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Erhardt, Erik Barry. "Bayesian Simultaneous Intervals for Small Areas: An Application to Mapping Mortality Rates in U.S. Health Service Areas." Link to electronic thesis, 2004. http://www.wpi.edu/Pubs/ETD/Available/etd-0105104-195633/.
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Thesis (M.S.) -- Worcester Polytechnic Institute.Keywords: Poisson-Gamma Regression; MCMC; Bayesian; Small Area Estimation; Simultaneous Inference; Statistics Includes bibliographical references (p. 61-67).
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Sermsri, Daovilay Banchongphanithpha hpani Santhat. "Utilization of health center service among the villagers in rural areas of Khonkaen Province, Thailand /." Abstract, 2005. http://mulinet3.li.mahidol.ac.th/thesis/2548/cd375/4737954.pdf.
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Shaikh, Babar Tasneem. "Determinants of health seeking behaviours and health service utilization : an analytical study of health seeking behaviours in the Northern areas of Pakistan." Thesis, University of Liverpool, 2008. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.501601.
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Currently the health policy planning process in Pakistan is impaired by a lack of analysis of how people use public, private and informal health care. Understanding the drivers of health seeking behaviour is important in order to develop rational policies to provide efficient, effective, acceptable, cost-effective, affordable and accessible health services and an overall responsive health care system. Better information is required on the determinants of health seeking behaviour such as socio-demographic, economic, physical accessibility, financial accessibility, women's autonomy and health service factors. To study the determinants of health seeking behaviour and their role in health service utilization in the population of the Northern Areas of Pakistan; and to improve the health policy planning process by providing evidence based information to the local government and the health care providers (private and traditional).
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Bocskay, Ildiko Roxane. "Methicillin-Resistant Staphylococcus Aureus Infections in the Eight Service Planning Areas of Los Angeles County." ScholarWorks, 2016. https://scholarworks.waldenu.edu/dissertations/2473.
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Methicillin-resistant staphylococcus aureus (MRSA) has become resistant to antibiotics. The purpose of this quantitative, retrospective cohort study was to examine the relationship between length of hospitalization and invasive MRSA infection rates among different racial and ethnic groups in the 8 service planning areas (SPAs) of Los Angeles County. Cane, O'Connor, and Michie's theoretical domain framework was used. Secondary data from the Healthcare-Associated (HA) Infections Program of the California Department of Public Health were analyzed. For the first research question, a Pearson correlation analysis was conducted to assess the relationships between length of hospitalization and invasive HA-MRSA infection rates and counts. Length of hospital stay was not correlatedwith HA-MRSA infection rates; however, it was strongly and positively correlated with HA-MRSA infection counts. For the second research question, a one-way ANOVA was conducted on the infection count rate data, with SPA as the between-subjects factor. The results were statistically significant, indicating that HA-MRSA infection counts varied among the 8 SPAs. The findings might help medical professionals better understand the risk factors associated with MRSA infections. In doing so, findings may relieve some of the burden on the U.S. health care system and improve the overall quality of life of the patients involved.
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Vinod, Shalini Kavita Public Health & Community Medicine Faculty of Medicine UNSW. "A lung cancer patterns of care study in the South Western Sydney Area Health Service." Awarded by:University of New South Wales. School of Public Health and Community Medicine, 2004. http://handle.unsw.edu.au/1959.4/22463.
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Background: The South Western Sydney Area Health Service (SWSAHS) contains many areas of socio-economic disadvantage and ethnic diversity. It has a high incidence of lung cancer, which is the leading cause of cancer deaths. The aims of this study were to document lung cancer patterns of care (POC) for SWSAHS residents, compare POC before and after the opening of an oncology centre in SWSAHS and compare POC with other areas in NSW. Methods: The study population consisted of SWSAHS residents diagnosed with lung cancer in 1993 and 1996. A clinical audit of medical records was performed to extract details on patient demographics, management of lung cancer and outcomes. Collaborating investigators performed identical studies in the Northern Sydney Area Health Service (NSAHS) and the Hunter Area Health Service (HAHS) for lung cancers diagnosed in 1996. Results: The SWSAHS study population comprised 527 patients. Nine percent did not have a pathological diagnosis. Twelve percent did not see a lung cancer specialist. Twenty-eight percent did not receive any treatment throughout the course of their illness. The median survival was 6.7 months and five-year actuarial survival was 8% (95% CI 6%-10%). Increasing age and poorer performance status were associated with a lower likelihood of obtaining a pathological diagnosis, specialist referral and treatment. Socio-economic factors did not influence POC. The establishment of an oncology center resulted in more referrals to medical oncologists and palliative care services. Other aspects of POC and survival were similar. Variability in POC was noted between SWSAHS, NSAHS and HAHS. HAHS residents were almost twice as likely not to have pathological confirmation of diagnosis or treatment. Despite this survival was not significantly different. Conclusions: This study has identified deficiencies in the management of lung cancer. To improve outcomes, referral to specialists and utilisation of treatment, particularly radiotherapy and chemotherapy, needs to be increased. Ageist and nihilistic attitudes need to be overcome. Prospective data collection is necessary to ensure quality of patient care. The formation of national guidelines for the management of lung cancer will play an important role in achieving better outcomes.
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White, Christopher P. "NHS resource allocation 1997 to 2003 with particular reference to the impact on rural areas." Thesis, St Andrews, 2009. http://hdl.handle.net/10023/825.
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Wilson, Gwendolyn Dianne. "A hearing services program for rural elderly individuals based upon their knowledge, preferences, attitudes and needs for these services /." Access Digital Full Text version, 1991. http://pocketknowledge.tc.columbia.edu/home.php/bybib/1116119x.
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Thesis (Ed.D.) -- Teachers College, Columbia University, 1991.Typescript; issued also on microfilm. Sponsor: Seymour Rigrodsky. Dissertation Committee: Eleanor B. Morrison. Includes bibliographical references: (leaves 82-87).
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Asfaw, Abay. "Costs of illness, demand for medical care, and the prospect of community health insurance schemes in the rural areas of Ethiopia /." Frankfurt am Main : Lang, 2003. http://bvbr.bib-bvb.de:8991/F?func=service&doc_library=BVB01&doc_number=010171224&line_number=0001&func_code=DB_RECORDS&service_type=MEDIA.
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Mofokeng, Shoeshoe. "Views of health service providers on the need for support services for HIV-positive mothers in the rural areas of Lesotho : an ecological perspective." Thesis, Stellenbosch : Stellenbosch University, 2015. http://hdl.handle.net/10019.1/96969.
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Thesis (M Social Work)--Stellenbosch University, 2015.ENGLISH ABSTRACT: HIV/AIDS is one of the worst pandemics affecting the world today. It cuts across all boundaries and many people are infected as well as affected. The virus has reached all the corners of the globe, but the most hit by it is Africa, especially southern Africa, which carries more than half of the population infected and affected by HIV/AIDS. The top five countries whose populationsare infected with HIV are in southern Africa. Lesotho is amongst the top three on this list and also has problems of poverty and a high unemployment rate. Women and children, who are the target groups that are most affected by poverty, are also those living in rural areas. Thus, being an HIV-positive mother living in the rural areas of Lesotho means one has to deal with poverty, the inaccessibility of services and the psychological impacts of HIV. The aim of the study was to gain a better understanding of the views of health service providers on the need and accessibility of support services for HIV-positive mothers in the rural areas of Lesotho from an ecological perspective. To achieve this aim, the objectives were: to offer an overview of the phenomenon of HIV and describe the psychosocial needs and sociocultural circumstance of HIV-positive mothers in the rural areas of Lesotho, and to discuss the HIV-positive mothers’ need for support services from an ecological perspective. Both quantitative and qualitative research approaches were used. The research utilised exploratory and descriptive design. Purposive sampling was used to select the 30 participants who took part in the study. Data was gathered by means of semi-structured questionnaires that were administered during individual interviews. The questionnaires were formulated on the basis of information retrieved during the literature review. The findings of the study reveal that HIV-positive mothers living in the rural areas of Lesotho have economic, social and cultural circumstance as factors hindering their treatment and prevention of HIV/AIDS. They are also faced with the psychological impacts of HIV, and the findings revealed that disclosure was the key to addressing their problems. The findings also show that most mothers receivedemotional, instrumental, informational and appraisal support from their families at the micro-level of the ecological perspective. The other levels – meso, exo and macro – provided only limited support for the mothers. The recommendations are that these mothers need social support at all levels of the ecological perspective to meet their needs
AFRIKAANSE OPSOMMING: MIV/vigs is een van die ergste pandemies in die moderne wêreld. Dit ken geen grense nie, en vele mense ly hetsy daaraan of daaronder. Die virus het reeds alle uithoeke van die aarde bereik. Tog gaan Afrika, veral Suider-Afrika, die swaarste daaronder gebuk, en word meer as die helfte van die totale populasie wat aan of onder MIV/vigs ly hier aangetref. Die vyf lande met die hoogste MIV-infeksiesyfers ter wêreld is almal in die streek geleë. Lesotho is een van die drie lande boaan hierdie lys, en het terselfdertyd te kampe met die probleme van armoede en ’n hoë werkloosheidsyfer. Vroue en kinders, synde die groepe wat die ergste deur armoede geraak word, woon ook meestal in landelike gebiede. ’n MIV-positiewe moeder in die landelike gebiede van Lesotho moet dus armoede, ontoeganklike dienste sowel as die sielkundige uitwerking van MIV trotseer. Die doel van hierdie studie was om vanuit die ekologiese perspektief ’n beter begrip te vorm van gesondheidsdiensverskaffers se sienings oor die behoefte aan en toeganklikheid van steundienste vir MIV-positiewe moeders in die landelike gebiede van Lesotho. Om hierdie doel te bereik, was die oogmerke om ’n oorsig van die MIV-verskynsel te bied, die psigososiale behoeftes en sosiokulturele omstandighede van MIV-positiewe moeders in die landelike gebiede van Lesotho te beskryf, en die moeders se behoefte aan steundienste vanuit die ekologiese perspektief te bespreek. ’n Kwantitatiewe sowel as ’n kwalitatiewe navorsingsmetode is gevolg, en die navorser het van ’n verkennende en beskrywende ontwerp gebruik gemaak. Doelgerigte steekproefneming is gebruik om die 30 studiedeelnemers te kies. Data is met behulp van semigestruktureerde vraelyste gedurende individuele onderhoude ingesamel. Die vraelyste is opgestel op grond van inligting wat in die literatuuroorsig bekom is. Die studie bevind dat ekonomiese, maatskaplike en kulturele omstandighede MIV/vigs-behandeling en -voorkoming vir MIV-positiewe vroue in die landelike gebiede van Lesotho belemmer. Daarbenewens moet hulle die sielkundige uitwerking van MIV die hoof bied, en die studie dui op openbaarmaking as die sleutel om hul probleme te hanteer. Die bevindinge toon ook dat die meeste moeders emosionele, fisiese, inligting- en bevestigende steun van hul families op die mikrovlak van die ekologiese perspektief ontvang. Die ander vlakke – meso, ekso en makro – bied slegs beperkte steun. Die studie kom tot die gevolgtrekking dat hierdie moeders op alle vlakke van die ekologiese perspektief maatskaplike steun moet ontvang om in hul behoeftes te voorsien.
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Brophy, Lisa Mary. "Using the emancipatory values of social work as a guide to the investigation : what processes and principles represent good practice with people on community treatment orders ? /." Connect to thesis, 2009. http://repository.unimelb.edu.au/10187/5760.
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This research explores good practice with people on CTOs - via a case study of one area mental health service in Victoria. The emancipatory values of Social Work were used to guide the investigation, thereby ensuring the involvement of consumers and their families or carers. Critical Social Work theory provided an important theoretical base for the research, and both critical theory and pragmatism supported the methodology. A mixed methods approach was undertaken. This included a cluster analysis of 164 people on CTOs. Three clusters emerged from the exploratory cluster analysis. These clusters, labelled ‘connected’, ‘young males’ and ‘chaotic’ are discussed in relation to their particular characteristics. The results from the cluster analysis were used to inform the recruitment of four people on CTOs who were the central focus of case studies that represented the different clusters. Semi-structured group interviews were also undertaken to enhance the triangulation of data collection and analysis. This resulted in 29 semi-structured interviews with multiple informants, including consumers, family/carers, case managers, doctors, Mental Health Review Board members and senior managers. The data analysis was guided by a general inductive approach that was supported by the use of NVivo 7.Five principles, and the processes required to enable them, emerged from the qualitative data: 1) use and develop direct practice skills, 2) take a human rights perspective, 3) focus on goals and desired outcomes, 4) aim for quality of service delivery, and, 5) enhance and enable the role of key stakeholders. These principles are discussed and then applied to the case studies in order to consider their potential relevance to practice within a diverse community of CTO recipients. The application of the principles identified two further findings: 1) that the principles are interdependent, and 2) the relevance of the principles varies depending on the characteristics of the consumer. The two most important findings to emerge from this thesis are that: 1) people on CTOs, their family/carers, and service providers are a diverse community of people who have a range of problems, needs and preferences in relation to either being on a CTO or supporting someone on a CTO; and 2) the implementation of CTOs is influenced by social and structural issues that need to be considered in developing any recognition or understanding about what represents good practice. Recommendations relating to each of the principles are made, along with identification of future research questions. A particular focus is whether application of the principles will enable improvements in practice on a range of measures, including reducing the use of CTOs, and the experience of coercion by consumers.
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Pick, William M. "Regionalization of health services in the Cape Province : a framework." Master's thesis, University of Cape Town, 1989. http://hdl.handle.net/11427/27193.
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Post-graduate students specializing in Community Health, are attached to different health authorities during their training. During these attachments they are exposed to the day-to-day management of health services and experience at first hand, the difficulties as well as the successes that are encountered in tending to the health needs of communities. It is also expected that post-graduate students do research projects during their attachments, usually on topics on which the health services managers need information. The topic discussed in this report was an assignment given to the author at the start of his attachment to the department of Hospital (Health) Services of the Cape Provincial Administration. The period of attachment was from February to May 1987. The whole question of the regionalization of health services is a complex one, and it is necessary that any proposals for a system of regionalization benefit from the inputs of many experts in different fields. However, as has been the experience in the United States of America, such inputs are no guarantee -that a successful system of regionalization will result. (1) In the local front, the Department of Works, at the request of the Director of Hospital Services, began an investigation into the existing system of regionalization of hospital services in 1985. This attempt was aborted, possibly because of the magnitude of the task, among other things. (2). What follows hereafter should therefore be seen as merely a framework for the development of a system of regionalization rather than as a blueprint for such a system. Perhaps a few remarks about the age-old problem of line-staff conflict would not be amiss at this stage. During the development of this framework, it became apparent that line officials might be expecting a quick proposal of regions and/ or sub-regions for the delivery of health services based on a purely management approach. As a staff official, the author naturally had different expectations. The report is an attempt to marry the two sets of expectations and it is left to the reader to judge to what extent, if at all, the author has succeeded in this attempt. Much of the data used in the study are new, and computation was done largely by hand. The generation of the data, was therefore time-consuming and much of the first phase of the study was devoted to the generation of the data and collection of data that were available from other sources. The study has proved to be a fascinating one and it is hoped that permission will be obtained to pursue the study in more detail. This report should therefore be seen as a preliminary report which addresses the question of regionalization of health services in the Cape Province in 'macro' terms. And finally, the author hopes that some of the information in this report may prove of value to those responsible for the delivery of health services to the people of the Cape Province.
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Le, Sabin De Anna. "An assessment of elderly health care needs and access in three urban San Bernardino communities." CSUSB ScholarWorks, 2002. https://scholarworks.lib.csusb.edu/etd-project/2320.
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This project was an assessment of elderly health care needs and access. Three urban San Bernardino communities in zip codes 92405, 92410, and 92411 were targeted. The assessment was structured according to King's theoretical construction of community as a multilevel interaction between personal, interpersonal and social systems. The components of the assessment included digital photographs, web-based internet assessments, key informant interviews, and community business visits.
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Santos, Simone Correia dos. "Espacialização dos sistemas de saúde de São Cristóvão - SE : a saúde sob o olhar geográfico." Pós-Graduação em Geografia, 2014. https://ri.ufs.br/handle/riufs/5563.
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The health system of a municipality has in their day-to-day challenge of ensuring that all its service network and information systems and work is executed in full, following the prerogatives of the SUS, not only ensuring the right of access health services as well as developing activities to prevent major diseases and disorders that plague the citizens of the municipality. In this context, this paper is to investigate the spatial organization of the city of São Cristóvão-SE Health Systems, with emphasis on Health Units agreements with the SUS. Through this goal, one approach is to recognize how these units are structured, and this was based on multiple meanings of space, both in geography and in view of health agencies. For this it was necessary to carry out the field work, construction and supply of georeferenced database and preparation of thematic maps. In total 21 health establishments that are part of the municipal Health System, to analyze the data collected were identified, it can be noted that the distribution of health facilities is disproportionate to the need of the population, since they are located mostly in two areas, the Municipal Headquarters and Housing Complex Rosa Elze, leaving areas without a proper physical structure and human health. It was observed that the total number of people served in the establishments is not proportional to the size of the coverage area of each unit, in this case it appears that there must be an error in filling these data, despite going up in 2012 are the most recent. Given the results of this study, we propose initially to managers distribute the units of health according to the population covered, distribute specialties according to the needs of health, contextualize the services to be offered from the analysis of life and work local population. Otherwise it will be possible to improve the services offered, creating healthy spaces where access to health will be increasingly closer to changing surface integral, benefiting the local population.O Sistema de saúde de um município tem no seu dia-a-dia o desafio de garantir que toda a sua rede de atendimento e sistemas informacionais trabalhe e seja executado de forma integral, seguindo as prerrogativas do SUS, não só assegurando o direito ao acesso aos serviços de saúde como também desenvolvendo atividades que previnam as principais doenças e agravos que assolam os cidadãos do município. Neste contexto, este trabalho tem como objetivo geral investigar a organização espacial dos Sistemas de Saúde do município de São Cristóvão-SE, com ênfase para as Unidades de Saúde conveniadas com o SUS. Através desse objetivo, um dos enfoques consiste em reconhecer como estão estruturadas essas unidades, e para isto baseou-se nos múltiplos sentidos de espaço, tanto na visão da geografia quanto na dos órgãos de saúde. Para tanto fez-se necessário realizar, trabalhos em campo, construção e alimentação do banco de dados georreferenciados e confecção de mapas temáticos. No total foram identificados 21 estabelecimentos de saude que fazem parte do Sistema de Saude municipal, ao analisar os dados recolhidos, pode-se destacar que a distribuição de estabelecimentos de saude é desproporcional a necessidade da população, uma vez que eles estão localizados na sua maioria em duas áreas, na Sede Municipal e no Conjunto Habitacional Rosa Elze, ficando áreas sem uma apropriada estrutura física e humana de saúde. Observou-se que a quantidade total de pessoas atendidas nos estabelecimentos não é proporcional ao tamanho da área de abrangência de cada unidade, nesse caso constata-se que deve haver um erro no preenchimento desses dados, que apesar de irem ate 2012 são os mais recentes. Diante dos resultados deste estudo, propõem-se inicialmente aos gestores distribuir as unidades de saude de acordo com a população coberta, distribuir as especialidades de acordo com as necessidades de saude, contextualizar os serviços a serem oferecidos a partir da analise de vida e trabalho da população local. Pois assim seria possível melhorar os serviços ofertados, criando-se espaços saudáveis onde o acesso a saude estará cada vez mais próxima de mudar de superficial para integral, beneficiando a população municipal.
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ARAÚJO, José Alencar Viana de. "A região de influência de Imperatriz-MA: estudo da polarização de uma capital regional, destacando a regionalização dos serviços públicos de saúde." Universidade Federal de Pernambuco, 2016. https://repositorio.ufpe.br/handle/123456789/17859.
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Este trabalho tem como objetivo compreender quais os fatores que determinantes para a formação de uma rede de cidades sobre influência de Imperatriz MA, tendo como foco quatro regiões de saúde localizadas no centro-oeste e sul do Maranhão: Região de Saúde Açailândia, Região de Saúde Barra do Corda, Região de Saúde Balsas e a relação dessas com a Região de Saúde Imperatriz. Para tanto, inicialmente se buscou realizar a fundamentação teórica dos conceitos chaves para o trabalho, como cidade média, rede urbana, diferenciação urbano-rural, região de saúde. Segue-se então para a caracterização de Imperatriz enquanto cidade média e polo regional segue então foram caracterizadas as quatro regiões de saúde em estudo visando caracterizar a rede urbana sob influência de Imperatriz, especialmente em relação aos serviços de saúde; para tanto é vital a utilização de dados levantados em várias instituições como IBGE, IPEA, DATASUS. Mediante a caracterização das regiões de saúde pôde-se concluir que Imperatriz se destaca como cidade média na qual vivem 93% de sua população municipal, também possui os melhores índices socioeconômicos e de saúde entre as quatro regiões. Também é um polo comercial, de educação e de saúde. Estes são fatores que centralizam em Imperatriz uma rede de cidades que constitui sua região de influência, tendo os serviços de saúde um importante papel de atração populacional.
This work aims to understand which factors decisive for the formation of a network of cities under the influence of Imperatriz - MA, focusing on four health regions located in the Midwest and southern Maranhão Health Region Açailândia, Region health Barra do Corda, Region health Balsas and the relationship of these with the Region health of Imperatriz. Therefore, initially sought to accomplish the theoretical basis of the key concepts to work, on average, urban network, urban-rural differentiation, health region. It follows then to characterize Imperatriz as average and regional hub city following were then characterized the four health regions in the study to characterize the urban network under the influence of Imperatriz, especially in relation to health services; for this it is vital to use data collected in various institutions such as IBGE, IPEA, DATASUS. By the characterization of health regions could be concluded that Imperatriz stands as average city in which they live 93% of its municipal population, also has the best socio-economic and health indexes among the four regions. It is also a commercial hub, education and health. These are factors that centralizes in Imperatriz a network of cities is its area of influence, and the health services an important role in population attraction.
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Schindler, Hamiti Adélaïde. "Offre de soins dans le Massif central : Territorialisation, gouvernance et initiatives pour faire face aux nouveaux enjeux." Thesis, Clermont-Ferrand 2, 2014. http://www.theses.fr/2014CLF20011/document.
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Le Massif central est un ensemble de territoires aux dynamiques variées. Il réunit toutefois des caractéristiques qui, ajoutées aux enjeux nationaux, induisent des difficultés dans la présence, l’organisation et l’accès aux soins, en particulier pour les territoires éloignés des zones urbaines et des structures hospitalières, peu peuplés, peu attractifs et dont la population vieillit. Ce travail de thèse a pour objectif de rendre compte des questionnements qui s’expriment dans ces territoires, des acteurs qui s’y investissent et des actions qui s’y déroulent, selon un angle d’approche territoriale et en particulier à travers les discours et les actions des institutions sanitaires, des collectivités territoriales et des professionnels de santé locaux. Prendre en compte ce qui fait les spécificités des territoires ruraux du Massif doit mieux aider à concevoir des solutions. La proximité des relations entre les professionnels de santé et la population, le faible nombre de professionnels, la place des élus locaux et les configurations des collectivités rurales, sont autant d’éléments à considérer. A partir des préoccupations et des postures de chacun et des exemples de projets innovants tels que les réseaux de santé de proximité, ce travail permet de mieux comprendre qu’au-delà des faibles dessertes de l’offre de soins et des situations d’éloignement aux services, c’est la capacité des acteurs à travailler ensemble et leurs modalités d’organisation et de collaboration qui contribuent au maintien, à l’accès et à la qualité de l’offre de soinsThe Massif Central is made up of several areas with specific dynamics. However, a number of common characteristics (rural and mountain areas, low population density) added to the national issues related to the health system make the organization of health care and its access difficult. Following a territorial approach and based on speeches and actions made by health care services, local authorities and health professionals, our research effort was focused on collecting and analyzing raised issues, actors involved in the field and actions that were taken. Evaluating the distinctive features of the rural areas in the Massif could allow new solutions to be developed. The close relationship between the populations and health actors, the low number of professionals, the role of the elected members and of the rural local authorities are key elements to take into account in Massif Central. We analyzed the interests and positions of each actor and explore new ongoing projects such as the healthcare centres with primary care teams or the local health care network developed in rural areas. This work contributes to the understanding of the pivotal role of the dialogue and cooperation among the main local actors (health professionals, political representatives and health institutions) on the success of the present and future projects to maintain and develop the supply of health care
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Lagerstedt, Marianne. "Är det mänskligt att fela? Synen på misstag och disciplinpåföljder i militär flygverksamhet och i hälso- och sjukvårdens verksamhet." Thesis, Linköping University, Department of Thematic Studies, 2002. http://urn.kb.se/resolve?urn=urn:nbn:se:liu:diva-1906.
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In the essay, the view of mistakes and disciplinary sanctions within the military aviation and health and medical service, are compared. The comparison shows that military aviation and health and medical service could have several points in common on how mistakes may occur, but that the present view of mistakes is different betwen the sectors. The view of mistakes and disciplinary sanctions is explicit within military aviation, and is based on a clear ideology on how mistakes occur, which is characterised of a systematic approach. Within health and medical service, an explicit and unequivocal ideology on how mistakes occur is missing, but, however, there are implicit ideas about infallibility and perfection. The comparison indicates that the view of mistakes is also, possibly directed by a bureaucratic model (instead of an ideology on mistakes), which aims to legitimacy, but that this may happen on the expense of not taking surrounding circumstances into consideration. In that way there may be a certain contrast in the health and medical service’s present system between rule of law and medical service safety.
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Lin, Fang-Yi, and 林芳儀. "Improving Health Service Quality in Rural Areas by Quality Function Deployment Model." Thesis, 2009. http://ndltd.ncl.edu.tw/handle/61249547780673163502.
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碩士國立澎湖科技大學
服務業經營管理研究所
97
There is no doubt we are among an era of aged society and ccompanied by higher level of education comes along higher expectations in quality standard of medical services. The Health Industry, even though traditionally leaned towards a one-way doctor-patient relationship, now inevitably faces vigorous competition. By adopting new perspectives from the service industry, health organizations have gradually developed a customer (patient)-oriented relationship when providing health services in order to promote customer satisfaction. Penghu is a rural island area and health care resources are generally poor and insufficient when compared to Taiwan mainland. The main issue that must be examined without any delays is how to reform the heath care standard of Penghu area, so the long lost trust factor of Penghu citizens can be regained. This study proposes the study subjects as patients who seek health care services at Penghu public regional hospitals. Different areas where the patients wished for more emphasis yet have been neglected and items of lower satisfaction are identified. With the application of Quality Function Deployment, QFD Model, the strategy on how to enhance rural health care service quality is formulated. Study results indicate the unsatisfactory areas where the rural island public would like more focus on are: “Not enough specialists”, “Insufficient doctors and staff”, and “Out dated medical equipment and facilities”. Analysis of QFD Model shows the top five concerns on the priority list of patients to health care services are: “Sufficient Doctors and staff”, “Adequate specialists”, “Auto-tracking system of patient recovery status”, “Modern medical equipment and facilities”, and “Waiting time”. The top five concerns on health administration are: “Sufficient Professionals”, “Customized health care services”, “Before and on-the-job educational training”, “Means to evaluate attitude of service personnel”, and “Usage of health information pamphlets”.
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Liu, Ting-yu, and 劉庭妤. "Exploring the Health Service Quality in Rural Areas after the Implementation of Integrated Delivery System." Thesis, 2011. http://ndltd.ncl.edu.tw/handle/4h9w48.
Full textAbstract:
碩士嘉南藥理科技大學
醫療資訊管理研究所
99
【Background and Motives】 The Bureau of National Health Insurance (NHI) has implemented ”The National Health Insurance Project of Integrated Delivery Systems in Mountainous and Islet Districts” (IDS program) in order to improve the accessibility and wholeness of medical care in rural areas. Because of the less researches of health services quality in the past, this study tried to explore the importance and satisfaction of health services quality which are perceived by people in rural areas after the implementation of IDS program. 【Objective】 The importance of health services quality not only to influenced patients’ satisfaction, but also to affected patients’ loyalty. The objectives of the study are as follows: 1. To understand the patients’ perceived importance and satisfaction of health services quality in rural areas. 2. To explore the factors that influences the perceived importance and satisfaction of health services quality in rural areas. 【Methods】 The study adopted the SERVQUAL questionnaire with five-point Likert’s scale and convenience sampling to collect data. Objects were residents who lived in Maulin, Namashia and Taoyaun and looked for medical services in health centre in the past one year. 286 valid questionnaires were collected with a response rate 84.62%. After data collecting, the study adopted SPSS 17.0 to run the descriptive analysis, bivariate analysis and regression analysis. 【Results】 On the aspect of the importance of health services quality, the most important one of five dimensions is “Responsiveness” (Mean=4.15, SD=0.689), and the lowest important one is “Empathy” (Mean=4.039, SD=0.703). As for the satisfaction of health services quality, the most satisfied one of five dimension is “Assurance” (Mean=3.842, SD=0.723), and the least satisfied one is “Tangibles” (Mean=3.72, SD=0.703). The results show us that “place of residence” and “transportation time” could significantly influence patients’ perceived importance and satisfaction. The residents who lived in Namashia perceived significantly lower importance and satisfaction of health services quality than residents who lived in Maulin and Taoyaun. The residents who spent less then thirty minutes to clinic perceived higher importance and satisfaction of health services quality than those who spent more then two hours. 【Conclusions and Suggestion】 The results show that there are all negative gaps of five dimensions of health services quality. The biggest gap of five dimensions of health services quality is “Responsiveness”, the administrators of hospitals and health centres should improve the professional skill and manner of all medical staffs first in order to minimize the gap. The study also suggests that the managers should improve the whole health services quality in order to raise the perceived importance and satisfaction by residents who live in Namashia. In addition, the residents who spent more then two hours to clinic percived lower importance and satisfaction of health services quality. Health services providers should provide more mobile health services to improve the accessibility and usability of health services.
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Masingi, Nkateko Tracey. "An evaluation of health-care service delivery in rural areas with specific reference to Ndengeza Township." Diss., 2019. http://hdl.handle.net/11602/1468.
Full textAbstract:
MPMDepartment of Public Health
The dawn of democracy in 1994 saw huge strides in the adjustment of various statutory instruments that aimed at opening the systems to all South Africans particularly the previously excluded groups. Health care system was one of the ear marked areas by the South African government for post-apartheid transformation. Resultantly, access to health care was declared a right and incorporated into the Constitution of the Republic of South Africa 1996. Numerous legislative and practical steps towards achieving access to health care for all have been made with notable results. However, due the apartheid spatial planning which persuaded separate development left some sections of the community remote and with no infrastructure to support health care delivery. As a result, this has made the realization of the health care for all dreams elusive. Reportedly, the most affected communities were mainly homelands which were largely rural and townships. Despite notable improvements in the delivery of health care services across the Republic, there are still major challenges faced in this sector mainly in the rural areas and townships. Therefore, the study was set to investigate and evaluate the state of health care service delivery in rural Ndengeza Township. The study employed both qualitative and quantitative method following a descriptive design (cross-sectional) and data was collected using a self-administered questionnaire and interview questions. The results revealed that transport, staff-patient relationship, unavailability of medication and medical staff were the major challenges of health care service delivery in rural areas. The respondents alluded that to improve health service delivery in the area, there is need to make available basic medication and trained medical personnel. It is believed, by the participants, that adding the number of staff will go a long way in changing the negative perceptions such as long queues, unavailability of critical services and unprincipled professionals that the public have of the local health care centers
NRF
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Chadoulis, Georgios. "Mental Health Service provision in remote areas in Greece: the experience of the Mobile Mental Health Units in Cyclades islands." Master's thesis, 2016. http://hdl.handle.net/10362/19607.
Full textAbstract:
RESUMO: O objetivo deste estudo foi identificar se e como a atuação das unidades móveis de
saúde mental nas Cíclades, na Grécia teve um efeito sobre a saúde mental da
população local. As ilhas Cíclades, embora mundialmente populares como destino de
verão, tinham um sistema quase inexistente de serviços de saúde mental. Devido à
falta de tais serviços, 2 unidades móveis foram fundadas há 10 anos, a fim de cobrir
esta lacuna. Oferecemos uma breve descrição da estrutura e dos mecanismos de
funcionamento das unidades móveis. Em seguida, apresentamos a situação atual e
sua evolução ao longo do tempo. Os dados foram processados em uma única base
de dados dos usuários das Unidades Móveis de Saúde Mental, em um período de 10
anos. Foram utilizados métodos quantitativos e análise descritiva para um conjunto
de variáveis e indicadores, para ajudar a chegar a uma conclusão sobre como medir
o impacto da prestação de serviço, bem como uma breve discussão em grupo focal
envolvendo os principais atores na comunidade.
A amostra do presente estudo é a população de 6.884 adultos, que foram
encaminhados para as unidades psiquiátricas móveis de EPAPSY do Oeste e Nordeste
de Cíclades entre os anos de 2003 e 2014. O presente estudo centrou-se na
identificação dos efeitos positivos da prestação de serviços das unidades para a
população local, bem como das barreiras e limitações durante a experiência de 10
anos nas Cíclades. Adicionalmente, abordamos alguns obstáculos atuais (como a
crise socioeconômica e de que forma tem afetado a prestação de serviços e o estado
de saúde mental dos usuários). Identificamos as principais razões para a variação e a
mudança no número de usuários por ano durante a década, o número e fonte dos
encaminhamentos, os pedidos iniciais dos pacientes aos serviços e como eles
evoluíram ao longo do tempo. Concluiu-se que os serviços oferecidos pelas unidades
móveis tiveram impacto positivo na redução da lacuna de tratamento e aumento da
sensibilização para as questões de saúde mental. Identificamos, ainda, alguns
indicadores que poderiam apontar para a redução do estigma nas comunidades.
Sugerimos alguns passos fundamentais para a melhoria dos serviços e,
eventualmente, sua avaliação, a fim de estudar o impacto geral sobre a saúde
mental da população das ilhas.ABSTRACT:The aim of this study was to identify if and how the operation of the mental health mobile units in the Cyclades in Greece has had an effect on the mental health of the local population. The Cyclades islands, although very popular as a summer destination globally, had an almost inexistent system of mental health services. Due to the complete lack of such services, 2 mobile units were founded 10 years ago in order to cover for this lack. We give a short description of the structure and working mechanisms of the mobile units. We then present the current situation and how it has evolved across time. We processed the data into a unique database of the users of the Mobile Mental Health Units in a period of 10 years. We used quantitative methods and descriptive analysis to a set of variables and indicators to help us reach a conclusion of how to measure the impact of the provision of service, along with a short focus groups discussion involving the key players in the community. The sample of the present study is the clinical population of 6,884 adults, who were referred to the mobile psychiatric units of EPAPSY in West and North-East Cyclades between the years 2003 and 2014. The current study has focused on the identification of positive effects of the service provision of the units for the local population, as well as the barriers and limitations during the 10 year experience in the Cyclades. In addition, we tackled some present obstacles (such as the socioeconomic crisis and how these have affected service provision and users’ mental health status. we identified the main reasons behind the fluctuation and change in the number of users per year over the decade, the number and source of referrals, the initial requests of the patients for services and how they evolved across time. We concluded that the services offered by the Mobile units had a positive impact in the reducing treatment gap and increasing awareness for mental health issues. We also identified a few indicators that could point towards a reduction of stigma in the communities. We suggested some key steps forward for the improvement of services and, eventually, their evaluation, in order to examine the overall impact on the mental health of the population of the islands.
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Tshabalala, Amme Mardulate. "Mobile clinic users' opinions on health care service provision in the Muldersdrift area,Gauteng province." Thesis, 2006. http://hdl.handle.net/10539/1880.
Full textAbstract:
Student Number : 0008922X -
MPH research report -
Faculty of Health SciencesThe use of the mobile clinics for rendering health care services in South Africa is part of the services rendered according to the Primary Health Care Service Package that was officially published in 2001. Mobile clinics have been found to be instrumental in rendering of health care especially in the rural and semi- rural areas. In the majority of these areas, the mobile clinic is the only source of health care provision at community level. Lack of well developed infrastructure and poor roads contribute to inaccessibility of health care services in rural and semi-rural areas. Health programmes are often of poor quality or offer incomplete services. Factors such as lack of knowledge of available health care services, satisfaction with the quality and range of services provided, and unavailability of the mobile clinic service when there is a health need, can result in the mobile health care clinic being less utilized. The purpose of the study was to address the following question: What are mobile clinic users’ opinions on health care service provision in the Muldersdrift area Gauteng Province? To answer the question three research objectives were formulated. These were to: describe the mobile clinic users’ level of service utilization, to assess their level of knowledge of available health care services and to determine their level of satisfaction with the services provided. To achieve the study objectives, an exploratory, descriptive survey was used as the research design. Three sampling techniques were used in this study. Cluster sampling was used for developing sampling framework for the 35 mobile points. Stratified sampling used to stratification of the mobile points. A non- probability convenience sampling was then used for final selection of the nine mobile clinic points and for selection of a sample size of 94 mobile clinic users’ to be included in the study. Data were analysed using the Statistical Package 7.0. The results show that the mobile clinic service was optimally utilized, 59% had used the service more than thrice within a period of six months. The majority of participants (89.3%) had knowledge of all the services being offered on the mobile clinic. Very few respondents (19.5%) were aware of the availability of HIV and AIDS counseling and testing on the mobile clinic. All most all the respondents (98.9%) were satisfied the range of services offered on the mobile clinic. Almost half (48.9%) were not satisfied with the service being offered once a month, (4.4%) with the attitude of the staff, (5.3%) with treatment of common ailments and (2%) said the mobile clinic service was bad.
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O'Hara, Denise Anne. "Organisational challenges: the boundary spanning role of divisions of general practice in Victoria, 1993-2006." 2007. http://repository.unimelb.edu.au/10187/2206.
Full textAbstract:
This qualitative study investigates the evolving role of Divisions of General Practice (Divisions) in linking general practitioners (GPs) and general practice with the wider health sector in Australia. The work draws on boundary role theory within organisations, integration theories, empirical research on service integration involving general practice, and structural interests theory to develop the conceptual framework on which the research was based. The data for the research came from both documentary and interview sources that gave voice to Divisions in the state of Victoria, Australia. The documents used represented the core working documents of Divisions, and the semi-structured interviews involved 30 key informants, these being leaders in all Victorian Divisions.
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Prithiviraj, Thamotharampillai Gerard. "The knowledge, attitude and practice among primary health care nurse practitioners regarding oral health and oral HIV lesions in QE II and Roma health service areas in Maseru, Lesotho." Thesis, 2012. http://hdl.handle.net/10539/11441.
Full textAbstract:
M.P.H., Faculty of Health Sciences, University of the Witwatersrand, 2011Although the nursing sector has not been spared the effects of human resource shortages and Human Immune-deficiency Virus/Acquired Immune Deficiency Syndrome (HIV/AIDS) crisis in Lesotho, it still remains the backbone of the primary health care delivery. There is a well-established linkage between oral health and HIV/AIDS with many of the early symptoms of HIV manifesting in the oro-facial region. However, the lack of oral health personnel at primary health care levels in Lesotho makes Primary Health Care Nurse Practitioners (PHCNPs) often the first health care providers to consult, manage and refer patients with such oral lesions. Aim: To assess the “knowledge, attitude and practice” (KAP) of the PHCNPs regarding oral health and oral HIV lesions in Queen Elizabeth II (QE II) and Roma health service areas (HSA) of Maseru district in Lesotho. Objectives: To assess the demographic profile of PHCNPs in the target health facilities, their knowledge, attitude and practice regarding oral health and oral HIV lesions. Methods and Materials: The research was a descriptive cross-sectional survey. A convenience sample of 57 primary health care nurse practitioners (PHCNPs) from QE II and Roma health service areas were identified. During their monthly PHC meeting, a questionnaire was administered to assess the knowledge, attitude and practice regarding oral health and oral HIV lesions. The information gathered was both quantitative and qualitative. Data was entered and analysed using the SPSS statistical package. Results: The response rate was 87.7%. There was 100% consensus regarding the importance of oral health to the total well being of individuals. The majority of the PHCNPs recognised oral candidiasis (OC) (94.7%), bleeding gums (87.7%), herpes lesions (71.9%) and dental caries (75.4%). Lesions such as acute necrotizing ulcerative gingivitis (ANUG) (40.3%), angular cheilitis (AC) (56.1%) and apthous ulcerations (24.6%) were also recognised but to a lesser extent. The respondents associated OC (84%), herpes (61%), AC (54%), Oral Hairy Leukoplakia (OHL) (49%), Kaposi‟s‟ sarcoma (KS) (49%) with HIV/AIDS. OC was the most common lesion associated with HIV. Some lesions commonly seen in the clinics such as apthous ulceration and ANUG were not significantly associated with HIV (18% and 33%, respectively). The majority of PHCNPs (81%) indicated that they had knowledge about oral HIV lesions. Twenty nine 6 respondents (50.8 %) reported having received this knowledge through training institutions. Mass media (Radio (53%), TV (40%), and newspapers/magazines (49%)) was one of the major sources of information. Forty-four PHCNPs (77.2%) saw only Zero or one (0-1) HIV patients with oral lesions. Similarly, 15.8 % and 7% of the PHCNPs saw 11 to 20 and more than 20 (21+) HIV patients with oral lesions, respectively. The two thirds of the PHCNPs (67%) said they would not advise patients to seek care from Traditional Health Practitioners (THP) due to their lack of trust and confidence in the practices, knowledge and the patient management of the THPs. However, 16% of them reported that they would refer because they thought traditional medicine boosts the immune system. Only seven respondents (12.3%) routinely washed their hands with antiseptics. However, 44 of respondents (77.2 %) cleaned their instruments with bleach and disinfectants. The majority (89.5%) washed their hands with water and soap. Forty three respondents (75.4%) wore gloves during examination. Routine use of facemasks was limited to only 12 respondents (21.1 %). Ninety eight percent of the PHCNPs stated that they would like to learn to manage oral lesions at health centres. The majority (79%) of the respondents said that they would like to receive more training on the management of oral lesions through workshops. Conclusions: There was an observable correlation between PHCNPs self-assessment of oral health knowledge and the objective knowledge as assessed by ability to identify the oral lesions on a chart ( 2 –sided Fischer‟s test-0.000-0.261).This needs to be confirmed by undertaking a study with a larger sample size. OC was the most common lesion associated with HIV as reported by the PHCNPs. The majority of the participants (94.7%) identified OC and associated it (84%) with HIV infection. The finding indicated that with training and/or mentoring, PHCNPs are likely to confidently diagnose oral HIV lesions. PHCNPs showed a positive attitude towards learning more about the oral manifestations of HIV/AIDS. PHCNPs should be utilised more effectively in the diagnosis and management of HIV/AIDS.
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Jiang, Benran. "A profile of young adults aged 20-30 years with cerebral palsy in Victoria: health, function, pain, quality of life, social participation, and service utilisation." 2009. http://repository.unimelb.edu.au/10187/7129.
Full textAbstract:
INTRODUCTION AND BACKGROUND: Cerebral palsy (CP) is the most common physical disability in childhood with a prevalence of approximately 2-2.5 per 100 live births. Improvements in paediatric care have increased the survival of individuals with CP. Overall 90% are expected to grow into adulthood yet little is known about the outcomes of young adults with this condition. In order to provide holistic services for this population, an understanding of various aspects of their lives is required.AIMS: To examine the outcome of young adults with CP from the perspective of perceived health status, functional ability, pain, quality of life (QOL), social participation, and healthcare service utilizations, compared with their able-bodied peers. To explore the determinants that contribute to the variation of these outcomes in the context of impairments, activity, participation, and personal and environmental factors.
METHODS: This is a population based cross sectional study of young adults with CP based on the WHO International Classification of Functioning, Disability and Health (ICF) model. A cohort of 335 young adults with cerebral palsy born in Victoria, aged 20 to 30 years, was recruited from the Victorian Cerebral Palsy Register. Data of typically developed peers selected from the Household, Income and Labour Dynamics in Australia Survey 2004 were used for comparison for the outcomes of perceived health, pain, and social participation. Data from a population-based sample of 751 young adults in U.S. were used for comparative analyses of QOL. Participants were asked to complete a multidimensional questionnaire by self report, or proxy report by parents or carers for those with intellectual or severe physical impairments. The questionnaire was comprised of the Quality of Life Instrument for Young Adults, the Short Form-36 Health Survey Questionnaire version 2, the Gross Motor Function Classification System, the Barthel Index, and a demographic section.
RESULTS: A total of 335 young adults with CP participated; 207 (62%) were able to self report and 128 (38%) were proxy reported. Compared with their able-bodied peers, self reported physical health in this population was lower but mental health was similar. Gross motor function, independence in self care, and limb distribution together explained 60% of the variance in the physical health data. They experienced more pain, impaired function, and reduced social participation, but despite this, their contact with medical and allied health professionals was low. Pain was linked with limb distribution and had a negative impact on functional ability, employment participation and QOL. Impaired functional ability, intellectual disability, and communication impairments had major effects in reducing social participation. Self reported QOL was similar to their peers in social relationship and environmental context domains, but was lower in the domains of physical health, psychological well-being, and role function. The impact of CP on the individuals’ QOL was on physical and functional aspects, and sometimes on social relationships, but not on psychological well-being.
CONCLUSION: This study has demonstrated that greater efforts are needed to improve the health, function, QOL, and social participation in individuals with CP, accompanied by more research to monitor the effectiveness of interventions for them.
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CHOU, YU-YU, and 周佑俞. "A Study on Healthcare Service Quality Satisfaction and Loyalty of Public Health Centers in Remote Areas-Using Yunlin County as an Example." Thesis, 2017. http://ndltd.ncl.edu.tw/handle/ts4fqu.
Full textAbstract:
碩士國立雲林科技大學
工業工程與管理系
105
This study aimed to explore the relationship between healthcare service quality and loyalty in remote areas, and to examine whether healthcare service quality and loyalty are varies based on demographic characteristics. The main purposes of this study are as follows: 1. To explore the importance, satisfaction, and loyalty of consumer to healthcare service quality in remote areas; 2. To investigate how healthcare service quality in remote areas varies based on demographic characteristics; 3. To understand the gap in healthcare service quality in remote areas as a basis for service quality improvement by public health centers in Yunlin County. The subjects of the study were patients and their family members visiting ten public health centers in Yunlin County; an effective sample of 300 was obtained. By referring to the relevant literature, we designed a scale to investigate the public’s level of importance, satisfaction, and loyalty. The findings obtained by the scale were analyzed using descriptive statistics and a correlation analysis, t-test, analysis of variance, and regression analysis. A decision matrix was plotted based on the analysis results, and conclusions and suggestions were proposed for service quality improvement in public health centers in Yunlin County. The following were the major findings of the study: (1) The three elements of service quality in public health centers that the public placed the most emphasis on were medical equipment, nursing personnel, and medical expertise and knowledge. (2) The three elements of service quality in public health centers that varied the most with reference to the public’s level of importance and satisfaction were medical equipment, preservation of medical records, and prompt response by nurses. (3) The three elements of service quality in public health centers regarding which the public experienced the least satisfaction were medical equipment, active reminders of follow-up visits, and dynamic spatial lines in public health centers. (4) Strengthening the quality of guaranteed services can enhance the public’s loyalty in public health centers. (5)To satisfy the satisfaction and loyalty for individuals with different demographic characteristics.
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Kruss, Julie L. ""Country women are resilient but....” : family planning access in rural Victoria." Thesis, 2012. https://vuir.vu.edu.au/21315/.
Full textAbstract:
Most women use family planning services during their reproductive lifetime, but many lack ready access to such services, particularly in a rural area. The aim of this study was to document and thus develop an understanding of the facilitators and barriers to accessing three types of family planning services (emergency contraception, termination of pregnancy, and options counselling) within a particular rural area of Victoria, Australia, and how these might affect women’s psychosocial health and their ability to make timely decisions about continuation of a pregnancy.
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parris, heather n. "Physical and Mental Health Interventions in a Rural, School-Based Setting: A comparative analysis of academic performance, behavioral outcomes, and attendance." 2010. http://trace.tennessee.edu/utk_graddiss/839.
Full textAbstract:
Abstract The purpose of this study was to determine the differences in academic achievement, behavioral health outcomes and attendance in poor, rural children receiving physical and mental health services regularly as opposed to those children not receiving the intervention. The intervention was a school-based health and mental health clinic located on the school’s campus. This study was analyzed by providing descriptive information for several variables including the number of suspensions per year, number of times corporal punishment was used as a means of correction, educational outcomes, total number of clinic visits per year, attendance percentages per year, and number of teacher and parent referrals to the school clinic. Data for this study were presented in multiple charts and graphs and schools are compared using descriptive information. The results suggested that as the number of clinic visits increased across the three year period, the numbers of, and rates of, corporal punishment in the clinic school decreased. In contrast, the available data suggested that across the first two years the numbers of, and rates of, corporal punishment increased in the control school. Further, in the majority of subject areas, the percentage of students’ proficiency levels in the clinic school increased across time and the percentages exceeded these in the control school. These findings were consistent with the hypotheses that there will be improvements in the behavioral outcomes associated with the presence of the clinic in the school. Unfortunately there were not enough data to conduct a test of statistical significance of the differences between schools for the third year.
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Mugisha, Emmanuel. "Delivery and utilisation of voluntary HIV counselling and testing services among fishing communities in Uganda." Thesis, 2008. http://hdl.handle.net/10500/2954.
Full textAbstract:
The study explored, described and explained the current models of voluntary counselling and testing services delivery and analysed the extent to which a given VCT model had influenced uptake of VCT services in the fishing communities along the shores of Lake Victoria, in Wakiso District, with an aim of designing optimal VCT service delivery strategies. The study was therefore exploratory, descriptive and explanatory, and collected both qualitative and quantitative data in a three-phased approach. Phase I involved the Kasenyi fishing community respondents, while phases II and III involved VCT managers and VCT counsellors at the Entebbe and Kisubi Hospitals.
The findings indicated that VCT services are generally available onsite at health facilities, and in the field through mobile VCT outreach or home-based VCT services provided at clients’ homes. Both client-initiated and health provider-initiated VCT services are available and services are integrated with other health services. Despite the availability of VCT, only about half of the respondents in phase I had accessed VCT services although almost all indicated a willingness to undergo HIV testing in the near future. The main challenges to service delivery and utilisation included limited funding and staffing as well as limited awareness in target communities. The strategies drawn are based on the need to increase availability, accessibility, acceptability and utilisation of VCT services.Health Studies
D. Litt. et Phil. (Health Studies)
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Dawson, David. "Experiential and Organisational Factors Predicting the Mental Health of Emergency Paramedics: Beyond the Trauma." Thesis, 2021. https://vuir.vu.edu.au/42952/.
Full textAbstract:
This research aimed to investigate the prevalence and distribution of mental health conditions across the paramedic workforce, to compare levels with the general population and to assess the association of stressors with scores on measures of mental health.
A survey was constructed to assess general psychological health, depression, anxiety, stress, suicidality, posttraumatic stress disorder, sleep health and the frequency and severity of stressor variables. Impact scores for stressor variables were generated by multiplying frequency and severity scores. Participant and workplace sociodemographic variables were measured. The survey was distributed within Ambulance Victoria in September 2010. Only data from 879 participants that transported emergency patients was analysed.
The ANOVA procedure and chi-square tests were employed to compare means and prevalences of psychological health scores within the paramedic sample according to sociodemographic variables. Independent-sample t-tests and chi-square tests for independence were used to examine means and prevalence rates by comparing this paramedic sample with general population statistics and other paramedic populations. Logistic and multiple regression analyses were conducted to investigate associations between stressor impact scores and mental health conditions.
Key findings were the higher levels of suicidal thinking and planning, PTSD, substandard sleep health and poor general psychological health compared to the general population. The level of PTSD was comparable to other paramedic populations while suicidality was higher: there were mixed findings on the other measures. Regression analyses found that stressors related to the organisation, the broader work context and shift work were significantly associated with measures of mental health while, with the exception of anxiety, emergency work was not. There were no meaningful differences in levels of mental health conditions within groups across the paramedic workforce except that PTSD caseness was higher outside the major cities and, higher levels of suicidality were reported in three ambulance service regions.
The higher levels of suicidality in this paramedic sample is a new finding although further research is needed to determine its nature and sources. Many stressors associated with mental health are not emergency work related but are instead associated with the organization and aspects of the broader working environment, suggesting that some stressors may be amenable to being managed. The lack of meaningful differences within this paramedic sample indicates that targeting mental health interventions is not practical, and should instead be directed across the entire workforce.
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Fitzpatrick, Maree. "Corporate governance in the Victorian public health sector." Thesis, 2008. https://vuir.vu.edu.au/1569/.
Full textAbstract:
This thesis sets out to investigate the meaning, understanding and application of corporate governance in a public sector health service provider in Victoria, Australia. The methodological and analytical approach is based on an adaptation of the Glaser and Strauss’ grounded theory, using ethnographic and survey techniques to collect
and describe data so as to capture a broad interpretation of how governance as a process is interpreted, understood and practiced in this organisation. Most studies of governance focus on economic compliance and performance, and
questions concerning less obvious human elements of governance involving decision-making are left largely unaddressed and unresolved. In this thesis, these
less tangible elements of governance are explored. The perspective presented here is that corporate governance is a socio-cultural phenomenon that requires not only an
examination of the governance structures and processes in place, but also the direct observations of social and cultural elements including individual and organisational
decision-making. There is a dearth of corporate governance research in the public sector, which has in the past decade adopted a system of governance more aligned to a private sector model. This thesis starts to address this lack. It combines a study of the Board and its accountabilities in the face of rapid change (analogous to the private sector model) with evidence from stakeholders to assess the impact of the governance in the public sector. From the analysis of the data collected and from the researcher’s observations, the health provider studied here can be described as having an effective Board. It appears
to have integrated decision-making, with the Board strategically setting the direction of the service and supporting the actions of management to meet the key performance targets and measures as prescribed by the Department of Human Services (DHS). This research explores how governance as a process is interpreted, understood and
practiced in the context of a public sector organisation. It offers a unique insight into the complex concept of corporate governance and offers a constructionist conceptual
paradigm for further governance inquiry.
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Porter, Sandra. "An exploration of the support needs of ambulance paramedics." Thesis, 2013. https://vuir.vu.edu.au/22296/.
Full textAbstract:
The work of ambulance paramedics is usually physically and emotionally draining and can place significant amounts of pressure on the emergency service worker. The work they do can impact their social life, their family and ultimately, their health. The primary aim of this research was to explore the psychological and social coping strategies of ambulance paramedics, in dealing with the day to day aspects of their work in the context of their long term health and well-being. A secondary aim was to examine the use of current peer support programs and other referral services used by paramedics. This study was a qualitative exploration of the experiences of ambulance paramedics through interviewing. Qualitative research has allowed the researcher to capture the stories of individuals, in their own words. This study included nine novice paramedics (first year) and 12 longer term employed (five plus years) paramedics within Rural Ambulance Victoria. Participants were also recruited to reflect the gender ratio in the paramedic workforce.
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Dada, Ebrahim. "Outpatient catchment populations of hospitals and clinics in Natal/KwaZulu." Thesis, 1987. http://hdl.handle.net/10413/7584.
Full textAbstract:
Catchment populations and cross-boundary flow characteristics of health
facilities in Natal and KwaZulu have not previously been determined. As
this information is essential to objective health service planning the
present study was undertaken.
Utilization. cross-boundary flow and catchment populations were determined in 1986 for each hospital and clinic in Natal and KwaZulu.
All of the 61 hospitals and 178 clinics in Natal and KwaZulu which are
operated by the public sector were included in the study.
The ratio of clinics-to-hospitals was 2.9 1. The overall average population per hospital and clinic was 106775 and 36591 respectively.
The size of the catchment populations of hospitals varied from 334972 to 272 and of clinics from 253159 to 877. Factors associated with these variations are discussed.
Inter-regional cross-boundary flow of patients varied appreciably. The
greatest influx of patients was experienced by the Durban sub-region where the teaching hospital is situated while the greatest influx of patients was experienced in the Port Shepstone sub-region.
Attendance rates per person per annum. according to racial group, were 0.9, 2.1, 1.7 and 0.8 respectively for Blacks, Coloureds, Indians and Whites.
Recommendations in respect of the distribution of health facilities and the
routine collection and use of health information relevant to the management process are submitted.Thesis (M.Med.)-University of Natal, Durban, 1987.
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Godfredson, Jeffrey. "An International Comparison of Emergency Medical Services Delivery Systems: Which Produces The Optimum Outcome For The Patient?" Thesis, 2018. https://vuir.vu.edu.au/37851/.
Full textAbstract:
This thesis was written to address a problem with ambulance service delivery
times in Victoria, Australia. For a number of years, ambulance response times have
been increasing to unacceptable levels. As a result of the ever-increasing problem it was
appropriate to see if the are other alternative solutions producing better results. There
are a number of different service delivery models for Emergency Medical Services
(EMS) around the world. The main two are the Anglo/American model (also known as
scoop and run) and the Franco/German model (also known a stay and play). There are
also two major delivery agencies; the British model of a separate third party public
sector service as used in UK, Australia and New Zealand or the fire service model
where the fire service is the main delivery agency such as most of Asia, Europe and
North America. Which model provides the best outcome for the patient? Such research
has not been done in the past. The research will also examine if the Metropolitan Fire
brigade has capacity to undertake possible EMS roles.
A number of case studies were undertaken and explored with key issues of
response times, patient outcomes, skills and new technologies compared. The results,
particularly of response time show that in Victoria the response time for fire EMS (8.3
minutes) to medical emergencies is similar to that provided by fire services delivering
EMS in North America. The MFB in Victoria is providing the equivalent of first
responder; the American and Canadian fire services are delivering Advanced Life
Support (ALS). The response times for Basic Life Support (BLS) in Victoria provided
by ambulance service are over twice as long (8.3 minutes for fire compared to 18.2
minutes for Victorian Ambulance at the 90%). The US and Canadian Fire Services
provide EMS response time considerably lower than Ambulance Victoria, some as low
as 7.43 minutes. UK Ambulance (on which the Victorian model is based) also provides
response time considerably less than Ambulance Victoria. The issue of whether the fire
service in Victoria has capacity to undertake further EMS delivery was explored and
whilst it has the capacity it is doubtful it could be delivered in the current industrial
environment with the union having the capability of vetoing managerial decisions.
The research raised fundamental questions regarding the effective use of scarce
public sector resources and agencies working across organisational boundaries in the
interests of serving the public. Data analysis involved pattern matching, explanation
building and time series analysis to identify trends and commonalities across the cases.
A number of themes emerged including continued increases in call volumes, challenges
meeting response times and the development of proactive programs to reduce the
impact of these trends.
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Austen, Tyrone. "A homelessness report card for Victoria, British Columbia: establishing the process and baseline measures to enable annual homelessness reporting." Thesis, 2010. http://hdl.handle.net/1828/2940.
Full textAbstract:
Systems-level homelessness report cards are an intricate part of managing and resolving homelessness within a community. Homelessness report cards can be used to both educate communities around the complexities of homelessness and capture pertinent data required to formulate evidence-based strategies towards ending (rather than managing) homelessness. The process of developing and implementing homelessness report cards can be fraught with challenges relating to: limited resources; fragmented information; and political roadblocks. To help reduce the potential of these roadblocks, a system-level Homelessness Outcome Reporting Normative framework (the “HORN Framework”) was developed. The HORN Framework is based on a literature review and synthesis of the best-practice, systems-level homelessness report card development and implementation methods. The framework was then tested in a case study with the Greater Victoria Coalition to End Homelessness (GVCEH), through the creation of their 2010 Greater Victoria Homelessness Report Card. The framework and case study results are presented in this thesis.
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Maxey, Hannah L. "Understanding the Influence of State Policy Environment on Dental Service Availability, Access, and Oral Health in America's Underserved Communities." Thesis, 2014. http://hdl.handle.net/1805/5993.
Full textAbstract:
Indiana University-Purdue University Indianapolis (IUPUI)Oral health is crucial to overall health and a focus of the U.S. Health Center program, which provides preventive dental services in medically underserved communities. Dental hygiene is an oral health profession whose practice is focused on dental disease prevention and oral health promotion. Variations in the practice and regulation of dental hygiene has been demonstrated to influence access to dental care at a state level; restrictive policies are associated lower rates of access to care. Understanding whether and to what extent policy variations affect availability and access to dental care and the oral health of medically underserved communities served by grantees of the U.S. Health Center program is the focus of this study. This longitudinal study examines dental service utilization at 1,135 health center grantees that received community health center funding from 2004 to 2011. The Dental Hygiene Professional Practice Index (DHPPI) was used as an indicator of the state policy environment. The influence of grantee and state level characteristics are also considered. Mixed effects models were used to account for correlations introduced by the multiple hierarchical structure of the data. Key findings of this study demonstrate that state policy environment is a predictor of the availability and access to dental care and the oral health status of medically underserved communities that received care at a grantee of the U.S. Health Center program. Grantees located in states with highly restrictive policy environments were 73% less likely to deliver dental services and, those that do, provided care to 7% fewer patients than those grantees located in states with the most supportive policy environments. Population’s served by grantees from the most restrictive states received less preventive care and had greater restorative and emergency dental care needs. State policy environment is a predictor of availability and access to dental care and the oral health status of medically underserved communities. This study has important implications for policy at the federal, state, and local levels. Findings demonstrate the need for policy and advocacy efforts at all levels, especially within states with restrictive policy environments.