Dissertations / Theses on the topic 'Health and community care system'
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Jenkins, Juliette Swanston. "Community Health Worker's Perceptions of Integration into the Behavioral Health Care System." ScholarWorks, 2019. https://scholarworks.waldenu.edu/dissertations/6908.
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Mental illness in the United States is a major public health problem. According to the Substance Abuse and Mental Health Services Administration, in 2017, 18.9% of adults in the United States had a mental illness. The purpose of this study was to gain insight into the perceptions held by community health workers (CHWs) regarding their integration into the behavioral health care system in Maryland. Using a social constructivism paradigm and phenomenological approach, a purposive sample of 11 CHWs who supported patients with behavioral health conditions in 17 counties in the state were interviewed. Howlett, McConnell, and Perl's five stream confluence policy process theory and Lipsky's street level bureaucracy theory provided the foundation to explore the perceptions of the CHWs about their integration into the behavioral health care system; the problems, policies, processes, and programs that impacted their ability to be integrated into the behavioral health team; and their function as a street level bureaucrat to facilitate their integration. A deductive iterative coding approach was used, culminating in the identification of the following 6 themes: health system utilization of CHW behavioral health integration, official policy recognition of the CHW profession, accountability for CHW integration, CHW practice support, integrated health care team management of physical and mental health and behavior, and building the CHW profession. The social change implications of this study are that CHWs' integration into the broadly defined, integrated, physical and mental behavioral health team can support having a more cost-effective way toward having healthy people and communities because they link the community to health and social services and advocate for quality care.
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Nganda, Benjamin Musembi. "Structural reform of the Kenyan health care system." Thesis, University of York, 1994. http://etheses.whiterose.ac.uk/14168/.
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Dlatu, Ntandazo. "The integration of mental health care services into primary health care system at King Sabata Dalindyebo Municipality Clinics." Thesis, Walter Sisulu University, 2012. http://hdl.handle.net/11260/d1008290.
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Introduction: Primary Health care refers to care which is based on the needs of population. Mental health care provided within general primary care services is the first level of care within the formal health system. There is no research in King Sabata Dalindyebo, carried out on issues around integration of mental health with primary health care. The present study is initiated to overcome this gap. Aim of the study: The aim of the study was to investigate the level of knowledge, implementation and barriers of integrating mental health care services into primary health care system at King Sabata Dalindyebo clinics, in Mthatha region. Methods: This descriptive cross-sectional study was conducted at King Sabata Dalindyebo Clinics, between January 2010 and December 2011. A 10% random sample of all health professionals from King Sabata Dalindyebo was interviewed concerning their demographic characteristics, education/ qualifications, general and further training in psychiatry, awareness about Mental Health Care Act 17 of 2002 and mental health care services characteristic related to the integration of mental health care services into primary health care system. For data analysis, the means of continuous variables across 2 groups were compared using Student-t test. The proportions (%) of the categorical variable across 2 groups were compared using Chi-square test. Results: A total of 52 health professionals (40.4% males, 59.6 females, 59.6 married, 3 doctors, 49 nurses, mean age 36.9± 8 years range 23 years-52 years), were surveyed. The participants were characterized by low level of qualification in specialization, further training in psychiatry, and by very low awareness about Mental Health Care Act 17 of 2002. Furthermore, there was no implication of expects (Regional psychiatrist, psychologist, social worker) and co-ordination of mental health care services. Working in remote and disadvantaged area, health workers with lower education qualification, absence of a coordinator for mental health care services and absence of workshop on Mental Health Care Act 17 of 2002 were determinants of lower awareness about Mental Health Care Act 17 of 2002. However, there was a good to excellent framework for potential implementation of mental health care services into primary health care system. The government support in infrastructures, drugs availability, transport and equipment was evident. Patients were helped within abroad based ethical, human rights and psycho-social framework. Conclusion: There is a lack of improving human capacity for mental health in terms of continuous training in mental health issues, policies, organisation and development. Globally, the integration of mental health care service in King Sabata Dalindyebo is non-optimal.
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Friedman, Nicole Lisa. "Impactful Care: Addressing Social Determinants of Health Across Health Systems." PDXScholar, 2019. https://pdxscholar.library.pdx.edu/open_access_etds/5073.
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There is emerging evidence that addressing health-related social needs through enhanced clinical-community linkages can improve health outcomes and reduce costs. Unmet health-related social needs, such as food insecurity, inadequate or unstable housing, and lack of access to transportation may increase the risk of developing chronic conditions, reduce an individual's ability to manage these conditions, increase health care costs, and lead to avoidable health care utilization. In response, work on social needs is happening across large health systems in the United States, but the pace of progress is slow and accountability is diffuse.
The goal of this applied research project is to examine Kaiser Permanente Northwest's patient navigator program as a case study for how health systems can transform into organizations that bridge clinical, social and behavioral health and redefine what it means to be a prevention-oriented delivery system. Kaiser Permanente Northwest (KPNW) provides high quality, patient-centered care to over 550,000 medical members and 240,000 dental members in Oregon and Southwest Washington. In conjunction with the Care Management Institute, KPNW created a patient navigator administered, social needs screening tool called "Your Current Life Situation" (YCLS). This thesis focuses on the data collected from this screening tool with an emphasis on operations management, workflows, and the technical tools that have been supported to do this work. The analysis also uses semi-structured qualitative interviews from patient navigators, physicians, social workers, community organizations and members to better understand the experience of social needs screening in clinical practice and its impact on members and community partners as they receive referrals for services outside the health care delivery system. Through using anthropological theory and methods, I seek to help health systems think and act differently by elevating the voice and experience of the community and translating vulnerable populations' needs into a language that can be integrated into multiple systems of care.
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Hepburn, Robert Cameron. "Environmental epidemiology in primary care using a geographic information system." Thesis, University of Aberdeen, 2001. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.268876.
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Mntambo, Ishmael Mbuso. "Development of the Public Health model of Community participation in the Kwazulu - Natal primary health care system." University of the Western Cape, 2017. http://hdl.handle.net/11394/5978.
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Philosophiae Doctor - PhD (School of Public Health)The purpose of this study was to develop the public health model of community participation for the KwaZulu-Natal primary health care system. The model is intended to improve the understanding of community participation and to explore its potential value in strengthening the facilitation of health promotion in the health facilities.
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Parr, Jennifer Simone. "Integration in South Africa: a study of changes in the community health system." Thesis, University of the Western Cape, 2014. http://hdl.handle.net/11394/4154.
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Philosophiae Doctor - PhDIn the thesis, I analyse a facilitated pilot project of integration of health care services at the community-level. The importance of the thesis is justified by three reasons: firstly integration and the creation of a district health system, as envisaged under Primary Health Care, is promoted as the solution to the health inequalities inherited from Apartheid in South Africa. However, many pilot integration projects have failed and analysing a failed project from an anthropological perspective provides valuable insight. Secondly a renewed interest in Primary Health Care, as the World Health Report of 2008 sets out, also makes this a pertinent pursuit from an international viewpoint. Thirdly the human experience is often ignored in health reform literature. I argue that anthropology can provide valuable insight into integration processes in a health system. Because anthropology explores the human experience, it provides a detailed understanding of the changes in a community health system and their impact on all role players. The data presented in the thesis were collected in an ethnographic communitylevel study in one township urban South Africa between October 1999 and October 2002. This makes this it a historical piece of work to a degree. I describe and critically analyse the facilitated process from the start of the project in October 1999 till its disintegration in failure in June 2001. I also describe and analyse the findings from community research conducted in 2002. For the analysis, firstly I build upon Scott’s concepts of dominance and resistance from his book Dominance and the Arts of Resistance to construct a framework. I argue that to understand a change process fully requires considering the historical context, the international arena, the present context and the facilitator.
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Haas, Becky, and Andrea D. Clements. "Building a Trauma Informed System of Care." Digital Commons @ East Tennessee State University, 2019. https://dc.etsu.edu/etsu-works/7197.
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Rawabdeh, Ali Ahmad Awad. "An integrated national health insurance system for Jordan : costs, consequences and viability." Thesis, Keele University, 1997. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.337091.
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Arguably, in common with many other nation states, Jordan could be said to have drifted into different ways of paying for health services without always foreseeing the long run consequences of taking the strategic direction necessary. In part, of course, as in many developing countries, the financing of Jordan's health care services has been influenced by its colonial past. This partly explains why, historically, Jordan has attempted not only to provide wholly free services, but to provide privileged access to medical services, not only to the military personnel but also to public servants in general. With world economic instability and recent economic difficulties, notwithstanding the opportunities created by Jordan signing the peace treaty with Israel, and the unclear but likely stark future conditions facing the Jordanian economy, it is highly improbable that Jordan will continue to be in a position to sustain, from central government monies, a health system which currently consumes about7percent of the GDP. Financing strategies will, therefore, have to address the heightened expectations for rising health expenditures. Options under active consideration at this time include: introducing or extending the present system of user charges; community financing (participation ); (increased) use of the private sector; public or private health insurance; and, improving efficiency in the use of hospital and community resources. These are all financing options open to the Jordanian government to adopt, whether singly or in combination, to generate more resources for the health system and to make better use of existing resources. Examining the range of different modalities of health services' financing reveals, not surprisingly, that there are advantages and disadvantages in each financing scheme. Nevertheless, depending on Jordan 's circumstances, some of the approaches may be more appreciated than others: that is from a political, cultural, socio-economic, or strictly fiscal point of view. This thesis focuses upon one particular health financing approach, "National Health Insurance (NU)", and is aimed to lead the government of Jordan to rigorously explore the concept, consider the options, and develop an implementation strategy benefiting, where appropriate, from other countries' experiences with systems of NHI. Specifically, the thesis first provides an overview (or situation analysis) of the healthiness of the Jordanian economy, its key demographic and epidemiological characteristics, and salient features of the Jordanian health sector. This is followed by a largely theoretical discussion of the principles of insurance, and its potential relevance to the unpredictability and uncertainty of health and disease. Methodological problems inherent in public or private health insurance schemes are highlighted, and then considered in a comparative context, drawing on lessons and experience around the globe. The thesis considers as its basic premise that a system of national health insurance is both desirable and feasible for Jordan as it faces the next millennium. To test that premise, the study is conducted by means of a series of investigations emphasising both secondary and primary sources of data, and a range of quantitative and qualitative research methods including: content and document analysis; experimental and survey methods; interviews; and questionnaires. The conclusions drawn from the evidence supports the contention that the introduction of NM is potentially both desirable and feasible in Jordan but subject to meeting very strict conditionalities, not least government ownership of the scheme, and the willingness to address the present choice and diversity in health service provision through health sector reform. These matters are as much political as technical matters. On the more technical front, nonetheless, the design of an appropriate NHI is shown to raise critical issues regarding: coverage; benefits; organisation and management; costing and financing; and, provider payment mechanisms. Various technical options are discussed in the thesis, and were consulted upon with key decision makers in Jordan. Further directions of research and development are also identified, which likely have applicability beyond the specifics of Jordan itself.
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Van, Driel Adrian Edgar. "An exploratory study into the benefits of the new health care system in South Africa, with specific reference to health care providers in the Western Cape." Thesis, University of the Western Cape, 2005. http://etd.uwc.ac.za/index.php?module=etd&.
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The research explored the new health care service vehicle of South African with special reference to health service providers in Western Cape Department of health for the period 1995-2001. A study was made of the District Health System and the shift of emphasis from tertiary and secondary level of health care to the more cost effective Primary Health Care Service rendered at District level.
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Mangan, Brian Gerard. "The implementation and evaluation of a quality assessment and quality improvement system in mental health services within a health board." Thesis, Queen's University Belfast, 1999. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.301742.
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Swartz, Alison. "Community health workers in Khayelitsha : motivations and challenges as providers of care and players within the health system." Master's thesis, University of Cape Town, 2012. http://hdl.handle.net/11427/12199.
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Community health workers (CHWs) play an important role in health care in South Africa and similar countries, but relatively little is known about CHW motivations and experiences in the provision of care. This thesis considers these issues in three parts: 1. A protocol for a study of community health work in Khayelitsha, an impoverished peri-urban settlement near Cape Town, which is home to a number of ‘flagship’ public health interventions aimed at HIV/AIDS and TB. 2. A review of literature on community health work exploring naturalistic versus economistic discourses around care work, and the complex intersections of these discourses. 3. An ethnographic account of CHWs who provide a wide range of community-based care work in Khayelitsha.
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Hunt, Jane. "Mixed funding within the British health care system : an examination of the effects on professional relationships between paediatric oncology outreach nurse specialists and other health care professionals." Thesis, University of Surrey, 1998. http://epubs.surrey.ac.uk/804409/.
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Jalal, Nafeesa. "Agricultural migrant workers navigating the health system: Access, continuity of care and the role of community health workers in De Doorns, Western Cape." University of the Western Cape, 2018. http://hdl.handle.net/11394/6362.
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Philosophiae Doctor - PhD (School of Public Health)South Africa has an estimated two million documented and undocumented immigrants. In addition, Statistics South Africa (2014) notes very significant internal migration. This mobile population is affected by chronic communicable and non-communicable diseases such as TB, HIV, and diabetes, although it has a Constitutional right to health and healthcare. Their quality of healthcare and disease control also affects the general population and the burden on the health system can be increased by inadequately managed chronic conditions as well as acute health care needs. Access to healthcare and continuity of care reflect both patient agency and the health system. Community Health Workers (CHWs) play an important role in linking communities and patients to health services and vice versa. The aim of this study was to understand how agricultural migrants in the Cape Winelands District of Western Cape Province of South Africa navigated the healthcare system to access healthcare services including securing continuity of care, and in particular the role of CHWs in this process, in order to inform policy and practice.
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Cortes, Soraya Maria Vargas. "User participation and reform of the Brazilian health system : the case of Porto Alegre." Thesis, London School of Economics and Political Science (University of London), 1995. http://etheses.lse.ac.uk/2445/.
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Municipal health commissions have been key elements in the reform of the Brazilian health system over the past thirteen years. The reform made publicly financed health care, in principle, universally accessible, while the system became better integrated as well as decentralised. Municipal health commissions have become a widespread institutional feature of the health system. They have gradually increased their planning and supervisory roles over health services located within their territorial jurisdiction. The participatory schemes of municipal health commissions can achieve better results in areas where they have the support of strong social and trade union movements. This is the case in the southern region of Brazil and, in particular, in Porto Alegre. This study analyses the ways in which users were involved in the municipal health commission of Porto Alegre, between 1985 and 1991, verifying which institutional-political factors have most influenced their involvement. The study develops a "methodology" for the assessment of user participation in statutory fora. The attendance lists and minutes of meetings, interviews with regular participants in the forum, and other sources of information, were used to build up indicators of user involvement and of the factors that could influence the participatory process. Two main sets of variables are identified. The first set of indicators is concerned with the ways in which users participated in the commission. Two indicator-variables were created to assess this participation: the attendance of users at weekly plenary meetings of the commission (the decision-making division of the forum) and the types of involvement of user representatives in the decision-making process. The second set of indicator-variables refers to institutional- political factors that could have most influenced the participation of users. Among these are; (a) major policy changes in the institutional framework of the Brazilian health system, (b) changes in the organisation of urban social movements in Porto Alegre (since trade unions had not regularly participated in the work of the commission), (c) changes in the relationship between public health professionals and leaders of urban social movements, (d) the types of interest which municipal, state and federal health authorities had in promoting the participation of user representatives in the decision-making process, and, finally, (e) the types of issues discussed in the majority of plenary meetings. Relationships were then established between both sets of variables to verify which factors most influence this involvement. The study concludes that, between 1985 and 1991, variations in the attendance of users at plenary meetings, as well as variations in the type of involvement user representatives had in the decision-making process of the forum, were strongly associated with important changes: (1) in the institutional framework of the Brazilian health system, (2) in the organisation of urban social movements in Porto Alegre and (3) in the relationship between public health professionals and leaders of urban social movements. The position of municipal health authorities on user participation has also influenced user involvement in the commission. The other factors, however, had apparently determined only short term changes in user involvement. The study also highlights the role of Brazilian health system reformers as promoters or stimulators of these changes. This policy community had a central role in attracting urban social movement activists to become involved in these formalised fora. They can be regarded as policy formulators as well as an active part of an alliance established between them and urban social movement activists. In the case of Porto Alegre, it is possible to affirm that social organisations, particularly those representing shantytown populations, sustained consistent involvement of their representatives in the overt political spaces of the local and municipal health commissions. These commissions had limited power over health services in the city, mostly due to delays in placing these services under municipality control. However, the case examined indicates the gradual formation of an alternative type of political relationship in the health sector in Porto Alegre, in which the interests of the urban shantytown residents are represented formally and publicly. In this sense, the consolidation of participatory fora can assist in the democratisation of Brazilian institutions, giving voice to social sectors traditionally excluded from the political system. Through their involvement in the commission, these representatives were also increasing the responsiveness of publicly financed health services to the needs of users who, individually, lacked the political power to sustain their demands.
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Oum, Sophal. "Development, implementation and evaluation of community-based surveillance system in rural Cambodia." Thesis, London School of Hygiene and Tropical Medicine (University of London), 2002. http://researchonline.lshtm.ac.uk/4646504/.
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A community-based surveillance system was developed and implemented in rural areas in Cambodia. The system aimed to provide timely and representative information on major health problems and life events that would permit rapid and effective control of outbreaks and communicable diseases in general in rural communities. In the system, lay people were trained as Village Health Volunteers to report suspected outbreaks, important infectious diseases, and vital events occurring in their communities to local health staff who analysed the data and gave feedback to the volunteers during their monthly meetings. An evaluation conducted one year after implementation of the community-based surveillance system began found that the system was able to detect outbreaks early, regularly monitor communicable disease trends, and to continuously provide updated information on pregnancies, births and deaths in the rural areas. The sensitivity and specificity of case reporting by Village Health Volunteers were found to be quite high. In addition, the community-based surveillance system triggered effective responses from both health staff and Village Health Volunteers in outbreak and disease control and prevention. The results suggest that a community-based surveillance system can successfully fill the gaps of the current health facility-based disease surveillance system in the rapid detection of outbreaks, in the effective monitoring of communicable diseases, and in the notification of vital events in rural Cambodia. Empowered local people and health staff can accurately report, analyse and act upon significant health problems in their community within a surveillance system they develop, own and operate. The community-based surveillance system could easily be integrated with the current disease surveillance system. Its replication or adaptation for use in other rural areas in Cambodia and in other developing countries would be likely feasible and beneficial, as well as cost-effective.
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Mitchell, Penelope Fay. "Mental health care roles and capacities of non-medical primary health and social care services : an organisational systems analysis /." Connect to thesis, 2007. http://eprints.unimelb.edu.au/archive/00003854.
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Simmons, Robert Earl. "African therapeutic systems : their place in health care in Liberia." Thesis, University of Liverpool, 1993. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.387349.
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Cross, Anna Elizabeth. "Building a health and environment geographical information system : an evaluation, looking at childhood cancer in Northern England." Thesis, University of Newcastle Upon Tyne, 1991. http://hdl.handle.net/10443/334.
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The aim of this research was to evaluate a relatively young technology, Geographical Information Systems (GIS), in a specific applications environment. The application adopted was that of searching for environmental causes of childhood cancer, in particular that of Acute Lymphoblastic Leukaemia (ALL), in Northern England. It is also relevant in terms of the WHO's intention to develop a Health and Environment GIS, and therefore the research aims to satisfy their recommendations for pilot studies. The subject matter of this thesis therefore covers two very high profile topics, which it is believed will mutually benefit from the research carried out. Firstly, very little is known about the aetiology of ALL, and thus any new methodology which is introduced to help analyse sensitive issues of causation is welcomed not only by those in the medical field but also the public. The application was made possible with the provision of detailed cancer data for Northern England and a weak but interesting hypothesis that environmental factors may be an attributable mechanism for causation. Key questions which are asked include; Where are incidences of ALL located? Why are they there? Is there a cluster? and What could be the cause? Secondly a Geographical Information System, in this case the proprietary software package ARC/INFO, was considered an excellent medium for tackling this spatial epidemiological problem. Especially with its capability to store large volumes of diverse data, and its inherent flexibility to deal with spatial information pertaining to health and environmental factors. More importantly the application itself offered a means of evaluating the implementation of a GIS. Establishing the advantages and pitfalls which accompany all stages of 'The GIS Process' and an invaluable documentation of the experiences acquired as an initiator, developer and implementor of this new technology. In addition, this research offers fresh ideas and techniques for improving those areas of the technology which appear to be lacking in these early phases of its development. The problems of spatial analysis in GIS and the provision of useful tools such as 'pattern spotters', 'relationship seekers' and 'error handlers' are discussed as alternative techniques. To ensure an exciting future for GIS technology in application environments the latter and other key areas of research which should be persued are highlighted in this thesis.
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Chang, Ting-Huan. "Determinants of hospital affiliation with health care networks." Thesis, Birmingham, Ala. : University of Alabama at Birmingham, 2007. https://www.mhsl.uab.edu/dt/2008r/chang.pdf.
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Ford, Sarah Theresa. "Analysing doctor-patient interactions in oncology : the development of the medical interaction process system (MIPS)." Thesis, University College London (University of London), 2002. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.272373.
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Khunga, Helen. "Factors affecting detection and referral of malnourished children to Primary Health Care (PHC) level in Kanchele community of Kalomo District, Zambia." Thesis, University of the Western Cape, 2012. http://hdl.handle.net/11394/4508.
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Magister Public Health - MPHBackground: Malnutrition in children under the age of 5 years is a global public Health problem. The UNICEF report states that 10.9 million children under five die in developing countries each year due to malnutrition. According to the Zambia Demographic and Health Survey of 2008 malnutrition is one of the main childhood illnesses in Zambia with almost 50% of the under five children being stunted. The referral system in Zambia is organized in a way that starts at the Primary Health Care (PHC) level within the community and managed by the Community Health Workers (CHW). At this level, Community Health Workers screen and identify children that have childhood illnesses which require treatment and they refer them to the Rural Health Centre (RHC). When the problem cannot be handled at the RHC level the child is referred to the district hospital or provincial hospital level within a particular province. However, most children with malnutrition arrive late at the hospital for treatment. Some of them die soon after admission. It was not clear what prevent the mothers from bringing these children early to the hospital for treatment. Methods: The main aim of the study was to explore factors that are associated with detection and referral of malnourished children from Primary Health Care (PHC) at community level to the Health centres in Kalomo district. The study was conducted in Kanchele community of Kalomo in Southern Province of Zambia. Kanchele is a rural community with most basic services such as health facilities not being easily accessed. The study focused on two PHCs which had the highest prevalence of malnutrition. All participants were asked to sign a consent form after the purpose of study had been explained to them. They were informed that all information would be treated with confidentiality and that participation was voluntary and that they had the right to chose not to participate in the study. Furthermore each participant was asked if they agreed to maintain the confidentiality of the information discussed by participants and researchers during the focus group session. The study was qualitative in nature and focus group discussions were conducted with mothers or caregivers of children under five years, community members who have lived in the community for more than one year and community health workers who have also worked in the community for more than one year. Focus group discussions were used to collect data from mothers and community members. While in-depth interviews were used to collect data from CHWs and nutrition group leaders working at the PHC and community leaders. The data collected from the focus group discussions was analysed using thematic approach. Barriers or hindrances to rehabilitating a malnourished child mentioned by the respondents included lack of knowledge on malnutrition, failure to link malnutrition to poor feeding and bad health seeking habits, poor response to referral as a result of a system which is not supported with adequate resource such as transport, a system that does not support parents with food in-case of the child being hospitalised, the current hospital system only provides food to the patient. The failure by health staff to see that malnutrition is a key childhood disease. Data from this study will be used to develop interventions to improve the management of malnourished children. Conclusion: The study shows that mothers and community members are misinformed about the causes and treatment of malnutrition. It also clearly showed that traditional healers and grandparents played an important role in the diagnosis and treatment of malnourished children in this community. Interventions to improve identification and referral of these malnourished children needs to taken into consideration.
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Atueyi, Kene Chukwu. "Implementing management information systems in the National Health Service." Thesis, Sheffield Hallam University, 1991. http://shura.shu.ac.uk/4990/.
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As a discipline Management Information System (MIS) is relatively new. Its short history has been characterised with epistemological dialectism. The current conflict and debate about MIS inquiry is broadly between the advocates of the social systems and technical systems perspectives. Few authors have made positive contributions toward clarifying the meaning and nature of MIS, and the appropriate design framework for MIS development. This thesis adds to their effort by using a MIS designed and implemented through action research at the North Western Regional Health Authority. There are seven Chapters in this thesis. Chapters One and Two examine the nature of the problem addressed by this research; the project history, ontological assumptions and research strategy. Chapter Three examines the debate, nature and conflicting views about MIS. It defines the theoretical problem addressed by this thesis and proposes a new concept of MIS. The theoretical problems are dealt with in Chapter Four. In Chapter Five the application of the theoretical concepts developed in Chapter Four is demonstrated in the design of MIS. Chapter Six relates some of the findings of this thesis to the work of other authors. It also examines the problem of human inquiry and the suitability of action research for MIS research. The main findings of this research summarised in Chapter Seven provide a new perspective of MIS as a purposeful system; the taxonomy of purposeful systems; primary context and secondary context of MIS; context analysis and context evaluation of MIS.
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Russell, Steven John. "Can households afford to be ill? : the role of the health system, material resources and social networks in Sri Lanka." Thesis, London School of Hygiene and Tropical Medicine (University of London), 2001. http://researchonline.lshtm.ac.uk/682239/.
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Household ability to pay (ATP) for health care services has become a critical policy issue in developing countries because of changes to health system financing and delivery that are likely to impose higher illness cost burdens on poor households. The research presented in this thesis was driven by widespread concern about ATP among different policy actors, and by the fact that conceptual and empirical understanding of the issue remains poorly developed. The thesis uses a conceptual framework for assessing ATP that is, at its core, concerned with the implications that illness costs and related coping strategies have for household livelihoods. The main research objectives were to measure the household costs of illness, examine the types of asset (e. g. financial, social) that are mobilised to cover illness costs, and to evaluate the impact of these illness cost burdens and coping strategies on household livelihoods in the medium term. In so doing, the thesis aimed to identify factors which make households robust or vulnerable to illness costs which development agencies might support. Research was conducted in two low-income communities in Colombo, Sri Lanka. A survey of 423 households was carried out to obtain a profile of illness, treatment actions and illness costs in the two communities, and to identify case study households. The main part, of the research was to follow 16 case study households for eight months, which enabled in-depth investigation of treatment seeking behaviour, expenditure patterns, asset strategies and their impact on household livelihoods. The main findings of the research were ' that free public provision of health services protected poor households from high treatment -costs. In particular, public tertiary hospitals protected households against potentially catastrophic treatment costs associated with inpatient care. This enabled households to access treatment without adopting risky coping strategies. However, aspects of the health system failed to protect households from illness costs, and in a context of low and insecure incomes, illness costs did not have to be high to exceed daily budgets and undermine ability to meet basic food needs. Consequently, households often required additional resources to meet illness costs, and people's financial and social resources were shown to be important factors influencing ability to manage illness costs. However, the research also found that income-poor households had weak social resource endowments which forced them into riskier borrowing or asset strategies. Policy actions to support household assets are examined.
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Ibrahim, Abdul Razak. "An integrated performance measurement system of healthcare services : an empirical study of public and private hospitals in Malaysia." Thesis, University of Strathclyde, 2002. http://oleg.lib.strath.ac.uk:80/R/?func=dbin-jump-full&object_id=23752.
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The purpose of this study is to explore performance measurement systems in the healthcare services in Malaysia. This study postulates a framework based on an analysis of the existing literature in the field and on the empirical evidence collected during fieldwork. This framework provides a useful perspective for studying performance measurement in developing countries such as Malaysia. Moreover, identification of gaps in the field enables both academics as well as practitioners to improve the existing systems, thereby creating more robust and better surveillance in the healthcare industry. The findings show that in order for systems to operate efficiently, three major components must work together, namely strategy formulation and deployment, internal control systems, and managing processes. The empirical framework developed in the study represents an amalgamation of approaches used in organisations. One of the findings is that top management commitments, people involvement, and structure to accommodate change process are the catalyst for measurement systems to work. Further analysis reveals (survey) that 80% of users are not satisfied with their measurement system. This means that there is a need for further research in the future. Performance measurement is in its embryonic stage in Malaysia as the survey reveals domains accomplishment of less than 50%. The healthcare industry is inevitably growing and the Malaysian government needs to address the importance of measuring performance in the long run. Learning from another country's experience is the best way forward. The thesis also provides a context in which performance measurement works. There are two contexts applied: healthcare industries and Malaysia. Both contextual elements are important; healthcare has special attributes that make it different from other industries, while Malaysia has unique properties that provide a fresh look at healthcare. The key to successful performance measurement is to ensure congruence in all elements of the systems: context (Malaysia and healthcare) and content (organisations where systems exist). Then integration can be accomplished.
26
Irozuru, E. C. "Information systems in district health authorities : a strategy for management." Thesis, University of Salford, 1999. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.299129.
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Li, Jun. "The use of child health computing systems in primary preventive care : an evaluation." Thesis, University College London (University of London), 1993. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.274686.
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Jones, Robert J. "An investigation into the development of a computerized information system for NHS physiotherapy services in England : an action research study." Thesis, University of Kent, 2000. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.324658.
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29
Kemp, Audrey June. "Quality of Life and the Health Care System in New River Valley, Virginia: Residents' Perceptions and Experiences." Diss., Virginia Tech, 2008. http://hdl.handle.net/10919/26611.
Full textAbstract:
The present study involved the implementation of one component, Community Health Status Assessment, of a comprehensive, strategic planning tool, Mobilizing for Action through Planning and Partnerships (MAPP), to qualitatively uncover the perceptions of the quality of life and local health care system of 28 residents in New River Valley (NRV), Virginia. The current study represents the initial qualitative study utilizing MAPP in Virginia. Interviewees perceived an overall good quality of life (e.g., ample green space, safe neighborhoods), with an urgent need for health care reform, affordable insurance, and transportation, particularly for after-hours medical care. The current study also reviews the specific findings from the one-on-one interviews, and provides a step-by-step look at the MAPP process for potential users as applied to a real-world community, specifically, the NRV.Ph. D.
30
Stamos, Peter Spiro. "The welfare state and the challenge of economic crises : the case of Sweden 1974-1987, with particular attention to the Swedish health care system." Thesis, University of Oxford, 1989. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.385812.
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Timmons, Stephen. "Resistance to computerised care planning systems by nurses in the NHS." Thesis, Anglia Ruskin University, 2001. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.368274.
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Byrne, Elaine. "A participatory approach to the design of a child-health community-based information system for the care of vulnerable children." Thesis, University of the Western Cape, 2004. http://etd.uwc.ac.za/index.php?module=etd&.
Full textAbstract:
The existing District Health Information System in South Africa can be described as a facility based Information System, focusing on the clinics and hospitals and not on the community. Consequently, only those who access health services through these facilities are included in the system. Many children do not have access to basic health and social services and consequently, are denied their right to good health. Additionally, they are excluded from the routine Health Information System. Policy and resource decisions made by the District Managers, based on the current health facility information, reinforces the exclusion of these already marginalised children. The premise behind this research is that vulnerability of children can be tackled using two interconnected strategies. The first is through the creation of awareness of the situation of children and the second through mobilising the commitment and action of government and society to address this situation. These strategies can be supported by designing an Information System for actionan Information System that can be used to advocate and influence decisions and policies for the rights of these children
an Information System that includes all children. An interpretive participatory action research approach, using a case study in a rural municipality in South Africa, was adopted for the study of a child-health Community-Based Information System. The context in which the community is placed, as well as the structures which are embedded in it, was examined using Structuration Theory. This theory also influenced the design of the Information System. As the aim of the research is to change the Information System to include vulnerable children, a Critical Social Theoretical and longitudinal perspective was adopted. In particular, concepts from Habermas, such as the creation of a public sphere and the &rsquo
Ideal Speech Situation&rsquo
, informed the methodology chosen and were used to analyse the research undertaken.
Based on the research conducted in this municipality, four main changes to the Health Information System were made. These were: &bull
determination of the community&rsquo
s own indicators
&bull
changes in data collection forms
&bull
creation of forums for analysis and reflection, and
&bull
changes in the information flows for improved feedback. Other practical contributions of the research are the development of local capacities in data collection and analysis, the development of practical guidelines on the design of a child-health Community-Based Information System, and the development of strategies for enabling participation and communication. In line with the action research approach adopted, and the desire to link theory and practice, the research also contributed on a theoretical level. These contributions include extending the use of Structuration Theory, in conjunction with Habermas&rsquo
Critical Social Theory, to the empirical context of South Africa
addressing the gap of Community-Based Information Systems in Information System design
extending the debate on participation and communication in Information Systems to &rsquo
developing&rsquo
countries, and developing generalisations from a qualitative case study.
33
Ruano, Ana Lorena. "The role of social participation in municipal-level health systems : the case of Palencia, Guatemala." Doctoral thesis, Umeå universitet, Epidemiologi och global hälsa, 2012. http://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-59865.
Full textAbstract:
Background: Social participation has been recognized as an important public health policy since the declaration of Alma-Ata presented it as one of the pillars of primary health care in 1978. Since then, there have been many adaptations to the original policy recommendations, but participation in health is still seen as a means to make the health system more responsive to local health needs, and as a way to bring the health sector and the community closer together. Aim: To explore the role that social participation has in a municipal-level health system in Guatemala in order to inform future policies and programs. Methods: The fieldwork for this study was carried out over eight months and three field visits between early January of 2009 and late March of 2010. During this time, 38 indepth interviews with provincial and district-level health authorities, municipal authorities, community representatives and community health workers were conducted. Using an overall applied ethnographic approach, the main means of data collection were participant observation, in-depth interviews, group discussions and informal conversations. The data was analyzed in two different rounds. In the first one we used documentary analysis, role-ordered matrices and thematic analsis (see papers I-IV) and in the second round, thematic analysis was utilized. Results: We found four themes that frame what the role of social participation in the municipality of Palencia is. The first theme presents the historical, political and social context that has contributed to shaping the participation policies and practices in Guatemala as a whole. The second theme takes a deeper look at these policies and how they have been received in the municipality of Palencia. The third theme presents data regarding the three situated practices of participation, each occurring at a different level: municipal, community and the individual level. Finally, the last theme presents reflections on what it means to participate to the people that were involved in this study. Conclusion: In the process of social participation there are two different and complementary kinds of power that depend on the amount and the kind of resources available at each level of the participation structure. Stakeholders that have higher levels of power to formulate policies will have better access to financial, human and material resources while stakeholders that have higher levels of power to implement policies will have resources like community legitimacy, knowledge of local culture, values and mores, as well as a deep understanding of local social processes. The coordination of financial, human and material resources is just as important as the legitimacy that comes from having community leaders involved in more steps of the process. True collaboration can only be obtained through the promotion and creation of meaningful partnerships between institutional stakeholders and community leaders and other stakeholders that are working at the community level. For this to happen, more structured support for the participation process in the form of clear policies, funding and capacity building is needed.
34
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.
Full textAbstract:
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.
35
Chadwick, Lionel Kevin. "Incentives influencing general practitioners in selected Western European health systems : a 1985 comparative study." Thesis, London School of Economics and Political Science (University of London), 1988. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.364370.
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Nolan, Michael Robert. "Timeshare beds : a pluralistic evaluation of rota bed systems in continuing care hospitals." Thesis, Bangor University, 1991. https://research.bangor.ac.uk/portal/en/theses/timeshare-beds--a-pluralistic-evaluation-of-rota-bed-systems-in-continuing-care-hospitals(5cbe7718-983f-4e5d-a6f6-ced07a4d4a36).html.
Full textAbstract:
This thesis reports the results of a pluralistic evaluation of rota bed systems providing respite care to carers of the dependent elderly. Using a multi-method triangulated design the study examines: the sources and determinants of carers' stresses and rewards; the subjective views of the main stakeholder groups as to the benefits and problems of the rota bed system; the rota bed experience as indicated by the environment and regime of care and the activity levels of rota bed users at two contrasting continuing care hospital wards. Using data from a national sample survey of members of the Association of Carers, convincing empirical support is provided for the transactional approach to the understanding of carer stress. In addition the results extend the conceptualisation of caring to include sources of satisfaction. The benefits and problems of the rota bed system are explicated and, on the basis of these suggestions are made as to how both respite care and related services to carers might be improved. Within the context of recent policy initiatives consideration is given to the nature of professional responses to carers and their dependants with particular reference to the role of the nursing profession.
37
Wynaden, Dianne Gaye. "The primary carer's experience of caring for a person with a mental disorder in the Western Australian community: a grounded theory study." Thesis, Curtin University, 2002. http://hdl.handle.net/20.500.11937/883.
Full textAbstract:
One in five Australians has a mental disorder and it is estimated that one in four families have a member who has a mental disorder. Since the 1960s there has been an 80 percent decrease in Australian institution-based mental health care. The majority of people who have a mental disorder are now treated in their local community and many of them live with their families. The change in the delivery of mental health care has seen the family emerge as one of the most important supports to their ill family member. While the changes in the delivery of mental health care have been based on human rights concerns, changes in mental health legislature, and economic factors, the multi-dimensional experience of being a primary carer of a person with a mental disorder remains relatively unexplored. The need for empirical evidence on the primary carer's experience is noted in both the scientific literature and from carers themselves and the principal aim of conducting this research was to address the identified need. This qualitative study, using grounded theory methodology, presents the findings of interviews with 27 primary carers and memos documented throughout the study. In addition, existing literature of relevance to the findings of this study is presented. A substantive theory of seeking balance to overcome being consumed is presented in this thesis. Using the grounded theory method the constant comparative analysis of data revealed that the basic social psychological problem shared by all participants was the experience of "being consumed". The problem of being consumed consisted of two stages: "disruption of established lifestyle" and a "sustained threat to self-equilibrium". Six conditions were identified as influencing participants' experience of being consumed.In order to address the problem of being consumed, participants engaged in a basic social psychological process of "seeking balance". When participants were engaged in this process they moved from a state of being consumed to one whereby they established and consolidated a balanced life perspective that incorporated their caregiving role. The process of seeking balance consisted of three phases: "utilising personal strategies to reduce the problem of being consumed', "restoring self- identity", and "reaching out to make a difference". In addition, data analysis identified the presence of a three phase sub-process entitled "trying to make sense of what was happening". Phases one of the core and sub- processes occurred primarily in the period prior to the time when a psychiatric diagnosis was made on the affected family member. Participants became engaged in the remaining two phases of the core and sub-processes when they became aware that their affected family member had a mental disorder. At the time of being interviewed for this study some participants were not yet engaged in the final phase of the process of seeking balance. Participants' experience of seeking balance was not related to the length of their caregiving experience but rather to their experience of seeking balance and the conditions influencing that process. Four conditions were identified as influencing participants' experience of seeking balance.This thesis presents the substantive theory of seeking balance to overcome being consumed. While the findings support existing scientific literature, the substantive theory also presents a new insight on caring from the primary carer's perspective. In particular, the findings challenge health professionals to actively pursue strategies to reduce carers' experience of being consumed. The findings of this study have implications for service provision and clinical practice, policy and planning, research, education, the general population, mental health consumers, and carers.
38
Clements, Andrea D., Becky Haas, and R. G. Bastian. "Progress in the Development of a Trauma Informed System of Care in Johnson City, Tennessee." Digital Commons @ East Tennessee State University, 2017. https://dc.etsu.edu/etsu-works/7240.
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39
Vellanky, Smitha. "Effect of computer decision support system on antibiotic utilization in a complex continuing care and rehabilitation hospital." Thesis, Kingston, Ont. : [s.n.], 2007. http://hdl.handle.net/1974/445.
Full text
40
Cohen, Deborah A. "Obtaining Genuine Family Involvement: Unpacking the System of Care Values and Principles." UKnowledge, 2014. http://uknowledge.uky.edu/csw_etds/9.
Full textAbstract:
Despite the federal government’s $1.5 billion investment between 1993 and 2010 to fund 164 separate community-based systems of care, there has been an extremely limited attempt to measure the impact of system of care. The impetus for this research is the struggle for how the value based concept of system of care is communicated within a community. While child mental health services researchers have published a number of randomized control trials to explore individual level supports for youth served in a system of care community, researchers have struggled to devise a way to measure system of care philosophy diffusion.
While system of care is a system level intervention, this study explored the role of the system of care value: family voice as it pertains to direct practice for children and families. The goal was to assess whether specific direct practices regularly associated with system of care (i.e., wraparound or home-based services) lead to greater family voice or if the mere presence of a high-functioning system of care community leads to equal family voice for all receiving community-based services.
The primary finding was a relationship between the perception of family functioning and perceived empowerment/self-efficacy. This finding suggests that as functioning improves, so does a caregiver’s perception of their personal empowerment/ self-efficacy. While the framing of this study was to “unpack” the system of care value of family voice, the findings do not support any clear cut explanation for how family voice is promoted or communicated to families. Based on the findings, it appears as if families feel more empowered as their child improves. Additional research needs to be done on the application of family voice within the practice setting to better understand how to best instruct staff to infuse family voice in their daily practice.
41
Maguire, Stuart. "The development of a methodology for the introduction of information systems within the National Health Service." Thesis, Lancaster University, 1998. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.287250.
Full textAbstract:
This thesis represents over five years of research focusing on the development and implementation of information systems within the National Health SefV1ce. It aims to contribute towards a better understanding of the information systems development process from inception through to system evaluation and review. Five long-term interventions have been undertaken in a range of National Health Service sites, examining different aspects of information provision. The length of the interventions ranged from nine months to almost two years. The five sites were all at different stages of system development. The research has been carried out using a combination of participant observation and action research. This has meant working with National Health Service staff on a series of system projects. The aim of the research is to try and help National Health Service (NHS) organisations deal more successfully with their information provision. The research question asks, "how can NHS organisations think about, and hence go about their information provision in such a way that successful information systems are introduced'!". Information systems development has generally been regarded as a technical discipline. This has led to a narrow view being taken of a number of areas that may affect the success or otherwise of system projects. Historically, the system development process has been concentrated in the hands of a small number of experts even though the implementation of systems can have far-reaching consequences for the organIsation. The output of the research is a set of issues that should be addressed when introducing information systems within the NHS. These have been translated into the OASES materials which form the appendices. OASES is not a prescriptive methodology but a set of principles and guidelines to try and improve the way that information systems are developed within the NHS. It IS hoped that the outcome of the research will be a situation in which effective information systems are developed that take account of the behavioural, cultural, and organisational issues that are important within complex organisations.
42
Frascina, Anthony Cosimo. "The integration of hospital information systems through user centred design." Thesis, Sheffield Hallam University, 1994. http://shura.shu.ac.uk/3185/.
Full textAbstract:
The development of computer systems in UK hospitals has in recent years been focused on the provision of hospital-wide information systems, known as Hospital Information Support Systems (HISS). This development has been motivated by National Health Service reforms and a realisation that earlier fragmented systems were not meeting the requirements of clinical and nursing staff in the most effective way. Such systems were often developed by external, centralised agencies using systems analysis techniques appropriate to the development of information systems in product orientated organisations. However, the hospital ward, an environment existing at the 'sharp end' of health care, in which many diverse and non-computer related activities take place, presents the system designer with many of the classic problems with which the discipline of Human Computer Interaction (HCI) is concerned. Although a HISS has the potential to improve both the work conditions of clinical staff and the delivery of health care, this may be impeded by many of the common obstacles associated with the introduction of a large and complex computer system into a work environment where tasks are ill defined. This thesis reports on a project that is based upon the application of HCI methods to the health care environment and their contribution to the solution of the problems that such an environment presents. Requirements for the users' interface to the potential HISS are derived using a task analytic approach, involving Task Analysis for Knowledge Descriptions (TAKD). A prototype system has been designed and subsequently evaluated in a hospital ward. The contribution of TAKD to the design and its further applicability to the environment are assessed. The research represents an original application of a formal task analysis method to the design of ward based computer systems, and as such makes a valuable contribution to the areas of medical informatics and HCI. It shows that TAKD has real but limited applicability in this sphere, in that its use can lead to the design of more usable interfaces, while there is a need to combine it with methods aimed at broader systems design if these benefits are to accrue in the development of a HISS. The potential for the integration of task analysis with Design Rationale methods is also demonstrated.
43
Keen, Justin Robert. "A systems approach to modelling services for people with dementia." Thesis, City University London, 1998. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.245863.
Full text
44
Davis, Christine S. "A future with hope the social construction of hope, help, and dialogic reconciliation in a community children's mental health system of care /." [Tampa, Fla.] : University of South Florida, 2005. http://purl.fcla.edu/fcla/etd/SFE0001040.
Full text
45
Winkelmann, Regina Anette. "Evaluation of cancer surveillance systems in the New Independent States of the former Soviet Union." Thesis, London School of Hygiene and Tropical Medicine (University of London), 1998. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.299377.
Full text
46
Cunningham, Brian Stewart. "Treatment outcomes of the augmented board and care system for the mentally ill: Focus on post-placement and diagnosis." CSUSB ScholarWorks, 1999. https://scholarworks.lib.csusb.edu/etd-project/1807.
Full text
47
Jones, R. T. "The development of the medical laboratory scientific officer profession : Qualifying systems, professional politics and technical change." Thesis, University of Sussex, 1986. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.373914.
Full text
48
Overholt, Sarah E. "Access, Equity, and Choice in the Mexican Health System: A Case Study of San Pablo Etla." Ohio : Ohio University, 2005. http://www.ohiolink.edu/etd/view.cgi?ohiou1125869288.
Full text
49
Sines, David Thomas. "Valuing the carers : an investigation of support systems required by mental handicap nurses working in residential services in the community." Thesis, University of Southampton, 1991. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.305651.
Full text
50
Wynaden, Dianne Gaye. "The primary carer's experience of caring for a person with a mental disorder in the Western Australian community: a grounded theory study." Curtin University of Technology, School of Nursing and Midwifery, 2002. http://espace.library.curtin.edu.au:80/R/?func=dbin-jump-full&object_id=15910.
Full textAbstract:
One in five Australians has a mental disorder and it is estimated that one in four families have a member who has a mental disorder. Since the 1960s there has been an 80 percent decrease in Australian institution-based mental health care. The majority of people who have a mental disorder are now treated in their local community and many of them live with their families. The change in the delivery of mental health care has seen the family emerge as one of the most important supports to their ill family member. While the changes in the delivery of mental health care have been based on human rights concerns, changes in mental health legislature, and economic factors, the multi-dimensional experience of being a primary carer of a person with a mental disorder remains relatively unexplored. The need for empirical evidence on the primary carer's experience is noted in both the scientific literature and from carers themselves and the principal aim of conducting this research was to address the identified need. This qualitative study, using grounded theory methodology, presents the findings of interviews with 27 primary carers and memos documented throughout the study. In addition, existing literature of relevance to the findings of this study is presented. A substantive theory of seeking balance to overcome being consumed is presented in this thesis. Using the grounded theory method the constant comparative analysis of data revealed that the basic social psychological problem shared by all participants was the experience of "being consumed". The problem of being consumed consisted of two stages: "disruption of established lifestyle" and a "sustained threat to self-equilibrium". Six conditions were identified as influencing participants' experience of being consumed.In order to address the problem of being consumed, participants engaged in a basic social psychological process of "seeking balance". When participants were engaged in this process they moved from a state of being consumed to one whereby they established and consolidated a balanced life perspective that incorporated their caregiving role. The process of seeking balance consisted of three phases: "utilising personal strategies to reduce the problem of being consumed', "restoring self- identity", and "reaching out to make a difference". In addition, data analysis identified the presence of a three phase sub-process entitled "trying to make sense of what was happening". Phases one of the core and sub- processes occurred primarily in the period prior to the time when a psychiatric diagnosis was made on the affected family member. Participants became engaged in the remaining two phases of the core and sub-processes when they became aware that their affected family member had a mental disorder. At the time of being interviewed for this study some participants were not yet engaged in the final phase of the process of seeking balance. Participants' experience of seeking balance was not related to the length of their caregiving experience but rather to their experience of seeking balance and the conditions influencing that process. Four conditions were identified as influencing participants' experience of seeking balance.
This thesis presents the substantive theory of seeking balance to overcome being consumed. While the findings support existing scientific literature, the substantive theory also presents a new insight on caring from the primary carer's perspective. In particular, the findings challenge health professionals to actively pursue strategies to reduce carers' experience of being consumed. The findings of this study have implications for service provision and clinical practice, policy and planning, research, education, the general population, mental health consumers, and carers.