Dissertations / Theses on the topic 'Health service evaluation'
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1
McCrone, Paul Richard. "Economic evaluation of a sectorised community mental health service." Thesis, King's College London (University of London), 2000. https://kclpure.kcl.ac.uk/portal/en/theses/economic-evaluation-of-a-sectorised-community-mental-health-service(e054bac1-158b-4e76-b358-699efe54008b).html.
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Holloway, Jacqueline Anne. "Performance evaluation in the National Health Service : a systems approach." Thesis, Open University, 1990. http://oro.open.ac.uk/57302/.
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This research explores the contribution which systems theories, methodologies and models can make in the design and application of effective performance-evaluation processes. Approaches to performance assessment of organisations are reviewed, and the history and structure of the NHS, its objectives, and dimensions for evaluation are described. Drawing on questionnaire and interview data from health service and civil service staff, and secondary data, current performance evaluation and planning processes in the NHS are described and some problems identified. To test the hypothesis that attention to systemic factors could improve performance evaluation, eight topics are analysed by the application of systems methodologies or models. Four of the topic and methodology or model combinations have received detailed analysis: 1. Making and implementing strategic plans; the Open University's Hard Systems Methodology. 2. Controlling NHS performance through structure and process, e. g. the use of annual reviews, performance indicators; double-loop learning and cybernetic control model. 3. Improving the quality of NHS care; Stafford Beer's Viable System Model. 4. Assessing performance through the outcomes of care; Peter Checkland's Soft Systems Methodology. The areas studied in less detail are: 5. Planning for uncertainty and complexity; 6. Issues related to the politics of health; 7. Reducing the length of waiting lists and times; 8. Planning for health (health promotion and the prevention of ill health).
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Niven, Karen J. M. "A longitudinal impact evaluation of health and safety management in the National Health Service." Thesis, University of Aberdeen, 2003. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.401203.
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The research aim was to evaluate whether it is possible to reliably measure change in health and safety performance when a formal health and safety intervention is introduced to the UK healthcare sector. The research methodology and design was informed by a review of relevant literature. Field study data was generated using a six-point design. This included: use of a before-and-after (longitudinal) design, use of comparison groups; use of an intervention that was of interest to participating NHS Trusts, use of a participative style which involved the participating Trusts; use of multiple measurement methods and multiple indicators of effectiveness. Seven NHS Trusts participated; two of which were a control group. The intervention was health and safety management workbook, introduced only to the test group. Evaluation of the impact of the workbook on health and safety performance involved two identical phases, the second approximately twelve months after the first. Each phase consisted of a staff opinion questionnaire survey, based on previously validated work; and a new Health and Safety Executive (HSE) methodology involving management root cause analysis plus cost estimations of incident data. There was wide variation in the numbers of incidents reported within each Trust, although the mean difference between phases was not significant (P<0.1). There was no significant difference between the test and control Trusts (P=0.05). Incident rates were in broad agreement with official HSC data, so far as fatal/major injury rates wee concerned, although there was less agreement for minor incidents. These results suggested that Trust reporting culture may be linked to overall reporting rates but that captured incidents, (which met the project inclusion criteria and therefore represented more serious incidents), were independent of reporting rate, size and type of Trust. The use of incident reporting rates as benchmarking indicators should therefore be used with caution until further work can be carried out to clarify the nature and scope of their limitations. There is also a need to clarify to relationship between major and minor incidents and whether they share similar root causes. This would help to establish whether recording only the more serious incidents with selective root cause analysis would be more cost effective than the processing and analysis of large numbers of incident reports.
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Day, Crispin Stuart Mark. "An evaluation of a needs-based community child mental health service." Thesis, King's College London (University of London), 2003. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.406747.
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Siripol, Samantha. "Health service delivery and health outcomes of at-risk populations." Master's thesis, Canberra, ACT : The Australian National University, 2018. http://hdl.handle.net/1885/154723.
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As required by the Master of Philosophy (Applied Epidemiology)
program I completed a field placement in the Strategic
Investment, Data and Evaluation Section in the Indigenous Health
Division, Australian Government Department of Health.
Following the introduction chapter (chapter 1), this thesis
contains three projects, which aimed to: 1) explore the
performance of health organisations providing social and
emotional wellbeing (SEWB) services for Aboriginal and Torres
Strait Islander peoples (chapter 2); 2) analyse the relationships
between health organisations’ cultural safety policies and the
uptake of Medicare Benefits Scheme (MBS) health assessments among
Aboriginal and Torres Strait Islander clients (chapter 3); and 3)
describe and the characteristics of inpatients who acquired vanA
vancomycin-resistant enterococci and compare the characteristics
of inpatients with vanA versus vanB sterile site infections at
the John Hunter and Calvary Mater Newcastle hospitals in
Newcastle, New South Wales (chapter 4).
My first project was a national survey of SEWB service delivery
in 2014-15 using a quantitative questionnaire, administrative
data and qualitative case studies. Service delivery strengths
included accessibility, capability, continuity, appropriateness,
responsiveness and sustainability. Fifteen opportunities to
strengthen SEWB service delivery were identified, including in
the areas of: client access, perceptions and experiences of
service delivery; strengthening the SEWB workforce; and
facilities required to support service delivery. These
opportunities represent potential approaches that could improve
the SEWB of Aboriginal and Torres Strait Islander peoples.
For my second project, I used logistic regression to model
univariate relationships between seven cultural safety policies
and low or high uptake of MBS health assessments in 2014-16 using
existing administrative and service performance data. Data from
174 health organisations showed no associations between cultural
safety policies and health assessment uptake, however this is
likely due to study and data limitations.
In my third project, I conducted two case series analyses. The
first described numbers and proportions of 168 vanA and vanAB
acquisitions in 2013-2015. It also examined potential
contributing environmental exposures and other risk factors that
might lead to infection or colonisation. The second case series
used Wilcoxon rank-sum, Chi-squared or Fisher’s exact tests to
compare morbidity and mortality outcomes between vanA and vanB
for 42 inpatients with laboratory-confirmed sterile site
infections in 2015. No specific environmental exposures or risk
factors that likely contributed to acquisition, and no difference
in morbidity and mortality outcomes between genotypes, were
identified. This may suggest that vanA is endemic to the hospital
environment, highlighting the importance of standard, enhanced
and tailored infection prevention and control precautions.
To meet the teaching requirements, I presented to my peers on
logic models and confounding. Additional to the program
requirements, I completed an internship in the Ebola Community
Engagement Team at the World Health Organization, Geneva,
Switzerland. Chapters 5 and 6, respectively, reflect on these
experiences.
I highly value the opportunities and the skills, experience and
knowledge in epidemiology, public health research and practice I
developed in the program. I applied my knowledge of logic models,
skills in data analysis and interpretation, and knowledge of the
importance of understanding and accommodating culture and belief
systems when addressing public health issues in my paid
employment in my field placement.
6
Phala, Arnold Victor Mamonyane. "Service delivery at Itsoseng psychology clinic a programme evaluation /." Pretoria : [s.n.], 2008. http://upetd.up.ac.za/thesis/available/etd-11252009-232622.
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Joss, Richard. "An evaluation of total quality management projects in the National Health Service." Thesis, Brunel University, 1998. http://bura.brunel.ac.uk/handle/2438/1393.
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This thesis sets out to account for the relative failure of Total Quality Management (TQM) experiments installed in the NHS between 1990 and 1994. In the study, only two NHS pilot sites in a large sample of hospitals and community services were found to have made significant progress on implementing TQM. Whilst most of these TQM sites made more progress on structured quality improvement than a group of non-TQM NHS quasi-controls, all were outperformed by two commercial TQM companies in the sample. The analysis is based on 850 semi-structured interviews carried out with a wide range of staff as well as documentary analysis, non-participant observation, and feedback workshops at selected sites. In accounting for the results, the thesis tests eight propositions about the application of rationalistic private sector models of change to a complex public sector organisation like the NHS. The analysis demonstrates the limitations of such approaches when they are not adapted to take account of the technical, systemic and behavioural differences between the two sectors. It can also be said that funding for the NHS experiments, whilst substantial, was an order of magnitude lower than that in the commercial companies. Similarly, support both centrally and locally in the NHS was not sufficient to provide for rigorous pre-planning and monitoring of progress. Numerous other changes being made at the same time were mostly incompatible with TQM principles and hindered progress on coherent change. Leadership commitment to, and understanding of, TQM was much weaker in the NHS than in the commercial companies. The requirement to move towards collective, userdefined, measures of quality met with opposition from staff groups who were used to their own individualistic and professional conceptions of quality. This led to NHS TQM sites being unable to demonstrate the organisation-wide changes that are said to be hallmarks of TQM.
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Begley, Susanne. "The establishment and evaluation of a domiciliary pharmaceutical service." Thesis, University of Brighton, 1995. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.282561.
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Mills, Nicola J. "Evaluation of a primary care epilepsy specialist nurse service." Thesis, University of Bristol, 2000. http://hdl.handle.net/1983/ca074637-81c8-4133-b77a-8c5d64b7371a.
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This thesis reports on an evaluation of an intervention to improve the quality of care for adults with epilepsy. The intervention comprised an epilepsy specialist nurse working in 14 general practices in north west Bristol, England. A multi-method approach was employed. As part of a quasi-experimental trial, baseline and two annual follow-up questionnaires were sent to all patients in the practices aged 16 years and over and currently on drugs for epilepsy. In addition, interviews were undertaken with those having seizures to explore further some questionnaire findings and to appraise the appropriateness, acceptability and accessibility of the nurse service. The epilepsy nurse was interviewed to assess the feasibility of providing the new service. Baseline results highlighted deficiencies in services for people with epilepsy and suggested the need for structured care and increased discussion. The main effects of the nurse service were improved communication about epilepsy between health care providers and patients and increased access, especially for those with the greatest needs. The nurse service had limited impact on patients’ health status. There were indications of a negative impact on the perceived effect of epilepsy on aspects of everyday life. After one year, an intention-to-treat analysis suggested improvements in satisfaction with care from GPs, but decreased adherence to medication. A comparison of nurse service users with non-users after two years showed a reduction in the use of polypharmacy in users, and an increased proportion who queried GPs’ knowledge about epilepsy. Users reported increased visits to their GP. Interview data showed that the decision to use the nurse service depended on factors other than the severity and frequency of seizures. The service was most appropriate for those who perceived themselves to need care or information. This method of delivering care was feasible, but several operational problems were identified. The study supports the use of specialist nurses in primary care. Impact is, however, limited. The greatest contribution to improving care is by supporting and advising patients with specific and defined needs.
10
Surender, Rebecca Miriam. "Managed competition and the National Health Service : an evaluation of General Practice fundholding." Thesis, University of Oxford, 1998. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.285536.
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Boyes, Allison. "Women's selection and evaluation of obstetric hospitals a survey of the Northern Sydney area /." Connect to full text, 1998. http://hdl.handle.net/2123/393.
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Thesis (M.P.H.)--University of Sydney, 1999.Title from title screen (viewed Apr. 16, 2008). Submitted in fulfilment of the requirements for the degree of Master of Public Health to the Dept. of Public Health and Community Medicine, Faculty of Medicine. Degree awarded 1999; thesis submitted 1998. Includes bibliography. Also available in print form.
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Letsoalo, Ngokwana Jacqueline. "An evaluation of a selected component of a primary health care service : a nursing perspective." Thesis, Stellenbosch : Stellenbosch University, 2003. http://hdl.handle.net/10019.1/49745.
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Thesis (MCur)--University of Stellenbosch, 2003.ENGLISH ABSTRACT: Nationally and internationally emphasis is placed on quality care in health services. The researcher identified a need to evaluate a component of primary health care service in the Northern province. A study based on the combination of qualitative and quantitative methods was conducted to formulate and evaluate structure, process and outcome standards for selected clinics in the Northern Province. The most important results are: • The standard relating to the structure was suboptimal. Physical and human resources are of critical importance to the rendering of quality patient care. However this did not comply with the pre-set standard norm of 80%. • Process standards focused on physical examination of patients taking into account the age of the client and the systems involved. Substandard care was found in all these aspects. • Outcome standards determined by the patient questionnaire also revealed negative findings. Recommendations include the development of a quality improvement model for the Northern Province Health Services, formulation of standards for all disciplines of health care, annual evaluation of patient care and the institution of a formal staff development programme. Key words: quality care, formulation of standards, structure, process, outcome
AFRIKAANSE OPSOMMING: Nasionaal en internasionaal word die belang van gehaltesorg in gesondheidsdienste beklemtoon. Die navorser het enbehoefte ge'identifiseer om en component van prirnerre gesondheidsorgdienste in die Noordelike provinsie te evalueer. en Kombinasie van kwalitatiewe en kwantitatiewe metodes is gebruik om struktuur-, proses en uitkomsstandaarde in geselekteerde klinieke in die Noordelike provinsie te formuleer en evalueer. Die belangrikste resultate was: • Die standard ten opsigte van die standard was suboptimal. Fisiese en menslike hulpbronne is van kritiese belang vir gesondheidsdienslewering. Die standaard hiervan het nie voldoen aan die voorafbepaalde norm van 80% wat gestel is nie. • Prosesstandaarde het op fisiese ondersoek van die pasiente gefokus met inagneming van die ouderdom van die klient en die simptome waarmee pasiente presenter. Sub-standaardsorg is ten opsigte van al hierdie aspekte gevind. • Uitkomsstandaarde is deur middel van en pasientevraelys gemeet en he took negatiewe bevindinge opgelewer. Aanbevelings sluit in die ontwikkeling van engehalteversekeringsmodel vir die Noordelike Provinsie se gesondheidsdienste, die formulering van standaarde vir aile dissiplines van gesondheidsorg, jaarlikse evaluering van pasientesorq en die instelling van enformele personeelontwikkelingsprogram. Kernwoorde: Gehaltesorg, formulering van standaarde, struktuur, proses, uitkomsstandaarde.
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Alderton, Norman. "A quantitative and qualitative audit evaluation of a provincial hospital service for hospice patients." Master's thesis, University of Cape Town, 2003. http://hdl.handle.net/11427/9369.
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Bibliography: leaves 54-55.Hospice-in-the-West is situated in Krugersdorp on the West Rand. There is no hospice dispensary and the patients must, of necessity, obtain their terminal care medications from the Yusuf Daddoo Provincial Hospital. The hospital has a policy protocol in place that must be followed by all patients attending the hospital in order for them to obtain their monthly supply of medications. This policy has been in place for the past eight years. An evaluation of the provincial hospital's policy protocol was undertaken in an attempt to identify areas for possible improvement.
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Patel, Brijesh. "Performance and the National Health Service : modelling for formative policy evaluation and strategic planning." Thesis, University of Westminster, 2007. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.441078.
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Horton, Julie Frances. "The evaluation of information systems in the organisational context of the National Health Service." Thesis, Aston University, 1992. http://publications.aston.ac.uk/10665/.
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This thesis describes a project which has investigated the evaluation of information systems. The work took place in, and is related to, a specific organisational context, that of the National Health Service (NHS). It aims to increase understanding of the evaluation which takes place in the service and the way in which this is affected by the NHS environment. It also investigates the issues which surround some important types of evaluation and their use in this context. The first stage of the project was a postal survey in which respondents were asked to describe the evaluation which took place in their authorities and to give their opinions about it. This was used to give an overview of the practice of IS evaluation in the NHS and to identify its uses and the problems experienced. Three important types of evaluation were then examined in more detail by means of action research studies. One of these dealt with the selection and purchase of a large hospital information system. The study took the form of an evaluation of the procurement process, and examined the methods used and the influence of organisational factors. The other studies are concerned with post-implementation evaluation, and examine the choice of an evaluation approach as well as its application. One was an evaluation of a community health system which had been operational for some time but was of doubtful value, and suffered from a number of problems. The situation was explored by means of a study of the costs and benefits of the system. The remaining study was the initial review of a system which was used in the administration of a Breast Screening Service. The service itself was also newly operational and the relationship between the service and the system was of interest.
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Hackworth, Naomi Jean, and n/a. "Development and application of a methodology for the evaluation of a health complaints process." Swinburne University of Technology, 2007. http://adt.lib.swin.edu.au./public/adt-VSWT20070928.092053.
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The aim of the current study was to develop and test a methodology that could be
applied to the evaluation of the complaints processes of regulatory bodies of health
professionals in Australia including mental health regulatory bodies such as the board
that the Council of Australian Governments (COAG) are planning to set up to
regulate the psychology profession. The methodology was applied to the evaluation
of the complaints process at the Office of the Health Services Commissioner of
Victoria (HSC). There were four main research questions. The first research
question related to the extent to which the methodology was able to determine how
well the HSC was performing in their role of resolving health complaints. The second
research question explored the implications of the findings of the evaluation of the
HSC complaints process for the management of health complaints in general. The
third research question related to the strengths and limitations of the methodology
when applied in a practical setting and the final research question related to further
improvement of the methodology for future applications. Questionnaires and
telephone interviews were used to examine the experiences of 133 providers and 150
complainants whose complaints had been reviewed and closed in one year. The
methodology proved successful in assessing the performance of the complaints
process at the HSC. The findings of the evaluation indicated that complainants and
providers were generally satisfied with the process by which their complaints were
managed. However, they were in general less satisfied with the outcome. In
particular the evaluation highlighted the unintended negative consequences that
complaints processes can have on the complainants and respondents. It was
concluded that these maladaptive behavioural responses to complaints most probably
have their origins in the negative emotional overlay attached to health complaints
which has the potential to lead to unrealistic expectations of the process and
outcomes on the part of complainants, and maladaptive post-complaint practices for
health service providers. The findings highlight the importance of providing
advocacy and support for the parties involved in health complaints as a means of
minimising these maladaptive responses. Finally, it is acknowledged that these
findings are specific to Australian health regulatory systems.
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Smith, Catherine Tillie, and Dahlia Avila. "An evaluation of the California Brief Multicultural Competence Scale and training for mental health practices." CSUSB ScholarWorks, 2011. https://scholarworks.lib.csusb.edu/etd-project/3317.
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This study was designed to investigate the effectiveness of the California Brief Multicultural Competence Scale (CBMCS) and training as a tool to increase cultural competency skills. The interest of this was to determine if the training brought about a change in empathy or effectively increased knowledge about the importance of culture.
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Hooker, Taylor. "Equine Assisted Programs for Military Service Members| A Program Evaluation Using Importance-Performance Analysis." Thesis, Clemson University, 2018. http://pqdtopen.proquest.com/#viewpdf?dispub=10792627.
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Developing research, anecdotal evidence and a growing focus on non-pharmacological interventions for veterans with post-traumatic stress support the use equine-therapy as a therapeutic outlet; however, programmatic factors that contribute to veteran’s desire to attend such programs are under-investigated. Furthermore, evaluative processes in equine therapy for this particular population are scare and vary greatly from program to program. The use of the Importance-Performance Analysis (IPA) tool when applied to social services yields direct, applicable feedback of program success and relevancy. In this study, interviews with the selected population informed the evaluation tool used to assess the importance, and subsequent performance, of various program factors in a national military-specific equine therapy program. Results of this study provided insight into key factors being sought after in similar equine therapy programs to inform the development and maintenance of programs serving the veteran population. The application of the IPA, a consumer feedback tool typically reserved for market research, to the health and human services sector provided a new pathway for quality assurance and program analysis for the equine therapy field.
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Knowles, Kathleen Bernardette. "An evaluation of organisational change in the community psychiatric nursing service of one district health authority." Thesis, Manchester Metropolitan University, 2001. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.367731.
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Griffin, Stephanie Christine. "Economic Evaluation Of Injury And Injury Prevention Interventions In The U.S. Fire Service." Diss., The University of Arizona, 2014. http://hdl.handle.net/10150/332672.
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Previous research has shown that firefighters and emergency services personnel are at increased risk of fatal and non-fatal occupational injury compared to other U.S. workers. Analyses of injury and workers’ compensation claims data in this population has demonstrated that injuries are both common and an economic burden on the fire service, especially those caused by overexertion and that lead to sprains/strains. The increased risk of injury is associated with specific job tasks, including physical exercise, patient transport and fireground work, and with personal characteristics such as physical fitness. The economic evaluation of injury and injury prevention can help inform decision making on the part of leadership, including the identification and evaluation of potential targets for injury prevention programs. The aims of the current study were to: 1) evaluate a fitness intervention for new firefighters in terms of health, fitness, injury outcomes as well as workers’ compensation claims costs; 2) to analyze workers’ compensation claims data for trends in cause and injury type, as well as the effect of worker age; and 3) to model the expected change in back injury frequency and costs among emergency medical services personnel following the implementation of electrically powered stretchers. Primary data for the current study, including injury surveillance and workers’ compensation claims data, were provided by the Tucson Fire Department (TFD), Tucson, Arizona. The Probationary Firefighter Fitness Program (PFF-Fit) was designed by University of Arizona researchers in partnership with TFD. The program was implemented in the 2012 recruit academy. Outcomes, including measures of health and fitness, injury, workers’ compensation claim frequency and claims costs, were measured over 17 consecutive months for the intervention class, and compared to outcomes from controls comprised of the three most recent TFD recruit classes for the same time period. Comparing the intervention class to controls, health and fitness outcomes were statistically equivalent. The intervention group experienced statistically significantly fewer injuries, filed significantly fewer claims, and accrued aggregated claims costs approximately $33,000 less than the controls with an estimated equivalent reduction in indirect costs for a total of $66,000. The program implementation costs were nearly $69,000, leading to a one-year return on investment of -0.52 if based only on direct costs (workers’ compensation claims) or -0.048 if an estimate of indirect costs is included. Injury in the U.S. fire service has been the subject of many previous studies but the pattern of workers’ compensation claims has been studied much less frequently. Specifically, the effect of increasing worker age on the frequency and cost of claims has not been studied in this population. Routine injury surveillance and workers’ compensation data from TFD were merged and costs were described by mechanism of injury, injury type, body region and by age of the worker. The analysis of claims data shows that acute overexertion injuries are significantly more costly than injuries caused by other mechanisms, and that sprain/strain injuries are significantly costlier than other injury types. Results also show that age is an important predictor of claims cost in this population, with claims costs for firefighters over age 50, 120 to 144% greater than claims for workers under age 30. Back injury is common and costly among emergency services employees, including firefighters and emergency medical services providers, who transport patients. Previous research has demonstrated that electrically powered stretchers (EPS), which lift and lower the patient and stretcher between the loading and transport positions, are an effective means of reducing back injury among emergency medical services (EMS) providers, but to date no economic evaluation of this device has been conducted. A Markov decision analysis model simulation of a cohort of emergency services employees for incident back injury, disability and associated costs was used to compare outcomes with and without the use of the EPS. Implementation of the EPS resulted in an average cost savings of $4,617-$5,422 per emergency services employee over the service life of the equipment. Results of the current study show the PFF-Fit program may be a worthwhile program to reduce injury and claims costs but further research is needed to better understand the program’s potential effectiveness. We observed reductions in injury frequency and compensation costs among PFF-Fit program participants compared to controls; however, the mechanisms by which the PFF-Fit program were believed to be effective did not appear to be responsible for this difference. Workers’ compensation claims data analysis results continue to highlight the importance of targeting injuries caused by acute overexertion and injuries that result in sprain/strain. The results also indicate that targeting injury prevention efforts toward the specific needs of older workers may lead to important cost savings for the fire service. The EPS is likely an effective intervention to reduce back injuries and claims costs among fire and emergency services personnel, but further research is needed to evaluate injury and claims costs following implementation at several departments.
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Botham, David. "Exploring the processes of action learning in the National Health Service : dilemmas and paradoxes of evaluation." Thesis, University of Salford, 1993. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.386479.
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Phahladira, Martha Thapelo. "A critical Evaluation of the Locality Rule regarding the rural health care service in Public Sector." Diss., University of Pretoria, 2020. http://hdl.handle.net/2263/75388.
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The South African health sector encounters significant challenges of inequality in terms of access to health care services. A ‘quadruplet burden of disease’ does not make access to health any easier. Patient’s access to health care can be hindered by the patient’s residential area. Rural patients are faced with hospitals that do not have specialist care while urban areas are swamped with patient who need specialist care. Medical general practitioners’ scope of practice is limited and that creates challenges when patients need specialised care in a resource constrained environment. The time it takes for the patient in public health sector to access health services may be affected by their locality. The same challenges may be experienced by patient in private sector with medical Aids who are residing in the rural areas. The state’s impression is that demand is more than supply. On the other hand the court pursues justice for people who do not receive timeous access to healthcare. The study will be researching on locality issues that can jeopardise the standard of care. Although The Health Professions Council of South Africa is silent about the Locality Rule but it has unanimously adopted prerequisites and contraindications for using the Locality Rule as a defence. The Council has a duty in terms of Health Professional Act 56 of 1974 to uphold patient safety. The work seeks to understand the origin of the locality rule, its application in terms of the Constitution of the Republic Of South Africa, case law and relevant legislature. The work will also take into consideration the historical background of the South African health system and its responsibility in advancing socioeconomic rights for the citizens of South Africa. The prerequisite for using resource constrains and special circumstances will be discussed.Dissertation (MPhil)--University Of Pretoria, 2020.
Public Law
MPhil
Unrestricted
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Holmes, Elizabeth Ann. "An evaluation of the Midwifery Development Unit service specifications, through the quality assurance model for midwifery." Thesis, University of Glasgow, 1995. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.295331.
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Van, Slingerland Krista. "Design, Implementation, and Evaluation of a Sport-Focused Mental Health Service Delivery Model Within a Canadian Centre for Mental Health and Sport." Thesis, Université d'Ottawa / University of Ottawa, 2021. http://hdl.handle.net/10393/42792.
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The overall aim of this Participatory Action Research (PAR; Chevalier & Buckles, 2013; Lewin, 1946) project was to design, implement, and evaluate a specialized sport-focused mental health service delivery model for competitive and high-performance athletes, integrated within a broader Canadian Centre for Mental Health and Sport (CCMHS). A transformative mixed methods research design (Cresswell, 2014) guided by the PAR approach was employed across three phases during which (a) a sport-specific mental health service delivery model for competitive and high-performance athletes was collaboratively designed by stakeholders (Design Phase [Study 1]), (b) the model was pilot-tested within the CCMHS (Implementation Phase [Study 2]), and (c) the model was evaluated to understand whether practitioners and service-users perceived the care delivered / received within the model to be acceptable and appropriate (Evaluation Phase [Study 3]). Design Phase (Study 1). The purpose of study 1 was to (a) perform an environmental scan of the Canadian mental health care and sport contexts, and (b) design a sport-focused mental health service delivery model for competitive and high-performance athletes within a broader CCMHS. To meet these objectives, 20 stakeholders from the sport and mental health sectors explored (a) the availability and effectiveness of mental health care for competitive and high-performance Canadian athletes, and (b) the strengths, weaknesses, opportunities and threats associated with creating a CCMHS, via two iterations of stakeholder-led focus groups (Rio-Roberts, 2011). The resulting data informed a subsequent Group Concept Mapping (GCM; Burke et al., 2005; Kane & Trochim, 2007; Rosas & Kane, 2012) activity undertaken by stakeholders, which produced an actionable framework (i.e., concept map) organized into six clusters that visually represented the elements (e.g., services, personnel, organizational structures) that stakeholders deemed important to include in the sport-focused mental health care model (e.g., bilingual services, a triage system, sport-specialized practitioners). In addition, the results revealed that misconceptions about the competitive and high-performance population’s mental health and experience of mental illness were widespread and required clarification before significant advances could be made. This led the group to develop six principles designed to establish a common language and understanding upon which to build effective models of mental health care, improved programming, and strategic education for Canada’s competitive and high-performance athletes, coaches, and organizations (Article 1). The framework that emerged from the GCM activity served to guide the remainder of the project, and supported actions (e.g., develop eligibility criteria to access services, hire a team of mental health practitioners with sport competencies [i.e., CCMHS Care Team]) to build the CCMHS and test the model during the Implementation Phase (Article 2). Implementation Phase (Study 2). The purpose of study 2 was to pilot test the mental health service delivery model designed during the first phase of the research project. To do so, an illustrative case study (Keegan et al., 2017; Stake, 1995, 2005) was carried out to demonstrate how (i.e., intake, referral, and service delivery processes) the CCMHS Care Team provided mental health care to a high-performance athlete, and what outcomes resulted from this process. Data to inform the case study was gathered through a review of the service-user’s clinical documents (e.g., intake summary, session notes), and qualitative interviews (n = 2) with the athlete’s Collaborative Care Team lead and the CCMHS Care Coordinator. Document analysis (Bowen, 2009) was used to organize the details of the case found within clinical documents under the categories of the case study framework (i.e., intake and referral process, service-user description, integrated care plan, and outcomes), while a conventional descriptive content analysis (Hsieh & Shannon, 2005) served to extract salient data from the interviews to further build out the case study. Results revealed that sport significantly influenced the onset and experience of mental illness for the athlete service-user. The lead practitioner’s sport-specific knowledge played a significant role in the diagnosis, treatment and recovery of this athlete given the nature of the athlete’s concerns and high athletic identity. Findings support the notion that specialized mental health care models and teams are necessary to address sport-related factors that can pose unique threats to the diagnosis and treatment of mental illness in athletes (Article 3). Implementation Phase (Study 3). The purpose of study 3 was to evaluate the acceptability and appropriateness of the mental health service delivery model designed during Phase 1 and implemented during Phase 2. Qualitative data from three sources (CCMHS practitioners, CCMHS service-users, and CCMHS stakeholders) were collected and analyzed using a multi-step, multi-method process, including16 one-on-one semi-structured interviews with CCMHS practitioners (n = 10) and service-users (n = 6), and a meeting with CCMHS stakeholders (captured via meeting minutes). In addition, 47 documents (e.g., clinical, procedural) created during the implementation phase of the project by CCMHS team members (i.e., practitioners, stakeholders, members of the board of directors) were used to triangulate the other data (Carter, Bryant-Lukosius, DiCenso, Blythe, and Neville, 2014). The Framework Method (Gale et al., 2013; Ritchie and Spencer, 1994) was used to analyze, synthesize, integrate, and interpret the dataset. The deductive data analysis approach taken was guided by the seven components of acceptability developed by Sekhon and colleagues (2017), and the Canadian Medical Association’s definition of appropriate care. Findings showed that the care provided and received within the CCMHS service delivery model was perceived to be acceptable and appropriate, and each component of the model uniquely contributed to practitioner and service-user experiences. For example, the collaborative interdisciplinary approach contributed to the ethicality of the model, promoted the professional development of team members, and enabled Pan-Canadian service provision. The sport-centered nature of care was perceived to enhance the ethicality of services delivered, effectiveness of care, and affective experience of service-users. Implications for further research and practice were discussed in light of areas of the model that emerged as needing improvement (e.g., prohibitive cost of care, practitioner burden from collaborative processes and procedures). Overall, the findings of the research project demonstrate that collaborative approaches to inquiry and practice can be successfully applied in sport to guide stakeholders in developing and testing novel models to improve the health outcomes of sport participants. The research also shows that an interdisciplinary team of practitioners can successfully deliver sport-focused mental health care that is acceptable and appropriate to service-users. Lastly, the project provides data on the first known empirical project to design, implement and evaluate a specialized mental health service delivery model applied nationwide in person and virtually with competitive and high-performance athletes experiencing mental health challenges and symptoms of mental illness.
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Horgby, Per-Johan. "Essays on sharing, management and evaluation of health risks /." Göteborg : Nationalekonomiska inst., Handelshögsk, 1997. http://bvbr.bib-bvb.de:8991/F?func=service&doc_library=BVB01&doc_number=008000677&line_number=0001&func_code=DB_RECORDS&service_type=MEDIA.
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Phiri, Besinati. "An economic evaluation of reproductive health service delivery in central Lusaka : a cost-effectiveness analysis of different modes of family planning service delivery: hospital, clinic and community based distribution." Master's thesis, University of Cape Town, 2000. http://hdl.handle.net/11427/7839.
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The main aim of this study was to assess the relative cost-effectiveness of the hospital, clinic and community based distribution of family planning services in central Lusaka. The data collection process involved the administration of a multiple-choice questionnaire to 208 randomly selected family planning clients at the three delivery modes under study.
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Koljonen, H. "Building evaluation capacity in to a large public sector emergency service : an action research study." Thesis, University of Salford, 2012. http://usir.salford.ac.uk/29434/.
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This action research study investigated the feasibility of building evaluation capacity into the design process of Greater Manchester Fire and Rescue Service’s (GMFRS) community initiatives. GMFRS runs over 400 community initiatives every year and an appropriate evaluation framework is needed to provide evidence of their impact and effectiveness. Information that previous evaluation processes had failed to provide. The feasibility of establishing an evaluation framework for use by non-specialists users was explored, the development of a new evaluation system for GMFRS was examined critically, and the processes and challenges involved in embedding evaluation within a large public sector emergency service investigated. Mixed research methods -- document analyses, qualitative interviews, observations and focus groups -- were used in the three action research cycles conducted between April 2008 and April 2010. In cycle one, existing evaluation materials and key characteristics of the initiatives were assessed. GMFRS’s community initiatives were found to lack direction, and the existing evaluation tool lacked the detail required for use by personnel with no previous evaluation experience. Hence, new evaluation materials were developed and, in the second cycle, their use was observed, and interviews conducted to ascertain the barriers to evaluation practices. Lack of resources, organisational guidance, and support with evaluation activities were identified as barriers. In the third cycle focus groups were used to gain feedback on the usability of the new evaluation material and processes. The principal conclusions of the research are that there were no theoretical models and/or guidance to assist Emergency Services to develop internal evaluation capacity. Insufficient attention has been paid to organisational support processes to nurture individuals’ evaluation skills and abilities, and to assist complex organisations utilise evaluations. For evaluation to become an embedded and systematic activity, it has to be supported by a project management methodology that underpins evaluation processes.
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Asim, Oya M. "The use of the results from economic evaluation in applied decision-making in the UK health service." Thesis, University of Bristol, 2006. http://hdl.handle.net/1983/39540c0a-9026-4277-bf1e-ec12585bc2ed.
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Makakole, L. "Evaluation of strategies instituted to improve the tuberculosis control program within Scott Hospital Health Service Area, Lesotho." Thesis, University of Limpopo (Medunsa Campus), 2010. http://hdl.handle.net/10386/544.
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Thesis (M Med(Family Medicine))--University of Limpopo (Medunsa Campus), 2010.Background: In spite of the substantial progress made in the development and implementation of many strategies necessary for effective tuberculosis control, the disease continues to be the leading cause of death, and in Africa, because of the expanding HIV epidemic, there has been an increase of HIV associated TB. In 2005 African health ministers declared TB a regional emergency. Although TB treatment is free and Lesotho has 100% DOTS coverage, the country still reported an incidence of 485 per 100,000 population (2005) and a treatment success of 74%, which is still lower than 85% WHO target. Objective: This six-month study at Scott Hospital Health Service area in Lesotho was undertaken to assess the outcome measures of strategies instituted to improve the tuberculosis control programme and determine the effect on TB treatment outcome indicators and TB/HIV integration. xi Methodology: The study design was a quantitative, descriptive study. The principal researcher and a research assistant used a questionnaire to collect data from the outpatient, TB suspect and treatment registers. Study population and sample: The subjects of the study were all adult new sputum- smear positive TB patients enrolled and registered in the Scott Hospital Health Service area TB register from 1st January to 30 June 2006. Results and discussion: A total of 100 new sputum smear positive adult TB patients presenting at Scott Hospital during the research period formed the sample group of this study. This included 47 female and 53 male patients. Their ages ranged from 18 years to 84 years with the mean age of 42 years. Majority 52 (52%) were in the age group 20-39 years, followed by 27 (27%) in age group 40-59 years and 19 (19%) in the age group 60-79 years. There was a high TB/HIV co-infection of 40 (81.6%) among the 49 (49%) who accepted HIV counseling and testing. Active screening of patients for TB resulted in 378 (86.3%) of the 438 TB suspects having their sputa tested. Of these, 100 (26.5%) were new sputum smear positive. Good xii adherence and treatment supervision resulted in sputum conversion rate of 89 (89%). Rigorous implementation of the DOTS strategy showed increased treatment outcomes: cure rate of 76 (76%) and treatment success of 85 (85%). These results were similar to findings of other studies carried out in Cambodia, Tanzania and Rwanda to assess TB programme performance following introduction of improvements. Conclusion: This study demonstrates that implementation of activities consistent with new stop TB DOTS strategy to improve TB control is possible in a rural setting and leads to improvement in TB case detection and treatment success and a decrease in both defaulter and death rates.
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Salisbury, Christopher John. "Out of hours general practice : evaluation of a co-operativey by comparison with a deputising service." Thesis, University of Bristol, 1998. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.263979.
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Anderson, Lela Ann. "What factors influence client participation in mental health services." CSUSB ScholarWorks, 2002. https://scholarworks.lib.csusb.edu/etd-project/2216.
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The purpose of the study is to develop a foundation of knowledge that could improve the current policies and procedures with regards to their implementation within the mental health services provided by the Children's Bureau.
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Madiba, Thomas Khomotjo. "Evaluation of dental emergency outcomes of the Oral Health Fitness Classification of the South African Military Health Service (SAMHS) in Gauteng - South Africa." Diss., University of Pretoria, 2012. http://hdl.handle.net/2263/30881.
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Background: The South African National Defence Force (SANDF) like other Defence Forces of the world, conducts medical classification on their members. This medical classification has, as one of the components, an Oral Health Fitness (OHF) classification which is done according to North Atlantic Treaty Organisation (NATO) standards. The aim of the Oral Health Fitness classification is to standardize dental readiness, assess oral health, prioritize dental care, minimize the number of dental emergencies (DE), and emphasize the importance of good oral health to all active duty and reserve forces. Medical classification is conducted by the South African Military Health Services (SAMHS). Aim: The aim of the study was to evaluate the dental emergency outcomes of the Oral Health Fitness classification of the SAMHS in Area Military Health Unit Gauteng (AMHU GT), South Africa Objectives: To determine dental emergency rate for the SAMHS, analyse the dental emergencies and to make recommendations regarding dental emergencies to the SAMHS Methods: A cross-sectional retrospective record analyses of members of the SANDF that received an OHF classification of 1 and 2 in AMHU GT in 2009. The AMHU GT members were followed up for a year to determine if they developed dental emergencies. Data analysis included frequency tables, chi-square tests and logistic regression analysis. The level of significance was set at p<0.05. Results: The dental emergency rate for AMHU Gauteng was 307/1000 per year. The type of dental emergencies were: 58.5% dental restorations, 13% extractions and related complications, 4.3% crown and bridge, 3.9% emergency root canals, 9.9% recementations, 3.6% denture related problems while other emergencies were 6.8%. Patients were more likely to experience a dental emergency if they were white, female, of OHF 2 classification and older than fifty years of age. Conversely they were least likely to experience a dental emergency if they were black, male, of OHF 1 classification and in the age group 31-40. Conclusion: The dental emergency rate of 307/1000 per year for the SANDF is high compared to military health units from other countries and it was influenced by race, age and gender. The types of dental emergencies were mainly preventable.Dissertation (MChD)--University of Pretoria, 2012.
Community Dentistry
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Shao, Jung-Hua. "Evaluation of health-related outcomes following a self-management program for older people with heart failure." Thesis, Queensland University of Technology, 2008. https://eprints.qut.edu.au/20702/1/Jung-Hua_Shao_Thesis.pdf.
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Background. Heart failure (HF) which is a chronic, disabling disorder is mainly found in older people and is one of the leading causes of hospitalisation and readmission around the world. Unfortunately, the mortality and morbidity rates for HF remain high. HF is a complex combination of symptoms which are related to an inadequate perfusion of the body tissues caused by fluid and sodium retention. Hence, enhancing HF patients’ self-efficacy to change their behaviours to perform fluid & sodium control is one of the most important issues for the management of HF. A self-management program has the potential to raise self-efficacy and self-care which is a method to improve health for those with chronic illness and to decrease patients’ health service utilisation and also to enhance these patients’ health status. Aim. The study aims to examine the effectiveness of a self-management program, based on self-efficacy theory, in older people with heart failure in Taiwan. Methods. An experimental design was used to examine the effectiveness of a self-management program on diet and fluid control among HF patients. A total of 93 subjects from two medical centres in Taiwan were randomly assigned to the intervention and control groups. In order to examine the effectiveness of self-management, data were collected at baseline, week 4, and week 12 using the following instruments: self-efficacy for salt and fluid control, HF self-management behaviour, HF related symptoms, and body weight. Moreover, health service utilisation and patient’s evaluation of care received were collected on all patients for the 12 weeks prior to commencing the study and for the 12 week study period. Demographic and disease information was also collected including age, gender, marital state, education, and New York Heart Association (NYHA) functional classification. A structured, individualized self-management training program created by the investigator was implemented for the intervention group through home visits and telephone follow-ups. This program emphasized self-monitoring of diet control and body weight for the self-management of heart failure. The purpose was to improve patients’ self-efficacy in their diet control behaviour. The “diet control” in this study focussed on sodium and fluid restriction. Outcome measures were analysed using the Statistical Package for the Social Sciences (SPSS) 15.0 version, and the level of significance (á) was set at 0.05 for statistical analysis. Results. There were differences for older Taiwanese HF patients’ self-efficacy for salt and fluid control, self-management behaviour, and HF related symptoms for participants who received a self-management intervention compared to those who did not. However, there were no significant differences between the two groups in weight and health serves utilization (p>.001). Conclusion. The self-management program had a positive impact on the improvement of self-efficacy for salt and fluid control, HF related self-management behaviours and symptoms in older Taiwanese with HF. This program may bridge the gap between theory and practice. Health care providers need to provide older people in Taiwan with HF the appropriate skills for self-managing their condition and thereby promoting their health status. These patients with HF and their caregivers have to receive individualized education that emphasizes self-efficacy in the self-management of their disease, thus improving their quality of life.
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Shao, Jung-Hua. "Evaluation of health-related outcomes following a self-management program for older people with heart failure." Queensland University of Technology, 2008. http://eprints.qut.edu.au/20702/.
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Background. Heart failure (HF) which is a chronic, disabling disorder is mainly found in older people and is one of the leading causes of hospitalisation and readmission around the world. Unfortunately, the mortality and morbidity rates for HF remain high. HF is a complex combination of symptoms which are related to an inadequate perfusion of the body tissues caused by fluid and sodium retention. Hence, enhancing HF patients’ self-efficacy to change their behaviours to perform fluid & sodium control is one of the most important issues for the management of HF. A self-management program has the potential to raise self-efficacy and self-care which is a method to improve health for those with chronic illness and to decrease patients’ health service utilisation and also to enhance these patients’ health status. Aim. The study aims to examine the effectiveness of a self-management program, based on self-efficacy theory, in older people with heart failure in Taiwan. Methods. An experimental design was used to examine the effectiveness of a self-management program on diet and fluid control among HF patients. A total of 93 subjects from two medical centres in Taiwan were randomly assigned to the intervention and control groups. In order to examine the effectiveness of self-management, data were collected at baseline, week 4, and week 12 using the following instruments: self-efficacy for salt and fluid control, HF self-management behaviour, HF related symptoms, and body weight. Moreover, health service utilisation and patient’s evaluation of care received were collected on all patients for the 12 weeks prior to commencing the study and for the 12 week study period. Demographic and disease information was also collected including age, gender, marital state, education, and New York Heart Association (NYHA) functional classification. A structured, individualized self-management training program created by the investigator was implemented for the intervention group through home visits and telephone follow-ups. This program emphasized self-monitoring of diet control and body weight for the self-management of heart failure. The purpose was to improve patients’ self-efficacy in their diet control behaviour. The “diet control” in this study focussed on sodium and fluid restriction. Outcome measures were analysed using the Statistical Package for the Social Sciences (SPSS) 15.0 version, and the level of significance (á) was set at 0.05 for statistical analysis. Results. There were differences for older Taiwanese HF patients’ self-efficacy for salt and fluid control, self-management behaviour, and HF related symptoms for participants who received a self-management intervention compared to those who did not. However, there were no significant differences between the two groups in weight and health serves utilization (p>.001). Conclusion. The self-management program had a positive impact on the improvement of self-efficacy for salt and fluid control, HF related self-management behaviours and symptoms in older Taiwanese with HF. This program may bridge the gap between theory and practice. Health care providers need to provide older people in Taiwan with HF the appropriate skills for self-managing their condition and thereby promoting their health status. These patients with HF and their caregivers have to receive individualized education that emphasizes self-efficacy in the self-management of their disease, thus improving their quality of life.
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Rhoda, Moegamat Faarieg. "Community empowerment through municipal service delivery : a proposed operational framework." Thesis, Stellenbosch : Stellenbosch University, 2001. http://hdl.handle.net/10019.1/52168.
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Thesis (MPhil) -- Stellenbosch University, 2001.ENGLISH ABSTRACT: Legislation encourages local government! municipalitiesl local authorities in South Africa, to fulfil a development role. One of the main objectives of municipalities performing a development role is to empower communities, especially previously disadvantaged communities. This study argues that the services delivered by municipalities are an essential component of a development orientation. In view of this fact, the study proposes an operational framework, whereby community empowerment can be achieved through municipal service delivery. The operational framework suggest that for community empowerment to be achieved through municipal service delivery, requires that the empowerment enabler (municipalities or departments within municipalities) should assure that: disadvantaged communities have access to services, services must be delivered in a non-discriminatory manner, the community should understand the rationale as to why the service is delivered, opportunity should be given for community participation in the delivery process, there should be a constant information channel between the giver (enabler) and receiver of services, and human resources from the local community should be utilised where possible in the delivery process. Lastly, a descriptive evaluation is undertaken of the health department's approach (at the Stellenbosch Municipality) to the delivery of primary healthcare services and service infrastructure. The purpose of the evaluation is to ascertain whether the principles as proposed in the operational framework are present in the health department's approach to service delivery. The evaluation reveals that most of the proposed principles of the operational framework features in the health department's approach to the delivery of primary healthcare services and services infrastructure. Thereby, concluding that the health department follows to a certain extent an approach to service delivery that could ultimately lead to community empowerment.
AFRIKAANSE OPSOMMING: Wetgewing vereis dat plaaslike regering/ plaaslike owerhede/ munisipaliteite in Suid-Afrika, 'n ontwikkelingsrol moet vervul. Een van die doelstellings van 'n ontwikkelingsrol vir munisipaliteite, is om gemeenskappe te bemagtig, spesifiek gemik op agtergeblewe gemeenskappe. Hierdie studie argumenteer dat die dienste gelewer deur munisipaliteite 'n essensiële komponent vorm van 'n ontwikkelings-orientasie. Gevolglik, stel hierdie studie 'n operasionele raamwerk voor, waarvolgens gemeenskapsbemagtiging bewerkstellig kan word deur middel van munisipale dienslewering. Die operasionele raamwerk stel voor dat om gemeenskapsbemagting deur dienslewering te bewerkstellig, vereis dat die bemagtiger (munisipaliteite of departemente binne munisipaliteite) moet toesien dat: agtergeblewe gemeenskappe toegang het tot diente, dienste moet gelewer word op 'n niediskriminerende wyse, die gemeenskap moet verstaan waarom die diens gelewer word, geleentheid moet geskep word vir gemeenskapsdeelname aan die diensleweringsproses, 'n kommunikasie kanaal tussen die ontvanger en leweraar (bemagtiger) van dienste, moet geskep word en laastens moet daar van plaaslike arbeid (waar moontlik), in die diensleweringsproses gebruik word. Laastens word 'n beskrywende evaluering onderneem na die Gesondheidsdepartement (by die Stellenbosch Munisipaliteit) se benadering tot die lewering van primêre gesondheidssorgdienste asook diens infrastruktuur. Die doel van die evaluering is om te bepaal of enige van die faktore, soos beskryf in die operasionele raamwerk, teenwoordig is in die gesondheidsdepartement se benadering tot dienslewering. Die resultate van die ondersoek toon aan dat die meeste van die faktore, soos voorgestel in die operasionele raamwerk, wel teenwoordig is in die gesondheidsdepartement se benadering tot dienslewering. Gevolglik kan daar afgelei word dat die gesondheidsdepartement wel tot 'n mate, 'n benadering tot dienslewering volg, wat kan lei tot gemeenskapsbemagtiging.
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Scott, Colleen. "Evaluation of Key Components of Draft Guidelines for the National Weather Service TsunamiReadyTM Community Program." Digital Commons @ East Tennessee State University, 2014. https://dc.etsu.edu/etd/2347.
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The National Tsunami Hazard Mitigation Program partnered with the National Weather Service (NWS) in 2000 to create the TsunamiReadyTM (TR) Community program. TR is designed to help communities in coastal areas plan and prepare for tsunamis. To achieve TR recognition communities must meet certain criteria including specific emergency planning and management actions within the categories of mitigation, preparedness, response, and recovery.
This study’s purpose was to evaluate the acceptability and usefulness of key components of a proposed revised set of TR Community program guidelines. Research was guided by the Elaboration Likelihood Model (ELM) using Community Based Participatory Research methods to gather input from expert panels composed of local expert community stakeholders from 5 states and 1 US territory. Two qualitative data collection methods were used: online prediscussion surveys administered via Survey Monkey© and focus group discussions. Fifty participants attended 1 of 6 focus group discussions, with 20 participants completing surveys.
Data analysis focused on 8 discussion topics: subdivision of communities by vulnerability, proportion of the population to be protected, evacuation effectiveness, evacuation drills or exercises, vertical evacuation, educating businesses, educating residents, and acceptability of a revised guidelines format. Supporting and opposing themes were identified, providing rich information of community-level perceptions regarding the guidelines. Most notably, the fidelity of the 2 ELM pathways were confirmed as separate. The peripheral pathway demonstrated a significant need for clarification and definition of program terms and activities through the surveys, while focus groups facilitated the central pathway for participants to discuss and debate various program guidelines.
This study provides several recommendations based on community input for updating and revising the TR Community program guidelines including: revisions to the overall format, a new focus on community tsunami hazard, and additional actions and activities to improve community tsunami mitigation and preparedness efforts. Finally, the data and recommendations provided will be used to compile a final draft of the TR Community program guidelines for the NWS.
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Singleton, Destiny L. "Supporting Students with Chronic Health Conditions: An Evaluation of School Nurses’ Collaborative Practices with School Psychologists." Scholar Commons, 2019. https://scholarcommons.usf.edu/etd/7945.
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Many students in primary and secondary schools are impacted by a chronic health condition. Researchers have postulated that interprofessional collaboration between medical and mental health providers can be beneficial in improving the academic, behavioral, and social-emotional outcomes of students with chronic health conditions (Drotar, Palermo, & Barry, 2003; Shapiro & Manz, 2003). An emerging area of focus is on the school-based collaboration between school nurses and school psychologists regarding supporting students with chronic health conditions. This study investigated school nurses’ perceptions of the benefit of collaborating with school psychologists, school nurses’ awareness of the roles of school psychologists, the frequency of collaborative practices, the relationship between the awareness of roles and frequency of collaborative practices, and the barriers and facilitators to the collaborative process. A total of 1,054 school nurses were recruited from National Board for Certification of School Nurses to participate in the study, and 240 surveys were completed (23% response rate). Findings indicate that school nurses perceive the collaborative practice as being beneficial for supporting students with chronic health conditions. Additionally, school nurses were able to accurately identify many roles of school psychologists. Despite school nurses perceiving collaboration with school psychologists as beneficial, and being aware of the roles of school psychologists, the frequency of collaboration between school nurses and school psychologists was low. Further analysis found a significant and positive relationship between awareness of the roles and collaborative practices. Benefits of the collaborative process included cross-disciplinary problem solving and the opportunity to share resources.
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Malherbe, WF. "Die gehalte van ondersoeke en die institusionele oordra van data oor aanmeldbare voedselvergiftigingsuitbrake." Thesis, Cape Technikon, 1997. http://hdl.handle.net/20.500.11838/801.
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Thesis (MTech(Environmental Health)--Cape Technikon, Cape Town,1997The study project researched the quality of the investigations and the institutional transfer of data regarding notifiable food poisoning outbreaks reflected in "the study region", that is to say North-, East- and Western Cape Provinces. In comparing the data of the central-, provincial- and local governments' total notifiable food poisoning outbreaks notifications for specific local areas, problems relating to incomplete and poor data, poorly completed reports and ignorance of health workers re notifiable medical conditions were identified. Various conclusions and recommendations were made for "the purpose of future improvements.
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Jerrom, David William Andrew. "A description and evaluation of the introduction of a primary care clinical psychology service in one health district." Thesis, University of Stirling, 1985. http://hdl.handle.net/1893/24393.
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The introduction of a primary care clinical psychology service into one Scottish Health District is described and evaluated. The service was widely used by G.P.s, and the volume of referrals increased each year. After 5 years of operation 83% of G.P.s had referred cases. The types of problems referred are described, two thirds of patients were suffering from generalised anxiety or phobias. The patients were a chronic population, the average length of problem being 6.9 years. G.P. and psychiatrist referred patients were compared, the latter had longer histories and there were differences in the types of problem referred. Outcome was evaluated using a number of measures. Consultation rate fell significantly post treatment and a significant proportion of patients stopped psychotropic medication. There were significant reductions in psychologist ratings of severity and in handicap, and in patient self-ratings of severity and General Health Questionnaire scores. Patient satisfaction with treatment 6 months post discharge was surveyed. The G.P.s satisfaction with the service was surveyed and found to be high. At follow up G.P.s rated 69% of patients as receiving "definite benefit" and 31% as "unchanged". A study of treatment of the commonest problem referred, generalised anxiety, was conducted using a waiting-list control group. Treatment group patients improved significantly on self rating questionnaires, controls did not change, but showed a similar order of treatment response when they did enter treatment. The costs of the service are compared to another report in the literature, and it is concluded that the service was cost-effective. A number of recommendations are made for further research in the field. It is concluded that primary care psychology services are feasible in terms of staffing levels, and also lead to significant patient benefit.
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Waters, Heidi C. "Evaluating the Impact of Integrated Care on Service Utilization in Serious Mental Illness." ScholarWorks, 2017. https://scholarworks.waldenu.edu/dissertations/3374.
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Serious mental illness (SMI) affects 5% of the United States population and is associated with increased morbidity and mortality. Use of high-cost healthcare services is common, including hospitalizations and emergency department (ED) visits. Integrating behavioral and physical healthcare may improve care for consumers with SMI, but prior research findings have been mixed. This quantitative retrospective cohort study addressed the impact of integrated care on physical health and ambulatory care sensitive (ACS) utilization via a program evaluation of an integrated health clinic (IHC) at a community mental health center (CMHC). The research questions assessed whether there was a predictive relationship between IHC enrollment and physical health and ACS-specific service utilization for consumers with SMI when controlling for demographic characteristics and disease severity. Secondary administrative healthcare data, including authorization and electronic medical record data, were provided by the CMHC. Logistic regressions assessed the odds of experiencing an inpatient admission or ED visit before or after IHC enrollment; the predictive relationship between IHC enrollment and service utilization was assessed using multiple linear and Poisson regression analyses. There was no statistically significant impact of integrated care clinic enrollment on physical health or ACS-specific utilization. The sample had lower levels of physical health utilization than would have been expected. In terms of positive social change, results may help the CMHC assess the IHC program, overall clinic success, and use of data. Since policy and payment structures continue to support integrated care models, further research on different programs are encouraged, as each setting and practice pattern is unique.
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Ngah, Zahari. "A formative evaluation research into the use of psychology service by adolescents and young people : a preliminary investigation ito attendance/non-attendance." Thesis, University of Surrey, 1998. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.246040.
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Mills, T. "The political economy of co-ordination challenges in the National Health Service : a postpositivist evaluation of diabetes policy and governance." Thesis, University of Westminster, 2016. https://westminsterresearch.westminster.ac.uk/item/9ywzy/the-political-economy-of-co-ordination-challenges-in-the-national-health-service-a-postpositivist-evaluation-of-diabetes-policy-and-governance.
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The present PhD thesis develops and applies an evaluative methodology suited to the evaluation of policy and governance in complex policy areas. While extensive literatures exist on the topic of policy evaluation, governance evaluation has received less attention. At the level of governance, policymakers confront choices between different policy tools and governance arrangements in their attempts to solve policy problems, including variants of hierarchy, networks and markets. There is a need for theoretically-informed empirical research to inform decision-making at this level. To that end, the PhD develops an approach to evaluation by combining postpositivist policy analysis with heterodox political economy. Postpositivist policy analysis recognises that policy problems are often contested, that choices between policy options can involve significant trade-offs and that knowledge of policy options is itself dispersed and fragmented. Similarly, heterodox economics combines a concept of incommensurable values with an appreciation of the strengths and weaknesses of different institutional arrangements to realise them. A central concept of the field is coordination, which orientates policy analysis to the interactions of stakeholders in policy processes. The challenge of governance is to select the appropriate policy tools and arrangements which facilitate coordination. Via a postpositivist exploration of stakeholder ‘frames’, it is possible to ascertain whether coordination is occurring and to identify problems if it is not. Evaluative claims of governance can be made where arrangements can be shown to frustrate the realisation of shared values and objectives. The research makes a contribution to knowledge in a number of ways a) a distinctive evaluative approach that could be applied to other areas of health and public policy b) greater appreciation of the strengths and weaknesses of different forms of evidence in public policy and in particular health policy and c) concrete policy proposals for the governance and organisation of diabetes services, with implications for the NHS more broadly.
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Coovadia, Mohamed Yusuf. "Identification and evaluation of patient satisfaction determinants in medical service delivery systems within the South African private healthcare industry." Diss., University of Pretoria, 2008. http://hdl.handle.net/2263/23094.
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The aim of the study was to identify, evaluate and compare the determinants of patient satisfaction in fee-for-service, and health maintenance organisation (HMO), medical service delivery centres. Staff at both centres, who were also patients, were surveyed to determine the congruence with patients’ quality improvement priorities. The survey was conducted using a questionnaire consisting of closed questions given to patients as they departed from the medical centres. The questionnaire was tested for convergent and divergent validity, content analysis and reliability. A rating scale was then applied to yield the scores for each determinant. The unique Patient Satisfaction Priority Index was determined using determinants that were rated low on satisfaction but high on importance. The results revealed that patients at the fee- for- service medical centre were significantly more satisfied than patients at the HMO. The priority index for patients were found to be different to that of the staff at both medical centres, proving that staff and patient priorities were incongruent. Accordingly, the recommendations were that patient satisfaction be continuously evaluated at medical service delivery centres, in order to achieve a competitive advantage, sustainability and growth in South Africa’s highly competitive private healthcare industry. CopyrightDissertation (MBA)--University of Pretoria, 2010.
Gordon Institute of Business Science (GIBS)
unrestricted
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Adams, Claire E. "Help-seeking for mental health problems among older adults with chronic diseases: An evaluation and intervention." Thesis, Edith Cowan University, Research Online, Perth, Western Australia, 2022. https://ro.ecu.edu.au/theses/2516.
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Older adults have high rates of chronic diseases, leaving them more vulnerable to associated mental health declines. Nevertheless, the intentions of older adults with chronic diseases to seek help from mental health support systems are low. Couched in the Theory of Planned Behaviour (TPB), this thesis aimed to 1) identify antecedents to help-seeking for mental health problems in older adults with chronic diseases, and 2) to design, develop and test a behaviour change intervention, promoting mental health help-seeking among older adults with chronic diseases in Australia. An overview of this thesis is presented in Chapter 1. A literature review on the relationship between mental health problems, chronic diseases, and help-seeking in older adulthood is then provided (Chapter 2). A scoping review was conducted, which mapped 49 articles that applied the TPB to mental health help-seeking in adults aged >18 years (Chapter 3). A considerable evidence base was found on the TPB for predicting mental health help-seeking intentions, and to a lesser extent behaviour. A survey instrument, to measure mental health help-seeking intentions among older adults (MHHS-OA), was developed and piloted with a sample of 54 adults aged 65 to 94 years living in metropolitan Perth, Western Australia (Chapter 4). The MHHS-OA demonstrated acceptable reliability and validity for measuring the TPB constructs of attitudes, subjective norms, and behavioural intention (Cronbach alphas .64 to .82). Modifications were made to improve the measurement of perceived behavioural control. The modified MHHS-OA was utilised in a cross-sectional study with 108 adults aged 65 to 93 years, living in metropolitan Perth, diagnosed with cardiovascular diseases, respiratory diseases, and/or type 2 diabetes (Chapter 5 and 6). The cross-sectional study sought to identify factors associated with intentions to seeking help, and barriers to seeking help, among older adults with chronic diseases. Using multiple linear regressions, the TPB was found to be a suitable model for understanding mental health help-seeking intentions in older adults with chronic diseases, accounting for 69.7% of the variance in intentions (Chapter 5). Attitudes and perceived behavioural control had the strongest association with help-seeking intentions, followed by subjective norms. Two common barriers to help-seeking were identified: ‘wondering whether the mental health problem is significant enough to warrant treatment’ (endorsed by 51.9% of participants), and ‘not having a regular primary health care provider to speak with’ (endorsed by 39.6% of participants). Multiple linear regressions revealed past use of mental health services had the strongest association with both barriers; past help-seeking behaviour was associated with less endorsement of barriers to help-seeking (Chapter 6). Identifying factors associated with intentions to seek help (attitudes, perceived behavioural control, and subjective norms), and barriers to seeking help, the first aim of this thesis was achieved. To achieve the second aim of this thesis, an intervention aimed at promoting mental health help-seeking was developed and tested in a pilot randomised controlled trial (RCT) (Chapter 7). The intervention was designed to address the antecedents to help-seeking that were identified (Chapters 5 and 6). Nine stakeholders were interviewed to inform the design and development of the intervention and 241 adults aged 66 to 90 years were randomised to receive the intervention or control materials. The intervention consisted of a TPB-based brochure, aimed at promoting mental health help-seeking. Results indicated the intervention is an acceptable and feasible method for improving mental health help-seeking in older adults with and without chronic diseases. Repeated measures ANOVAs, regarding the effectiveness of the intervention, indicated the intervention is effective in improving attitudes and intentions towards seeking help for mental health problems. Finally, Chapter 8 summarises, concludes, and proposes future research directions. This thesis helps to delineate factors associated with intentions as well as barriers to help-seeking and provides researchers and health professionals with an empirically based intervention aimed at increasing the likelihood of help-seeking intentions and behaviour among older adults with chronic diseases.
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Kabeja, Adeline. "Effectiveness of task shifting in antiretroviral treatment services in health centres, Gasabo district, Rwanda." Thesis, University of the Western Cape, 2012. http://hdl.handle.net/11394/4049.
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Magister Public Health - MPHIn the context of human resource crisis in African countries, the World Health Organization has proposed task-shifting as an approach to meet the ever-increasing need for HIV/AIDS care and treatment services. Rwanda started the process of task shifting towards nurse-based care in ART services in June 2010. After one year of implementation, a need to determine whether task shifting program has been implemented as intended and if it achieved its primary goal of increasing accessibility of people living with HIV to ARV therapy and improving nurse capacity in HIV patient care was imperative.A multi-method program evaluation study design, combining cross sectional, retrospective review and retrospective cohort sub-studies were used to evaluate the implementation,maintenance processes and outcomes of task shifting in 13 Health Centres (HCs) located in the catchment area of Kibagabaga District Hospital, in Rwanda. The study population consisted of HCs providing task shifted care (n=13), nurses working in the ART services of the 13 HCs(n=36), and more than 9,000 patients enrolled in ART care in the 13 HCs since 2006. All 13 HCs and 36 nurses were included in the evaluation. Routine data on patients enrolled in the pre-task shifting period (n=6 876) were compared with the post task shifting period (n=2 159), with a specific focus on data in the 20-months periods prior to and after task shifting. A cohort of patients 15 years and older, initiated onto ART specifically by nurses from June to December 2010 was sampled (n=170) and data extracted from patients medical files.Data collection was guided by a set of selected indicators. Three different data collection tools were used to extract data related to planning, overall programmatic data and individual data from respectively, the program action plans/reports, HIV central databases and patients medical files. Descriptive analysis was performed using frequencies, means and standard deviations (SD). The paired and un-paired t-tests were used to compare means, and chi-square test was used to compare categorical variables. To compare and to test statistical difference between two repeated measurements on a single sample but with non-normally distributed data, Wilcoxon signed rank test was used. To judge if current task shifted care is better, similar or worse than non-task shifted care, comparisons were made of program outputs and outcomes from the central database prior to and after the period of task shifting, and also with the cohort of nurse initiated patients.Results showed that 61% of nurses working in the ART program were fully trained and certificated to provide ART. Seven out of 13 HCs met the target of a minimum of 2 nurses trained in ART service delivery. Supervision and mentorship systems for the 13 HCs were well organized on paper, although no evidence documenting visits by mentors from the local district hospital to clinics was found. In term of accessibility, the mean number of patients newly initiated on ART per month in the HCs increased significantly, from 77.8/month (SD=22.7) to 93.9/month (SD=20.9) (t test (df=38), p=0.025). A small minority of patients was enrolled in late stages of HIV, with only 15% of the patient cohort having CD4 counts of less than 100 cell /μL at initiation on ART. The baseline median CD4 cell count was 267.5 cells /μL in the cohort as a whole. With respect to quality of care, only 8.8% of patients in the cohort had respected all appointments over a mean follow up period of 17.2 months; and although follow up CD4 counts had been performed on the majority of patients (80%), it was done after a mean of 8.5 months(SD=2.7) on ART, and only a quarter (24.7%) had been tested by 6 months (as stipulated by guidelines). From central ART program data, a small but significant increase of patients on 2nd line drugs was observed after implementation of task shifting (from 1.98% to 3.00%, 2=13.26,p<0.001), although the meaning of this shift is not entirely clear.The median weight gain was 1 kg and median CD4 increase was 89.5 cells /μL in the cohort after 6 months of receiving task shifted care and treatment. These increases were statistically significant for both male and female patients (Wilcoxon signed rank test, p<0.001). With regard to loss to follow up, only three of the 170 patients in the cohort followed up by nurses had been lost to follow-up after a mean of 17.2 months on treatment. The routine data showed a decrease of patients lost to follow up, from 7.0% in the pre-task shifting period to 2.5% in the post-task shifting period. In general, the mortality rate was slightly lower in the post-task shifting period than in the pre-task shifting (5.5% vs 6.9% respectively), although this was not statistically significant (2=2.4, df=1, p=0.1209).This study indicates that, after over one year of implementation of task shifting, task shifting enabled the transfer of required capacity to a relatively high number of nurses. In an already well established programme, task shifting achieved moderate improvements in uptake (access) to ART, significant reductions in loss to follow up, and good clinical outcomes. However,evaluation of process quality highlighted some concerns with respect to adherence to testing guidelines on the part of providers and follow up visits on the part of patients. Improvements in processes of monitoring and follow up are imperative for optimal mid-term and long-term task shifting in the ART program.
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Neufeld, Jennifer. "The Development and Delivery of a Mental Health Literacy and Counselling Skills Workshop for Educators: A Pilot Study." Thesis, Université d'Ottawa / University of Ottawa, 2018. http://hdl.handle.net/10393/37200.
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School settings are increasingly being targeted as ideal entry points for youth mental health initiatives and naturally, educators have been identified as playing a critical role in supporting youth in distress. The current study set out to investigate how to strengthen the ability of educators to support youth experiencing bullying and mental health difficulties. The study was conducted in two phases: an initial phase in which a mental health literacy and communication skills workshop for educators was developed and refined, and a second phase in which the workshop was pilot-tested. The 2-hour workshop was delivered to two groups of students (N = 35) in a Teacher’s Education (B.Ed.) program at a Canadian university. Participants completed a questionnaire following the workshop to assess their satisfaction with the workshop experience and their degree of change in knowledge and awareness of bullying and mental health difficulties, as well as self-efficacy and perceived confidence in communicating with young people in distress. Results showed that participant satisfaction with the workshop was high and that most participants would recommend the workshop for pre-service and in-service teachers. In addition, participant knowledge, awareness, self-efficacy, and self-confidence in communicating with youth in distress increased from pre- to post-workshop. Taken together, the results of the pilot study provide support for further development and delivery of this workshop to pre-service and in-service teachers to help prepare educators for the complex, demanding, and vital role of supporting young people in distress due to bullying and mental health difficulties.
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Urbonaite, Miglė. "Evaluation of non-pharmaceutical intervention effectiveness in Covid-19 pandemic by using excess mortality metric." Thesis, Södertörns högskola, Miljövetenskap, 2021. http://urn.kb.se/resolve?urn=urn:nbn:se:sh:diva-46154.
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INTRODUCTION: The study focuses on finding a methodology for evaluating the effectiveness of the nonpharmaceutical intervention in the face of a new pathogen entering the population. Different interventions can have different effectiveness levels in different populations; thus, studying possible correlations and effectiveness among different groups is essential. With better knowledge of the topic, the outbreak management could be done more cost-effectively, reducing the need for antibiotics, vaccines, and possible reduction of infectious diseases caused burden in developing regions. Furthermore, the study aims to determine the ways of using excess mortality as an evaluation technique for nonpharmaceutical interventions used in the Covid-19 pandemic. METHOD: The variables in time-series format were used to calculate a cross-correlation score alongside other correlation coefficient tests. With the cross-correlation, the lag will be established to estimate how the variables correlate in the timeline. In addition, the study will attempt to establish the connections between different nonpharmaceutical interventions and their strengths and different age groups. RESULTS: The most frequent lag scores identified were 1 with 16 observations and 2 with 9 observations. The highest lag score was 4, which was observed once for the dataset of Hungary. The correlation between excess mortality and different harshness of NPI's was calculated. The correlation coefficient ranges from -0.3 to -0.39, indicating an overall low to medium correlation. The highest correlation was detected with stay-at-home requirements (-0.36), workplace closing (-0.37), and gathering restrictions (-0.39). In the final step, age-based correlations were established. The correlation ranged from 0.26 – 0.36, indicating an overall medium correlation. The lowest correlation can be seen in the youngest age group, 15-64 (correlation coefficient of 0.26), while the highest correlation of 0.36 can be seen in the 75-84 age group. Surprisingly the age group 85+ had a little lower correlation than the 75-84 age group. DISCUSSION AND CONCLUSIONS: A stronger correlation between excess mortality and stringency index was detected in the countries with a higher death per capita. The two groups of intervention effectiveness were established: more effective (school closing, workplace closing, public event limitation, gathering restriction, and stay at home requirement) and less effective (public transport limitation, restriction on internal movement, international travel control, public information campaigns, protection of elderly campaigns). This suggests that NPI effectiveness depends on population size. In the age-group-based analysis, the correlation became stronger with the age increase, indicating nonpharmaceutical intervention effectiveness against high mortality in older adults.
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Probandari, Ari. "Revisiting the choice : to involve hospitals in the partnership for tuberculosis control in Indonesia." Doctoral thesis, Umeå universitet, Epidemiologi och global hälsa, 2010. http://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-37894.
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Tuberculosis (TB) is a major public health problem in many low- and middle-income countries, including Indonesia. To accelerate TB case detection, and to improve the quality of diagnosis and treatment provided by all providers, the Public-Private Mix for implementing Directly Observed Treatment Short-course (PPM DOTS) was introduced in 2000. However, previous studies on PPM DOTS have focused on private practitioners and there has been a scarcity of research on PPM DOTS in the hospital setting. This dissertation aims to capture the potential of the PPM DOTS strategy, and identify the barriers to its implementation in hospitals in Indonesia. This dissertation is based on four separate but interrelated studies: 1. A costeffectiveness analysis, comparing incremental cost per additional number of TB cases successfully treated under three strategies of PPM DOTS in four provinces. 2. An evaluation of the access to TB services by a cross-sectional study among 62 hospitals, by estimating the proportion of TB cases receiving standardised diagnosis and treatment according to the DOTS strategy. The data were analysed using poststratification analysis. 3. The quality aspect was explored in a multiple-case study, including eight selected hospitals. The data were analysed using cross-case analysis. 4. The process of partnership was explored through a qualitative study. In-depth interviews were conducted with 33 informants, who were actors involved in PPM DOTS in hospitals in Yogyakarta province. Content analysis was applied to the qualitative data. PPM DOTS in hospitals was shown to be a cost-effective intervention in this particular context. However, the quality of the implementation was commonly suboptimal. In addition, a substantial number of TB cases did not get standardised diagnosis and treatment as per the DOTS strategy. The process of creating partnership among hospitals and National TB Programme was shown to be complex and dynamic. Process factors, such as commitment to collaboration and interaction and trust among the actors, were shown to be important. The rapid scaling-up of PPM DOTS in hospitals at the national level in Indonesia should be revisited. Indeed, considering the importance of hospitals in TB control, the implementation should be continued and expanded. However, more attention needs to be given to process, context and governance.
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Santos, Ana Flávia de Oliveira. "Familiares cuidadores de usuários de serviço de saúde mental: sobrecarga e satisfação com serviço." Universidade de São Paulo, 2010. http://www.teses.usp.br/teses/disponiveis/59/59137/tde-08112013-154830/.
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Familiares cuidadores de usuários de serviço de saúde mental têm sido chamados a participar cada vez mais ativamente como provedores de suporte e cuidados às pessoas em situação de sofrimento mental. Neste contexto, a avaliação do serviço mostra-se central em se considerando a mudança de paradigma na assistência em saúde mental. O presente estudo objetivou avaliar a sobrecarga e a satisfação com o serviço de familiares cuidadores de pessoa em sofrimento mental, verificando sua relação com estresse, estressores do cuidado, qualidade de vida e enfrentamento. Participaram 54 familiares de usuários que frequentavam um serviço substitutivo de saúde mental em cuidado intensivo e semi-intensivo de uma cidade de médio porte do interior paulista. Os instrumentos utilizados foram: Escala de Sobrecarga dos Familiares de Pacientes Psiquiátricos (FBIS-Br); Escala de Avaliação da Satisfação dos Familiares em Serviços de Saúde Mental (SATIS-Br); Inventário de Sintomas de Stress para Adultos de Lipp (ISSL); Inventário de Estratégias de Coping de Folkman e Lazarus; Escala de Qualidade de Vida versão abreviada (WHOQOL-Bref) e Roteiro Complementar. Os dados foram tratados por meio de estatística não-paramétrica e se adotou valor p<=0,05. Verificaram-se moderada sobrecarga objetiva e de moderada a elevada sobrecarga subjetiva. Entre participantes com estresse, foi maior a sobrecarga objetiva (p=0,000) e subjetiva (p=0,04). As mulheres apresentaram maior sobrecarga objetiva devido à supervisão aos comportamentos problemáticos comparativamente aos homens (p=0,04). Foi encontrada maior sobrecarga objetiva entre participantes cujos usuários possuíam o diagnóstico de esquizofrenia (p=0,01). Verificou-se correlação positiva entre sobrecarga objetiva devido à assistência na vida cotidiana e tempo de diagnóstico (p=0,01) e tempo de tratamento (p=0,03). Observou-se correlação negativa entre sobrecarga objetiva e os domínios físico (p=0,04) e social (p=0,03) da qualidade de vida. Foi encontrada correlação positiva entre sobrecarga subjetiva e uso da estratégia de resolução de problemas (p=0,05). Em sua maioria, os cuidadores encontraram-se satisfeitos com o serviço frequentado pelo usuário. Verificou-se correlação negativa entre satisfação com resultado do tratamento e idade do usuário (p=0,006). Observou-se correlação negativa entre sobrecarga objetiva e satisfação com serviço (p=0,05). Dados descritivos apontaram para baixa participação do familiar cuidador no serviço e no tratamento do usuário. Concluiu-se que os familiares cuidadores apresentaram dificuldades no cuidado ao usuário. A sobrecarga apresentou impacto negativo na qualidade de vida dos participantes. O serviço de saúde mental não foi avaliado como possuindo recursos de alívio à sobrecarga do cuidador. Os dados apontam para a necessidade de maior articulação entre serviço substitutivo em saúde mental e rede básica, bem como elaboração e desenvolvimento de programas de intervenção que possam ajudar esses cuidadores no que diz respeito ao cuidado ao usuário e ao manejo de situações estressantes. (FAPESP).Family caregivers of mental health service users have been called on to participate more actively in providing support and care to people with mental suffering. In this setting, service evaluation becomes central, considering the paradigm change that is taking place in mental health care. The goal of the present study was to evaluate family caregivers of individuals with mental suffering in terms of their overload and satisfaction towards the service, analyzing the relationship with stress, care stressors, quality of life, and coping. Participants were 54 relatives of individuals who attended a substitutive mental health service for intensive and semi-intensive care in a medium sized city in the state of Sao Paulo. The following instruments were used: Family Burden Interview Scale for Relatives of Psychiatric Patients (FBIS-Br); Satisfaction Assessment Scale for Relatives of Psychiatric Patients (SATIS-Br); Lipp\'s Inventory of Stress Symptoms for Adults (ISSL); Coping Strategy Inventory by Folkman and Lazarus; Quality of Life Scale, shorter version (WHOQOL-Bref) and a Complementary Script. Data were treated using non-parametric statistics and considering p<=0.05. It was found that objective burden was moderate and subjective burden was moderate to high. Participants with stress had higher objective (p=0.000) and subjective (p=0.04) burdens. Objective burden was greater among women, because of the supervision of problematic behaviors, compared to men (p=0.04). Participants who were caregivers of users diagnosed with schizophrenia showed greater objective burden (p=0.01). A positive correlation was found between objective burden due to everyday life care and time of diagnosis (p=0.01) and time of treatment (p=0.03). A negative correlation was observed between objective burden and the physical (p=004) and social (p=0.03) domains of quality of life. A positive correlation was found between subjective burden and using the problem solving strategy (p=0.05). Most caregivers were satisfied with the service attended by the user. A negative correlation was observed between satisfaction towards the treatment outcome and user\'s age (p=0.006). There was also a negative correlation between objective burden and satisfaction towards the service (p=0.05). Descriptive data pointed at the poor participation of family caregivers in the service and in the treatment of the user. In conclusion, family caregivers face difficulties in providing care to the user. The burden had a negative impact on the participants\' quality of life. The mental health service did not have resources to relieve caregiver burden. The data show that there is a need to improve the articulation between substitutive mental health services and the primary care level, as well as to design and develop intervention programs that could help those caregivers in terms of providing care to users and managing stressful situations. (FAPESP).
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Monisse-Redman, Michael. "Using Maslow's hierarchy of needs to improve mental health service provision to high-risk youth : evaluation of the Peel Youth Counsellor Program." Thesis, Edith Cowan University, Research Online, Perth, Western Australia, 2007. https://ro.ecu.edu.au/theses/254.
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This research focuses on the development, implementation, and evaluation of a youth counselling program with an innovative service delivery model influenced by Maslow's Hierarchy of Needs. The Peel Youth Counsellor Program (PYCP) is a promotion, prevention and early intervention program conceived as a result of an identified local need for a specialised program to work alongside mainstream mental health to provide services to youth aged 15 to 25 years. The PYCP began operation in January 2001 and is administered by the Peel Community Mental Health Service although is located fulltime in a community youth centre. The central service provision framework and understanding of youth engagement is based on youth friendly mental health services and Maslow's research into human motivation and its application to service delivery. The research outlines a comprehensive evaluation that was conducted using Austin's (1982) 'Objectives-Orientated' approach that uses a six step process to guide the implementation and analysis of what the program has achieved. The results suggest that the use of a community based youth counselling program adjunct to mainstream mental health, improves opportunities for promotion and prevention, and early (prodrama) intervention with a range of youth health and mental health issues, especially depression and suicide. With this information it is hoped that consideration will be made about current practice as well as the future development of mainstream mental health both giving priority to "youth" as an important entity in service provision.