC was chosen that renders 24 hour services. The inclusive sample included all the different categories of nurses permanently employed at this CHC. The Attitude Scale for Mental Illness questionnaire was used to collect the data. Descriptive statistics: means, median and standard deviations were calculated for the following variables: separatism; stereotyping; restrictiveness; benevolence; pessimistic prediction and stigmatization. In conclusion it can be said that the nursing staff with more experience irrespective of category of nurse has less of a stereotyping attitude towards mental illness. The longer the nurse worked at the setting and irrespective of their nursing qualification the more positive their attitude towards the MHCU became.

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Dissertations / Theses on the topic 'Community health centres'

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