Dissertations / Theses: 'Health service provision (Australia)'

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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.

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Coe, Christine, and n/a. "Identifying the health needs of refugees from the former Yugoslavia living in the Australian Capital Territory." University of Canberra. Nursing, 1998. http://erl.canberra.edu.au./public/adt-AUC20060629.093233.

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Most health professionals are aware of the amazing diversity of the Australian population, which is made up of people from over 140 different countries. Of these, an increasing number have arrived as refugees under Australia's humanitarian resettlement program. Research indicates that at least 30% of the 12,000 or so people arriving in Australia under the humanitarian assistance programmes each year have been exposed to physical and emotional torture and trauma. They also have well documented health deficits relating to the health standards in their countries of origin, the level of deprivation experienced prior to arrival in Australia, and the time they have spent in transit before arriving in Australia. The purpose of this study was to review the health status of refugees from the former Yugoslavia, and to identify the perceived needs of this group, which represents one of Canberra's largest communities of recently arrived refugees. Utilising both qualitative and quantitative methodologies, findings showed that the cohort had significantly lower levels of both physical and mental health than the wider ACT and Australian population. The difficulties of socialisation of the refugees into the Australian lifestyle are highlighted. In particular, findings from the study have demonstrated the lack of appropriate information given to some refugees on arrival, and the struggles experienced by most of the group with learning a new language, and coping with unemployment and inadequate housing. The problem of covert political harassment in Canberra was also described during the interview process. Recommendations for improving the situation for these refugees were that information for refugees prior to, and following arrival in Australia needs to be consistent and readily available, and there needs to be provision of a formalised support system from the time of arrival, including a review of language facilities. The study also recommended that culturally sensitive health promotion and treatment programs should be incorporated into current health service provision. Nurses are identified as the appropriate health providers to take a leading role in developing such programs for refugees, although findings from this study indicate that current nurse education programs need to place more emphasis on a transcultural framework for the provision of care.

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Murphy, Angela University of Ballarat. "When urban policy meets regional practice : Evidence based practice from the perspective of multi-disciplinary teams working in rural and remote health service provision." University of Ballarat, 2004. http://archimedes.ballarat.edu.au:8080/vital/access/HandleResolver/1959.17/12747.

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"In the main, contemporary research on Evidence Based Practice (EBP) has taken place within metropolitan locations, and has offered urbocentric solutions and insights. However the transferability of these developments to rural services is untested empirically. In addition, evidence development and studies on the implementation of this evidence have tended to be discipline-stream-specific; there has been very little research into either the development of multi-disciplinary evidence guidelines or the implementation of EBP from the perspective of individual practitioners working within multi-disciplinary teams. This research shortfall has provided the rationale for this study...."
Doctor of Philosophy

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Murphy, Angela. "When urban policy meets regional practice : Evidence based practice from the perspective of multi-disciplinary teams working in rural and remote health service provision." University of Ballarat, 2004. http://archimedes.ballarat.edu.au:8080/vital/access/HandleResolver/1959.17/14586.

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"In the main, contemporary research on Evidence Based Practice (EBP) has taken place within metropolitan locations, and has offered urbocentric solutions and insights. However the transferability of these developments to rural services is untested empirically. In addition, evidence development and studies on the implementation of this evidence have tended to be discipline-stream-specific; there has been very little research into either the development of multi-disciplinary evidence guidelines or the implementation of EBP from the perspective of individual practitioners working within multi-disciplinary teams. This research shortfall has provided the rationale for this study...."
Doctor of Philosophy

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5

Hollingsworth, Bruce. "Economies of scope and efficiency in health service provision." Thesis, University of Newcastle Upon Tyne, 1999. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.287806.

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McKenzie, Briony. "Place and power: A history of maternity service provision in Western Australia, 1829-1950." Thesis, McKenzie, Briony (2015) Place and power: A history of maternity service provision in Western Australia, 1829-1950. PhD thesis, Murdoch University, 2015. https://researchrepository.murdoch.edu.au/id/eprint/29497/.

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The nature and provision of maternity services is shaped by many different factors including location and time period. This thesis is a historical study of Western Australia’s maternity services during the period 1829 to 1950. It examines the influence of the medical profession, the state, midwives and women themselves in bringing about important changes to the provision of these services. The study adopts a post-revisionist feminist approach which prioritises the voices of women both as mothers and as midwives. In doing so, it questions established traditional understandings of the quality of the midwifery services offered in WA during the pioneering period and highlights the ways in which medical practitioners and governments undermined empirically-trained midwives and brought about greater state control of their activities. In this analysis, birth in the past is ‘re-normalised’ through an exploration of what birthing may have been like for everyday women and the home is reimagined as a safe and comfortable birthing place. This study further explores important themes which have relevance to maternity care in the contemporary context. It investigates the changing location of birth and the power structures that influenced women’s experiences in different birth locations in the past. Women’s ‘choices’ in childbirth are explored with a focus on the extent to which women were limited in their decision-making by their socioeconomic and geographic status. The study questions the extent to which contemporary understandings of the social importance of birthing, including the emphasis placed on ‘choices’ and birthing location, can be applied to women of the past. It is argued that early twentieth century women in Australia had a complex and somewhat ambiguous relationship to birthing which limits the extent to which modern understandings of birth can be transposed into the historical narrative.

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Taggart, Laurence. "Service provision for adults with learning disabilities and mental health problems." Thesis, University of Ulster, 2003. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.272064.

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Okell, Claire Natasha. "Animal health in arid lands and recommendations for strategic animal health service provision in mobile populations." Thesis, Royal Veterinary College (University of London), 2016. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.731270.

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Mary, Joanna Elizabeth. "Learning from foster carers : the experience of fostering and mental health service provision." Thesis, University of Hertfordshire, 2003. http://hdl.handle.net/2299/14173.

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The current study used a grounded theory approach to better understand the experiences of foster carers with regards to how they understood and coped with the emotional and behavioural problems of children in their care and what types of support they required from Child and Adolescent Mental Health Services (CAMHS). Background: In recent years, there has been an increasing research interest in the qualitative experiences of foster carers, given the demands they face in the current context of child-care policy. Previous studies have focused on narrative accounts and specific aspects of experience, such as dealing with difficulties and support. There is, however, a lack of research using grounded theory to explore their experiences in detail. Over the last two years, following the government's "Quality Protects" initiative, new specialist mental health services for looked after children and their carers have been set up around the country. Given these recent service developments and limited research into their role with foster carers as yet, foster carers' views and experiences of CAMHS are valuable in informing future service provision for this client group. Method: In-depth, subjective accounts of eight foster carers from six foster families employed in one local authority were obtained through interviews. Results: Four major and inter-linking categories emerged from the interviews relating to ambivalent relationships with the children in their care, the children's parents and wider services, including CAMHS. However, one core category subsumed all of these categories and was referred to as the inherent contradiction in the foster carers' role - that of being a parent, but at the same time being a professional. Discussion: The themes that emerged from the interviews with the foster carers related to previous literature on their experiences and issues of support. The findings had implications in terms of specialist psychological support and consultation to foster carers.

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Holbrook, Hannah Mead. "Referral Patterns and Service Provision in Child Protective Services: Child, Caregiver, and Case Predictors." ScholarWorks @ UVM, 2019. https://scholarworks.uvm.edu/graddis/921.

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Child maltreatment, and recurrent maltreatment in particular, occurs at an alarmingly high rate. Frequency of reports to Child Protective Services (CPS) is associated with negative psychological outcomes, and children whose reports are unsubstantiated experience similar risk of behavioral, emotional, and substance use disorders as those whose reports are substantiated. Prior research has demonstrated that children with no CPS reports and children with one CPS report showed no significant differences in rates of maltreatment perpetration or substance use in adulthood, suggesting that prevention efforts after one report may have strong merit in reducing negative outcomes in adulthood. However, patterns and risk factors of unsubstantiated reports have been only minimally explored thus far, despite having been found to predict subsequent maltreatment. The current study extends upon previous research by (a) examining both substantiated and unsubstantiated reports to identify longitudinal patterns of timing and recurrence and (b) assessing the extent to which service provision mediates long-term recurrence after each type of report. Analyses were conducted using subsamples of a longitudinal national dataset from 2011-2015 containing data from CPS reports for 3,655,951 children. Measures included child, caregiver, and CPS case characteristics obtained at the time of first report in 2011. Latent class analysis of referral patterns indicated four classes of recurrence patterns: (1) 2011 unsubstantiation followed by moderate recurrence, (2) 2011 unsubstantiation followed by low recurrence, (3) 2011 substantiation followed by moderate recurrence, and (4) 2011 substantiation followed by low recurrence. Multinomial logistic regression with most likely class membership as the outcome variable indicated that domestic violence, caregiver substance abuse, and poverty were better predictors of initial substantiation status than of long-term recurrence. Prior victimization was predictive of initial substantiation status as well as long-term recurrence. Asian American race predicted low rates of recurrence. Latent class analysis of service provision revealed only two classes: a class of children who received services and a class of children who did not. Service provision partially mediated associations between initial substantiation status and five-year maltreatment recurrence, as measured by number of subsequent reports, number of subsequent substantiated reports, and number of subsequent years in foster care. Limitations are considered and implications of using predictive modeling to drive service prioritization are discussed.

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Eccleston, Anthony L., and n/a. "Coordinating information provision in government agencies using an integrated information management strategy." University of Canberra. Information, Language & Culture Studies, 1996. http://erl.canberra.edu.au./public/adt-AUC20060404.123006.

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The specific aims of this study were determined on a conceptual appreciation that management of information assets and services in some government agencies was deficient in meeting both existing and developing demands. This appreciation manifested itself in a commitment to investigate the principles and processes intrinsic to existing management methodologies, to relate these processes to the needs of users, and to determine a strategy which could more ably meet the information provision requirements of those users. The achievement of these aims predicated the use of the case study research method, selecting as the first case study the Department of Human Services and Health (DHSH), an agency that had recognised that a problem existed in the provision of information services, and had initiated action to address that problem. As a counter, the Department of Defence, an agency which adrmts to a problem, but which had yet to initiate an active, global program for its resolution, was chosen as the second case study. A theoretical model, which reflects extant international thinking and practice, was initially constructed in order to establish a basis on which to ascertain and evaluate the information management circumstances of the two case study departments. This model specified the objectives considered to be fundamental to effective information management in a public service environment. It included studying the foundation repositories of information services from which information in the portfolio domains of government are sought. These services are the traditional records centres or registries, the library services which provide a repository of published and grey material in printed, image and magnetic formats, and the computerised networks holding electronic records at varying levels of development. An analysis of findings was carried out separately on each case study agency before bringing the data together for cross-case analysis. In order to maximise the veracity and validity of the data collected and its subsequent interpretation by the researcher, the draft analysed case study findings were submitted to the respective agencies for review and critique. All matters of substance received have been incorporated in the final version. The findings from the two case studies and the cross-case analysis confm that, despite significant advances in some specific agencies, the initial hypothesis that government agencies are still deficient in providing optimum services to meet the information needs of users, is demonstrated. The advances that have been made, however, similarly support the other thesis hypotheses that the implementation of an integrated information management strategy in any government agency will provide a foundation for improved information provision and the timely delivery of relevant available information to the user. Finally, a model of optimum processes involved in such a strategy, derived from the theory and practical products of this study, is offered. This could be the subject for future evaluation and testing for realistic and functional application.

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Chakare, Rejoice Sesedzai. "Attitudes towards adolescent friendly health service provision among health workers at a primary health care clinic in Windhoek, Namibia." Thesis, Stellenbosch : Stellenbosch University, 2013. http://hdl.handle.net/10019.1/79966.

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Thesis (MPhil)--Stellenbosch University, 2013.
ENGLISH ABSTRACT: Health statistics on adolescents in Namibia indaicate high incidences of teenage unwanted pregnancies, unsafe abortions, baby dumping, maternal ill health, early marriages and STIs including HIV. These are indicators of underutilisation of adolescent friendly health services (AFHS) by adolescents as education on these problems are covered in it. Although Government has made some strides to esure implementation starts, there is a recognisable lack of its adoption by health workers. The aim of this study was to establish the reasons for the slow adoption of AFHS practices by health workers at Katutura Health Centre. A quantitative non-experimental cross-sectional descriprive research approach was used in this study. Evidence using both primary data collected in the field through self-administered semi-structured questionnaires (with both open and closed questions) and secondary data collected in the literature review was employed . A census of the entire population of health workers was prefered over sampling. A total of 56 health workers accepted to participate in the study and the questionnaire, 46 of which returned it within a stipulated three weeks data collection period. Descriptive statistics was utilised together with frequencies, mean and basic collection. Eighty two percent of the sample participated in the study of which 67% respondents were female and 33% were male. The majority of the respondents (78.3%) had tertiary education. The results indicated: AFHS were not known to the majority of health workers; there is slow adoption of AFHS; and the programme introduction could have been done better. Factors significantly associated with adoption of AFHS are knowledge of such services, sex, level of education, job position, work experience and effective implementation of the programme. A probability value of p<0.05 was adopted. The programme is well appreciated despite concerns of lack of training and proper implementation. Key recommendations were on staff recruitment, retention and training of health workers; creation of space for implementing AFHS and marketing the programme. The system is in place, what is left is to tighten some loose ends and programme is up and running.
AFRIKAANSE OPSOMMING: Gesondheid statistieke oor die jeug in Namibië verwys na hoë voorkoms van ongewenste tiener swangerskappe en onveilige aborsies, weg gooi van babas, swak moederlike gesondheid, vroeë huwelike en seksueel oordraagbare siektes, insluitend MIV. Dit is aanwysers van die onderbenutting van jeug vriendelike gesondheidsdienste (AFHS) deur die jeug, as die onderwys op hierdie probleme gedek word. Hoewel die regering 'n paar implementerings begin het, is daar 'n beduidende gebrek van aanneming deur gesondheidswerkers. Die doel van hierdie studie was om die redes vas te stel vir die stadige aanvaarding van AFHS praktyke deur gesondheidswerkers by Katutura Gesondheids Sentrum. 'n Kwantitatiewe, nie-eksperimentele navorsingsbenadering is gebruik in hierdie studie. Bewyse uit beide primêre data wat ingesamel is in die veld deur middel van self-geadministreerde semi-gestruktureerde vraelyste (met beide oop en geslote vrae) en sekondêre data wat ingesamel is in die literatuuroorsig was gebruik. 'n Sensus van die hele bevolking van gesondheidswerkers is verkies in plaas van steekproefneming. 'n Totaal van 56 gesondheidswerkers het aanvaar om deel te neem aan die studie en die vraelys, waarvan 46 teruggedien is binne die vasgestelde tydperk van drie weke se data-invorderingstermyn. Beskrywende statistiek is gebruik saam met frekwensies, gemiddelde en basiese versameling. Tagtig en twee persent van die steekproef het deelgeneem aan die studie, waarvan 67% respondente vroulik en 33% manlik was. Die meerderheid van die respondente (78,3%) het tersiêre opleiding. Die resultate het aangedui: AFHS is nie bekend aan die meeste van gesondheidswerkers nie, en daar is stadige aanneming van AFHS; en die program inleiding kon beter gedoen gewees het. Faktore wat beduidend verband hou met die aanneming van AFHS is kennis van sodanige dienste, geslag, vlak van onderwys, werk posisie, werkervaring en doeltreffende implementering van die program. 'n Waarskynlikheid waarde van p <0,05 is aangeneem. Die program is goed waardeer ten spyte van kommer aan 'n gebrek van opleiding en behoorlike implementering. Belangrikste aanbevelings was op die personeel werwing, behoud en die opleiding van gesondheidswerkers; skepping van ruimte vir die implementering van AFHS en bemarking van die program. Die stelsel is in plek, wat oorbly om gedoen te word, is om 'n paar los punte te versterk en die program is aan die gang.

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Panday, Sarita. "The role of female community health volunteers in maternal health service provision in Nepal : a qualitative study." Thesis, University of Sheffield, 2016. http://etheses.whiterose.ac.uk/16045/.

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Nepal achieved the Millennium Development Goal 5 by reducing its maternal mortality by more than two thirds. This achievement has been credited to Female Community Health Volunteers (FCHVs) delivering basic Maternal Health Service (MHS) to pregnant women and mothers in their communities. This thesis explores the role of FCHVs in MHS provision in two regions (the hill and Terai ), from the perspectives of health workers, service users, and FCHVs themselves. Data were collected between May 2014 and September 2014 using qualitative methods. Semi-structured interviews were conducted with 20 FCHVs, 11 health workers and 26 women in villages. In addition, four focus group discussions were held with 19 FCHVs and field notes were taken throughout the data collection. Data were analysed using thematic analysis. The study found that most participants viewed FCHVs as a valuable resource in improving MHSs. In both regions, the FCHVs raised health awareness among pregnant women or mothers and referred them for check-ups. They shared health messages through mothers' group meetings and the meetings were also used for discussions around budgeting and finance, which sometimes left little time for discussion on health topics. Such activities, combined with the FCHVs’ lack of education, often proved to be counterproductive to their service provision. The roles of FCHVs were crucial in the hill region where there was limited access to professional healthcare. An important area of FCHVs’ work involved accompanying and assisting women during delivery. In addition, they distributed medicines, administered pregnancy tests and informed women about emergency contraception and availability of abortion services. The FCHVs used novel methods to share maternal health information: for example, they sang folk songs which contained health messages or visited new mothers with food hampers. Such services were invaluable for women in the remote hill villages, who otherwise would not have received any healthcare. In terms of their motivations to volunteer, this study found that FCHVs viewed their work as a form of basic human and social responsibility. In addition, they reported feeling empowered as a result of training and socio-economic opportunities. However, a lack of financial and non-financial incentives was the key hindrance for them in delivering their services, followed by their perception of community misunderstanding about their services. In addition, health system factors such as lack of medical supplies and irregular supervision hindered them in carrying out their role effectively. In general, volunteers in the Terai received less support than those in the hill region. Furthermore, FCHVs perceived a lack of respect by some health workers towards them. A lack of coordination between government health centres and non-governmental organisations was also noted. The thesis concludes with several recommendations for policy makers, practitioners and researchers in order to improve the services by FCHVs. These include providing the FCHVs with context specific support - financial and non-financial incentives, access to supplies, educational training, and supportive supervision - to enable them to deliver services more productively. Recommendations are also made for ensuring that FCHVs are recognised and respected for their contribution to MHSs by local health workers and their communities, as well as coordinating activities among local organisations that mobilise FCHVs to ensure that their services flourish in the future.

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14

Al-Hamad, Alaa H. "Pressures of supply and demand in the provision of an out-patient service." Thesis, Lancaster University, 1992. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.335523.

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Maepa, Matjokotja William. "From ‘native health’ to primary health care : transformation in rural health care service provision in the former Transvaal, 1930s-1990s." Diss., University of Pretoria, 2020. http://hdl.handle.net/2263/77217.

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This thesis focuses on the transformation of healthcare services for the blacks in the former Transvaal during the period from the 1930s to 1990s. The thesis argues that over this period the healthcare of rural blacks from Union to Republican governments had incipient features of primary health care – haphazardly driven by progressive-minded individuals within the state, by missionaries, as well as other stakeholders, motivated by concerns over the socio-economic conditions of the blacks. Although the concept of primary health care did not exist in popular public health parlance during the Union era, prototypical concepts such as ‘native health’, ‘preventative health’ or ‘community health’ were used interchangeably to describe and formulate a variety of initiatives meant to deal with health challenges caused by diseases such tuberculosis, malaria, syphilis, HIV/AIDS and other poverty-related diseases. A brand of ‘Community-Orientated Primary Care’ was popularised by Sidney Kark to refer to his initiatives at the Pholela Health Centre, a model primary health care project of the early 1940s. The model inspired the establishment of similar health centres in the rural areas of the Transvaal and other provinces, as part of the broad sweep of social medicine from the 1940s. This thesis also argues that the road to the full embrace and implementation of primary health care was characterised by many challenges emanating from the state’s reluctance to support its implementation, as that had the potential of upsetting the policy of racial discrimination. Opposition to the state’s reluctance to implement a national healthcare system based on the precepts of primary health care emerged and intensified from the time the National Party came into power in 1948. Aspects of the healthcare system of the former Transvaal were also uniquely influenced by some former medical students of the University of Natal Medical School who, from the late 1960s to the early 1970s started to use their newly acquired skills and experience to deliver community health care services in parts of the Transvaal. Although the historic Alma Ata Conference of 1978 added impetus to the popularity of the concept of primary health care, its full implementation in South Africa was wobbled by the reluctant apartheid state. As expected, primary health care became a battleground of political wrestling between the state and liberation movements and other stakeholders. It was only after the 1994 general elections that the concept was declared a national policy, to be prioritised by all government departments. Although several scholars have dealt with progressive healthcare initiatives during South Africa’s twentieth century, a focus on the rural Transvaal offers a new opportunity to revisit key developments in the country’s public health history, and to reflect on the layered and indeterminate nature of the emergence of primary health care, with particular emphasis on the contribution of educated African healthcare professionals and grassroots movements. Like the Pholela and the National Health Service Commission initiatives which have been covered extensively in the literature, a history of the development of the public health system in the Transvaal offers a vista to understand the colonial origins and changing fortunes of rural primary healthcare over the course of an eventful seven decades in South Africa.
Thesis (PhD)--University of Pretoria, 2020.
National Institute of Human and Social Science (NIHSS) SAHUDA
Historical and Heritage Studies
PhD
Unrestricted

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Connell, Mong L. "A study of the cultural appropriateness of service delivery models in the Australian mental health system." Thesis, Edith Cowan University, Research Online, Perth, Western Australia, 2002. https://ro.ecu.edu.au/theses/714.

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This study is an attempt to examine the cultural appropriateness of the mental health system in relation to the Vietnamese refugee community in Australia. Culture and mental health, as widely acknowledged in the field of transcultural psychiatry, are closely linked. No aspect of the diagnosis or treatment methods can be justified without reference to the cultural traditions of the mental health system and the client. In a country like Australia, where multiculturalism is a dominant feature of the society, the need is even greater in incorporating culture into every aspect of the mental health system, if it desires to provide a culturally appropriate service to all immigrant groups. Every immigrant group brings with them different cultural values and attitudes. Included in these are viewpoints about mental health/illness that can diverge distinctly from those belonging to the more prevalent Anglo-Saxon cultural norms. How the illness is perceived as to its cause, treatment to healing are different in most cultures. According to the Australian Bureau of Statistics (1996), Vietnamese immigrants form one of the largest displaced people ever to be accepted into Australia as refugees. Their history of escape from the communist regime in Vietnam have sparked worldwide concerns about the state of their mental health. Their journey of escape is not without torture and trauma. Once settled into a country like Australia, they face many settlement obstacles. The cultural and social adjustments that they have to undergo have made them one of the most vulnerable and disadvantaged immigrant groups in Australia. Faced with such a group that have a high predisposition to mental stress and anxiety, the question lies in whether the Australian mental health system is sufficiently informed and prepared to provide a service which has relevance and meaning to these people. I argue that the system has not adequately provided a service to such a purpose. Although much progress and research has been done, it still operates very much within a Western philosophy. Its traditions, values and attitudes reflect a worldview that make little cultural sense to these people. Its racist assumptions and attitudes which promote cultural superiority of the West has resulted in a system labelled as culturally inefficient. Racism has been socially constructed and entrenched within the system for many years and it's origins are lost in the history of Western culture. Its mental health system is essentially monocultural. Culturally inappropriate diagnostic and treatment programmes and a shortage of professionals with the necessary linguistic, cultural and clinical competencies are just some of the deficiencies that exist within the system. Many training programmes have failed to evoke practitioners into questioning the effectiveness and cultural appropriateness of these fundamental structures supporting existing models of service delivery. This study is done through a discussion of the history of racism, certain important concepts, for example, culture and mental health/illness and the social, historical and political experience of the Vietnamese. The rest of the research focuses on certain specific barriers of accessibility and concludes with how these barriers can be addressed. In doing so, it advocates for a totally non-racist approach from an international to a personal level of service. Only through this approach can the mental health system claim to provide a service that is culturally sensitive and meaningful.

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Broughton, John, and n/a. "Oranga niho : a review of Maori oral health service provision utilising a kaupapa maori methodology." University of Otago. Dunedin School of Medicine, 2006. http://adt.otago.ac.nz./public/adt-NZDU20070404.165406.

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The goal of this study was to review Maori oral health services utilising a kaupapa Maori framework. The aims of the study were to identify the issues in the development, implementation and operation of Maori dental health services within each of the three types of Maori health providers (mainstream, iwi-based, partnership). The three Maori oral health services are: (i) Te Whare Kaitiaki, University of Otago Dental School, Dunedin. (ii) Te atiawa Dental Service, New Plymouth. (iii) Tipu Ora Dental Service, in partnership with the School Dental Service, Lakeland Health, Rotorua. Method: A literature review of kaupapa Maori research was undertaken to provide the Maori framework under which this study was conducted. The kaupapa Maori methodology utilised the following criteria: (i) Rangatiratanga: The assertion of Maori leadership; (ii) Whakakotahitanga: A holistic approach incorporating Te Whare Tapa Wha; (iii) Whakapapa: The origins and development of oranga niho; (iv) Whakawhanuitanga: Recognising and catering for the diverse needs of Maori; (iv) Whanaungatanga: Culturally appropriate forms of relationship management; (v) Maramatanga: Raising Maori awareness, health promotion and education; and (vi) Whakapakiri: Recognising the need to the build capacity of Maori health providers. Ethical approval was granted by the Otago, Bay of Plenty and Taranaki Ethics Committees to undertake interviews and focus groups with Maori oral health providers in Dunedin, Rotorua and New Plymouth. Information was also sought from advisors and policy analysts within the Ministry of Health. A valuable source of information was hui korero (speeches and/or discussion at Maori conferences). An extensive literature was undertaken including an historical search of material from private archives and the now defunct Maori Health Commission. Results: An appropriate kaupapa Maori methodology was developed which provided a Maori framework to collate, describe, organise and present the information on Maori oral health. In te ao tawhito (the pre-European world of the Maori) there was very little if any dental decay. In te ao hou (the contemporary world of the Maori) Maori do not enjoy the same oral health status as non-Maori across all age groups. The reasons for this health disparity are multifactorial but include the social determinants of health, life style factors and the under-utilisation of health services. In order to address the disparities in Maori oral health, Maori providers have been very eager to establish kaupapa Maori oral health services. The barriers to the development, implementation, and operation of a kaupapa Maori oral health service are many and varied and include access to funding, and racism. Maori health providers have overcome the barriers through two strategies: firstly, the establishment of relationships within both the health sector and the Maori community; and secondly, through their passion and commitment to oranga niho mo te iwi Maori (oral health for all Maori). The outcome of this review will contribute to Maori health gain through the recognition of appropriate models and strategies which can be utilised for the future advancement of Maori oral health services, and hence to an improvement in Maori oral health status. Conclusion: This review of Maori oral health services has found that there are oral health disparities between Maori and non-Maori New Zealanders. In an effort to overcome these disparities Maori have sought to provide kaupapa Maori oral health services. Whilst there is a diversity in the provision of Maori oral health services, kaupapa Maori services have been developed that are appropriate, effective, accessible and affordable. They must have the opportunity to flourish.

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Maria, Speciale Anna. "Midwifery in low resource environments. Challenges and opportunities in maternal and reproductive health service provision." Doctoral thesis, Universitat Autònoma de Barcelona, 2016. http://hdl.handle.net/10803/392672.

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Esta tesis busca responder la siguientes preguntas de investigación: “¿Están las parteras en países de bajos recursos proporcionando los servicios de calidad en salud materna y reproductiva que se necesitan?, ¿Qué brechas existen? ¿Cuáles mejoras en la formación son necesarias para que las parteras presten servicios de mayor calidad en salud materna y reproductiva? Esta tesis es una compilación de estudios de caso de tres investigaciones. Este trabajo identifica los problemas y brechas existentes en la calidad de la prestación de los servicios de partería y la formación del personal, además realiza una evaluación de proyecto proporcionando información sobre los resultados y mejoras en la calidad y disponibilidad de cuidados en partería. El primer estudio de caso se lleva a cabo en Afganistán y es una presentación del marco Tanahashi y su uso para identificar las barreras y obstáculos en la provisión de servicios de partería. Los resultados finales fueron bastante inquietantes luego de descontar la disponibilidad, aceptabilidad, accesibilidad y contacto, la cobertura efectiva restante fue del 12% para la población urbana y el 26% de la población rural. El estudio de caso de Tanzania ofrece una imagen muy completa de la (bajo) nivel de calidad que se puede encontrar sobre todo en entornos de bajos recursos. En la investigación aportada en esta tesis se demuestra que la calidad de los servicios ofrecidos por los recién graduados es muy baja y las pruebas de habilidades revelaron que menos del 25% de ellos eran capaces de realizar las estándares internacionales. El estudio de caso final tiene lugar en Ghana. Este estudio se basa en una evaluación de proyecto de formación de parteras. El caso de estudio presenta resultados cualitativos que demuestran que tanto los profesores, los preceptores y los alumnos, todos ellos, sintieron que el programa tuvo un impacto positivo. Los casos cuantitativos revisados revelaron que los preceptores ofrecieron servicios de planificación familiar de largo plazo y atención integral del aborto a la comunidad después de este proyecto. En la agenda posterior a 2015, las parteras han sido identificadas como los principales proveedores de servicios de salud materna y reproductiva. A nivel mundial hay una escasez importante de parteras e incluso los países con un número suficiente, existen graves preocupaciones sobre la distribución del personal de partería en los países de bajos recursos, con una tendencia hacia la concentración en entornos urbanos, mientras que la mayor necesidad se encuentra en las áreas rurales. Sin embargo, un aumento en el número de parteras sin un aumento de la calidad probablemente sería infructuosa. La partería es diversa en todos los países y existen grandes diferencias en la salud materna y reproductiva dentro de los países. Antes de diseñar nuevas intervenciones, evaluaciones como las que se contemplaron en esta tesis deben completarse. Este es un momento emocionante para la partería a nivel mundial, y en particular en países de bajos recursos. Se espera que esta tesis contribuya a la creciente literatura acerca de la partería y que esta ofrezca algunos ejemplos claros de estudio y la mejora (particularmente con respecto a la calidad y disponibilidad) de los servicios de partería en los países de bajos recursos. Mientras que los retos actuales son grandes, también lo son las oportunidades.
This thesis sought to answer the question: “Are midwives in low resource countries providing the quality maternal and reproductive health services that are needed? What gaps exist?” What training improvements will better prepare midwives to provide quality maternal and reproductive health services?” This thesis is a compilation of case studies: two investigative studies for problem identification and gaps in quality in midwifery service provision and midwifery education and one project evaluation providing information about outcomes and improvements in the quality and availability of midwifery care. The first case study takes place in Afghanistan and is a presentation of the Tanahashi framework and its use to identify barriers and bottlenecks in midwifery service provision. Final results were quite disturbing, as after discounting for availability, acceptability, accessibility, contact the effective coverage remaining was 12% for urban populations and 26% for the rural population. The Tanzanian case study offers a very complete picture of the level of quality of service that can be found particularly in low-resource settings. The research provided in this thesis demonstrated that quality of services being offered by recent graduates is very low, with less than 25% passing skills testing of crucial life-saving skills. Additionally it showed that the current curriculum and training system do not meet international standards. The final case study took place in Ghana. This case study was based on a project evaluation for a training intervention. This case study presents qualitative findings that demonstrate that the teachers, the preceptors and the students all felt that the program had a positive impact. Quantitative caseload reviews revealed that the preceptors offered more long term family planning and comprehensive abortion care services in the community after this project. In the post-2015 agenda midwives have been identified as the leading providers for maternal and reproductive health services. Globally, there is an important shortage in midwives and even countries with sufficient numbers, there are grave concerns about the distribution of the midwifery workforce in low resource countries with a tendency toward a concentration in urban environments while the greatest need is in the rural areas. However an increase in the number of midwives without an increase in quality will likely be fruitless. Midwifery is diverse in every country and great differences in maternal and reproductive health exist within countries. Prior to designing interventions, assessments such as those viewed in this thesis should be completed. This is an exciting time for midwifery globally, and particularly in low resource countries. It is hoped that this thesis contributes to the growing literature regarding midwifery and that it provides some clear examples of the study of and improvement (particularly with regard to quality and availability) of midwifery services in low resource countries. While the current challenges are great, so are the opportunities.

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Loo, Kwok-ying, and 魯國英. "Oral health of and provision of dental care service to kindergarten children in Hong Kong." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2012. http://hub.hku.hk/bib/B4961776X.

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The last oral health survey conducted by the government of Hong Kong in 2001 found that dental caries was common among the kindergarten children and that most of their dental caries was untreated. The overall aims of this research project were to find out the oral health status of the kindergarten children in Hong Kong and the outcomes of providing a private practice based dental service programme to these children. To achieve the first aim, an oral health survey was conducted in 2007. Through stratified simple random sampling, 12 kindergartens in Hong Kong Island were selected. All children attending grades 1 to 2, aged 3 to 5 years, in the kindergartens were invited to participate. Children with parental consent were clinically examined by one of two calibrated examiners. A questionnaire on the child’s demographic background and oral health related behaviours was completed by the parents. Response rate of the survey was 89% and 1,343 children were examined. Their mean age was 52 months (SD=7) and 51.5% were boys. Around one third (35.3%) of the children had experienced dental caries. The mean dmft score was 1.5, increasing from 1.2 at age 3 to 2.0 at age 5 (ANOVA, p=0.016). Soft, cavitated caries (dt) accounted for 90% of the dmft score. The prevalence and severity of dental caries in the children were associated with the children’s socio-demographic background, and their dietary and tooth-brushing habits. To find out the feasibility of implementing a private clinic based dental service program for the preschool children a total of 245 children attending grade 1 in 9 kindergartens were invited to participate. Baseline information of the children was collected through a clinical examination and a parental questionnaire at April 2007. After baseline data collection, the study children were randomly allocated into the test or the control group. Children in the test group were offered free dental services at regular intervals in 3 private dental clinics. Evaluation took place in July 2009 after the completion of the 24-month intervention programme through conducting clinical examinations and a parental questionnaire. After 24 months, 88% of the control and test group students remained in the study. The mean dental appointment attendance rate of the test group children was 53%. Individualized instructions on oral hygiene were provided to 82% of the children and 52% of the children had received topical fluoride application. Treatments were provided to more than 30% of the children and the mean number of dental fillings placed is 1.1. The mean total running cost per child was around HK$100 a year. The kindergarten children who were covered by the study dental service programme had better oral health than that of the children who were not. The study programme was effective in preventing development of new dental caries and in reducing the amount of untreated caries among the test group children. However, it was not effective in improving the oral health related behaviours and oral hygiene status of the children. The study programme was acceptable to the kindergartens, the parents and the children by the satisfaction study. Consumer satisfaction was reasonable high.
published_or_final_version
Dentistry
Doctoral
Doctor of Philosophy

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Duggan, Catherine Anne. "An evidence based approach to developing pharmaceutical service provision across the primary:secondary health care interface." Thesis, University College London (University of London), 1998. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.364857.

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Godia, Pamela. "Sexual reproductive health service provision to young people in Kenya : what is the best model?" Thesis, University of Liverpool, 2012. http://livrepository.liverpool.ac.uk/5873/.

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Background: Young people are a demographic force and their sexual and reproductive health (SRH) has become an area of focus for many national governments in both developed and developing countries. Addressing the SRH problems of young people is essential for the social and economic development of any nation and presents an opportunity for building human capital, respecting human rights and alleviating the intergeneration cycle of poverty across societies. Aim: This study aimed at firstly exploring experiences and perceptions of young people aged 10-24, community members, health service providers (HSP), programme managers and policy makers on the SRH problems of young people and available SRH services. Secondly, the study sought to explore the different models of SRH service provision and, through a stakeholder consultative process, develop an SRH service delivery model for young people in Kenya. The development of the model was also informed by findings from literature review on ASRH interventions and components of models of health service delivery. Methodology: This was a qualitative study which took a social constructionism approach. The study took place in four areas, Nairobi city and three district hospitals (Laikipia, Meru central, and Kirinyaga). Data was collected from a total of 8 health facilities, 5 integrated facilities and three youth centres, using focus group discussions (FGDs) and in-depth interviews (IDIs). 18 FGDs and 39 IDIs were conducted with young people; 10 FGDs with community members; 19 IDIs with health service providers; and 11 IDIs with facility managers and programme managers. Interviews were tape recorded and transcribed. With the assistance of NVIVO8 data was coded and analysed using the thematic framework approach. Results: Young people’s perceptions of available SRH services show variations between boys and girls with regards to the model of service delivery. Young girls seeking ANC and FP services at integrated facilities characterised the available services as good. On the contrary, boys indicated that SRH services at integrated facilities have been designed for women and children, and so they felt uncomfortable seeking services from these facilities. Apart from receiving SRH services at youth centres, young people place emphasis on the non-health benefits they personally receive from youth centres such as preventing idleness, confidence building, information gap-bridging, improving interpersonal communication skills, vocational training and facilitating career progression. Majority of community members are not aware of the SRH services available at the health facilities even in areas where youth centres are present. Community members approve of young people receiving services which they feel are educative and preventive in nature and disapprove of services which they feel encourage young people to engage in sexual activity such as promotion of contraceptives. HSP report not being competent in adolescent counselling, facing a dilemma and not being comfortable with providing SRH services to young people. HSP also report being torn between their personal feelings, cultural norms and values and respecting young people’s right to accessing SRH services. Broadly two models of SRH services are examined in this study; the integrated model and youth centres. Youth centres can either be facility-based or community-based. The findings presented in this study do not point to one single model as the best SRH service provision model as each have their own strengths and weaknesses. However, both models face implementation challenges which include: a weak monitoring and supervisory system, weak linkages with other government line ministries and departments and heavy reliance on donor funding. Specific to facility-based youth centres implementation challenges include: lack of ownership and support by district managers, being seen as parallel health structures and conflicts of interest in youth centre utilization between district managers and young people. Although the youth centre is reported as the preferred model by some young people and healthcare providers, its sustainability is not guaranteed. Moreover, the range of services it’s able to provide is limited due to deficiencies in staffing, supplies and equipments. Conclusion: Addressing the SRH problems of young people in Kenya remain a big challenge for the health sector. Although some progress has been made with regards to creating a friendly policy environment for SRH service provision, the major drawback lies in implementation of these policies. This study recommends a multi-component SRH service delivery model with six core services, a strong support structure onto which to anchor service delivery and linkages to existing government systems and processes to enhance sustainability. This is the first study to be conducted in Kenya using qualitative methodology and result in the development of a SRH service delivery model for young people after triangulation of views and experiences of young people themselves, community members, health care providers, programme managers and policy makers.

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Young, Susan Elaine. "A qualitative analysis of aftercare service provision for survivors of sex trafficking in North Carolina." The University of North Carolina at Chapel Hill, 2013.

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Almoshawah, Saad A. S. "An examination of the mental health service provision in Saudi Arabia with particular reference to counselling." Thesis, University of Hull, 2005. http://hydra.hull.ac.uk/resources/hull:10431.

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This thesis aimed at elucidating the meaning of mental health services within the context of counselling practice in Saudi Arabia. The delineation of mental health practice within this context may help to overcome the incongruence among counselling theory, research, practice, and the experience of counselling patients in that country. Consequently, mental health treatment systems in Saudi Arabia have a history of incompatible philosophies and conflicts that have been associated with poor treatment outcomes for persons diagnosed, which was linked to a deterrent Poor Law to one which incorporated those suffering from a wide range of mental disturbances, which was largely based on treatment willingly undertaken and freely available, and which was associated with a preventive Ministry of Health. It examines the concepts and intentions which underlay policy, and the impact of policy upon the service and its clients. It describes the ways in which the service was moulded by the changing and sometimes conflicting demands of the needs of the mentally patients' and of society as a whole. There is almost full agreement among all those concerned with Psychiatric health care in Saudi Arabia that current treatment is not beneficial and may be harmful to the patients'. Most psychiatrists agree that the major benefit for the patient occur in the first week of his \her treatment. Mental health provision in the Kingdom of Saudi Arabia hospitals, historical background and the use of the current medical model, is examined in the first part of the study and qualitative and quantitative methodology were used in the second part. From the analysis, the questionnaire, and exploratory interviews the major findings were, revealed statistically significant differences between practitioners in their aims and objectives, roles and responsibilities, awareness, effectiveness' , referral system and procedures, and personal development. Although, practitioners experienced dissatisfaction with the whole service; patients' were raised the same issues criticising the poor standard of services in their hospitals. In addition, practitioners felt the referral system was inflexible and unclear, psychiatrists and counsellors failed to understand their patients' needs. It was concluded that there were considerable the lack of training amongst practitioners. In the light of the findings, the researcher came up with several recommendations, the most important of which were the following. I ) there is a need for a viable model for mental health treatment in Saudi Arabia.;2) Improve the current provision regulation;3) establish a mental health Act in Saudi Arabia.

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Urwin, Jessica. "A return to rawls : applying social justice to mental health provision in the Youth Offending Service." Thesis, De Montfort University, 2015. http://hdl.handle.net/2086/11399.

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Mental health services provided through the Youth Offending Service (YOS) are inadequate to meet the needs of young offenders. The differing viewpoints of mental health and criminal justice are not incompatible, but require consideration in terms of how to work together. This has not occurred within youth justice, and there are tensions between the YOS and CAMHS. If the YOS structure better allowed for social justice approaches to occur within practice, these tensions could be avoided and the needs of young people better met. This research looked at the ways in which provision of mental health services impacts upon social justice within the YOS. A case study was constructed looking in detail at mental health provision, the challenges faced by mental health workers and their ability to overcome these problems. Mental health workers and managers within the YOS were interviewed to construct the case study. From this a number of issues were identified within practice that impact upon social justice, and how some youth offending teams had overcome them. From this both long and short-term suggestions and strategies for practice have been created to improve levels of social justice within youth justice practice.

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Godsell, Matthew John. "The social context of service provision for people with learning disabilities : continuity and change in the professional task." Thesis, University of Bristol, 2002. http://hdl.handle.net/1983/1b6457fb-b778-4d43-89b7-cb967a664bdc.

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Green, Quentine. "Service provision for people with multiple sclerosis : a qualitative study of one health authority in the United Kingdom." Thesis, City University London, 2006. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.446258.

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Improved understanding of health service provision for people with Multiple Sclerosis (MS) in relation to their perspectives provides vital information guiding efforts to meet their ongoing needs. This thesis presents a qualitative study of service provision for people with MS in one health authority in the UK. The philosophical/theoretical underpinnings of the study were social realism and symbolic interactionism. The study explored three key questions appertaining to service provision: how do people with MS utilise health services in this authority?; what problems occur in daily interactions between service users and providers that affect how needs are met for people with MS?; and how does the structure of current health services in this authority affect people with MS? The study was carried out in four stages incorporating: initial exploration; analysis of initial data with design and implementation of required pilot studies; a retrospective examination of cases of people newly diagnosed with MS; and a prospective examination of service use which involved monitoring how people with clinically confirmed MS used services over a 10-month period. Three main themes arose from the study: trust in the relationship between health professionals and people with MS; how health professionals and people with MS express their knowledge of MS; and service planning and design factors that influence whether and how the needs of people with MS are met. It was concluded that better understanding and improved promotion of trust between health and social care professionals and people with MS are critical to increasing the satisfaction of the latter with service provision. The findings are discussed in relation to an analysis of individual and collective factors which promote and impede the development of trust.

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Marquis, Ruth. "The meaning of quality in living service environments: An analysis of the experiences of people with disabilities, elderly people and service workers." Thesis, Edith Cowan University, Research Online, Perth, Western Australia, 1998. https://ro.ecu.edu.au/theses/976.

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The purpose of the study was to examine the experiences of both people with disabilities and elderly people and to identify their perceptions of quality as it relates to living in a service or being supported by a service to live in the community. The study was naturalistic in design and used a phenomenological approach and inductive analysis. It involved immersion in living services for a two year period, in-depth interviews with people living and working in services and participant observation. Fifty service users between the ages of twenty-one and ninety-six, and twenty-six service workers between the ages of twenty-six and fifty-four were informants in the study. The study comprised of three phases, the first phase involved repeated in-depth interviews with service users in two disability and two aged care living services to examine the experiences of people living in services and their perceptions of quality. As a result of the consistency with which relationships with key staff members emerged in the context of quality experiences, selected service workers who were named by service users were also interviewed. The findings in this phase indicated that relationships experienced by service users in their encounters with service workers were more significant in service users' evaluation of quality than tangible acts of physical and environmental care. Relational experiences of people living in services were variable. Some informants experienced consistent validation and socio-emotional support, whilst others experienced role distancing and negative communication experiences. Service workers who were interviewed as a result of being identified by service users in the context of quality, attached importance to the relational domain in the acts and behaviours of providing a service. They also attached personal meaning to their roles as service workers and shared the view that their role as service worker was underpinned by an ethos of communality. The second phase of the study involved accessing another five disability and five aged care services to collect further data to support or refute the findings from phase one. As a result a large data bank was established to confirm the consistency with which relational experiences in living services were linked to perceptions of quality by both service users and service providers. Acts and behaviours which were consistently present in the context of quality were also identified and the need for emotional support in the living context was further confirmed. The third phase of the study involved an in-depth analysis and identification of commonly experienced categories of relationships between service users and workers. Relationships were categorised into ethical and technical living service experiences and exemplars used to illustrate findings. Data analysis indicated that service experiences lie on a continuum, with mutually supportive relationships between service users and workers at one end, and physical and psychological abuse at the other. Experiences were variable in singular service contexts. This highlighted the individual nature of service relationships between service users and workers and the need to articulate human service as relationship. It also highlighted the inadequacies of using standard measures to evaluate quality in living services.

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Pagan, Jose. "Practices, Attitudes and Knowledge of Food Service Owners and Managers of South Central Kentucky Regarding Provision of a Smoke-Free Environment for Customers." TopSCHOLAR®, 1996. http://digitalcommons.wku.edu/theses/876.

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The harmful effects on health caused by exposure to enviromental tobacco smoke (ETS) are well documented. In 1987 and 1996 mail surveys were conducted to determine the change in practices, attitudes and knowledge of food service owners and managers of south central Kentucky on some issues relating to environmental tobacco smoke (ETS). Study subjects included all food service owners and managers of south central Kentucky that have a permit on file at the Barren River District Health Department. In 1987, a total of 127 out of 431 questionnaires were received ( 29.5% response rate). In 1996 the response rate was 30.6% (190 responses out of 620 questionnaires mailed). Most of the responses in the 1996 survey (42.6%) were from Warren county. Retail food services and school cafeterias made up 57.9% of the respondents. It was hypothesized that there has not been any changes in the percentages of food services establishments that offer a nonsmoking area to the customers between 1987 and 1996, that the percentage of food service owners that recognize the hazards of ETS has not changed, and that the percentage of food service owners that agree that the prohibition of smoking would result in a loss of customers has not changed since 1987. Using Chi-squares, frequencies and percentages it was determined that there has been an increase in the percentage of places that have a nonsmoking area 20.6% in 1987, 57.4% in 1996 (significant to 0.0001). It was also determined that there was a significance of 0.01 between the percentage of managers that agree that ETS is harmful to nonsmokers [ 71.2% in 1987 vs 98.1% in 1996 (item #3), and 43.5% in 1987 vs. 54.1% in 1996 (item #4)]. A significance of 0.0001 was found on the question of believing that a change to a smoke-free facility will result in a loss of customers. In 1987, 79.4% agreed on the statement being true vs. 53.5% in 1996.

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Knibb, Wendy. "The use of, and training provision for, healthcare assistants and support workers in the National Health Service in England." Thesis, University of Surrey, 2005. http://epubs.surrey.ac.uk/804400/.

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Gama, Elvis Sitithana Mpakati. "The implications of contracting out health care provision to private not-for-profit health care providers : the case of service level agreements in Malawi." Thesis, Queen Margaret University, 2013. https://eresearch.qmu.ac.uk/handle/20.500.12289/7457.

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Background: The Malawi government in 2002 embarked on an innovative health care financing mechanism called Service Level Agreement (SLA) with Christian Health Association of Malawi (CHAM) institutions that are located in areas where people with low incomes reside. The rationale of SLA was to increase access, equity and quality of health care services as well as to reduce the financial burden of health expenditure faced by poor and rural communities. This thesis evaluates the implications of SLA contracting out mechanism on access, utilization and financial risk protection, and determines factors that might have affected the performance of SLAs in relation to their objectives. Methods: The study adopted a triangulation approach using qualitative and quantitative methods and case studies to investigate the implications of contracting out in Malawi. Data sources included documentary review, in-depth, semi-structured interviews and questionnaire survey. The principal agent model guided the conceptual framework of the study. Results: We find positive impact on overall access to health care services, qualitative evidence of perverse incentives for both parties to the contracting out programme and that some intended beneficiaries are still exposed to financial risk. Conclusion: An important conclusion of this study is that contracting out has succeeded in improving access to maternal and child health care as well as provided financial risk protection associated with out of pocket expenditure. However, despite this improvement in access and reduction in financial risk, we observe little evidence of meaningful improvement in quality and efficiency, perhaps because SLA focused on demand side factors, and paid little attention to supply factors: resources, materials and infrastructure continued to be inadequate.

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Virdee, Gursharan. "The exploration of factors relevant to enhancing mental health service provision and psychological therapies for persons of South Asian origin." Thesis, City University London, 2015. http://openaccess.city.ac.uk/14623/.

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Background: Community participation is one element of the recovery process for people with schizophrenia, however little is known about how this occurs for persons of South Asian origin. Aims/objectives: This study explores the concept and experience of community participation and recovery amongst South Asians with schizophrenia living in Toronto, Canada. Methods: This longitudinal study took place over the course of eight months. Seven people of South Asian origin with schizophrenia were recruited through purposeful sampling strategy and interviewed at three time points. A theoretical sampling approach was employed to recruit 19 key supports and community members who were interviewed at least once during the course of the study in an effort to capture multi-level perspectives of persons of South Asian origin. Qualitative data was analysed using social constructionist Grounded Theory informed by Charmaz. Results: A rigorous grounded theory approach revealed five themes; i) cultivating an autonomous self within the collectivist family-based culture, ii) cultural conceptualizations of self and mental illness, iii) developing individual ethnic identity and sense of belonging in a community context, iv) points of exclusion in the community, v) points of inclusion in the community. These five themes interlinked, creating a complex dynamic between individuals, families, various communities’ people belonged to and, in turn, experience of mental health. The multi-level approach to data collection provided insight into the many systems and structures that impact on this community. These experiences shaped identity, self-concept, perceptions of self as well as other racial/ethnic groups, and in turn the spaces, places and people interacted with. Spaces that provided acceptance and inclusion also facilitated the cultivation of an empowered sense of self. Conclusions: Provider efforts to encourage community participation and recovery for persons of South Asian origin with schizophrenia should take into account the multiple and intersecting aspects of individual identity as well as those at a community level. A multi-level approach informed by social capital theory could lead to the promotion of social inclusion and integration of persons with schizophrenia. It is recommended that this strategy focus on three areas; i) advancing mental health service provision and psychological therapies, ii) education and training of health professionals and community members for example faith leaders, iii) local and national policy that addresses poverty and mandates services to address the specific needs of mental health in South Asian communities.

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Fenton, Sarah-Jane Hannah. "Mental health service delivery for adolescents and young people : a comparative study between Australia and the UK." Thesis, University of Birmingham, 2016. http://etheses.bham.ac.uk//id/eprint/7111/.

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This thesis explores policy and service delivery for adolescent and young adult or ‘transition age’ mental health service users aged 16-25 across different jurisdictions in the UK and Australia. The study explores the implications that policy formulation and implementation have for service delivery in these different contextual settings; and examines how young people (who are at a vulnerable stage developmentally in terms of mental health), have their access to services affected by the existing policy framework. A policy analysis was conducted along with qualitative interviews in six case sites (three in the UK and three in Australia). The thesis adopted a critical realist approach using a laminated cross-sectional interview strategy that was developed to include interviews with national policy makers; local policy makers and service managers; staff working within services; and the young people whom were accessing services as the recipients of policy. Findings from this thesis explore how young people use risk escalation as a way of managing delays to treatment and how practitioners identify particular difficulties for young people transitioning in services when they are due to ‘step up’ into more acute services, or ‘step down’ to a less intensive service. The thesis explores the implications and unintended consequences for young people of policy including processes of ‘cost-shunting’ and ‘resource envy’ at local and national levels. Finally, the thesis offers some learning for systems working to support 16-25 year olds through demonstrating the importance of the dual role of ‘curing’ and ‘caring’ in mental health services.

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Frerichs, Gudrun. "Balancing recognition and disrespect: recovery as the process of identity formation: a New Zealand study of how services shape recovery from sexual abuse." AUT University, 2007. http://hdl.handle.net/10292/344.

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This study explored how the recovery of victims of sexual abuse is shaped by services available. Using the philosophical underpinnings of critical theory within the framework of Honneth's recognition theory this study provides an understanding of participants' experiences and views of recovery from sexual abuse. The study was conducted with ten adult survivors of sexual abuse using semi-structured individual interviews and two focus groups with eight service providers. The analysis identified that the recovery from sexual abuse is the development of a positive sense of identity reflected by participants' self-confidence, self-respect, and self-esteem. In this study this is described as the process of identity formation. Services shaped recovery from sexual abuse by providing experiences of recognition and disrespect. Recognition was given in the form of emotional support and care, cognitive respect, and social esteem that led to an improvement of participants' functioning. Disrespect was perceived by participants as they struggled with the invisibility of sexual abuse, with inequality, and with the lack of understanding, through which their overall functioning deteriorated. Recovery emerged as a dynamic process that, most of all, required from services that they provide experiences of recognition and from survivors that they accurately perceive that recognition was given to them. For recovery to occur, participants needed to balance experiences of recognition and disrespect, a process in which they needed to surrender the longing for the entirely good and benign caregiver and accept that both 'good' and 'bad' qualities reside in each caregiver, agency, therapist, or generally the 'other'. This balancing resulted in the development of self-confidence, self-respect, and self-esteem. Recovery was experienced by participants when they were able to resist disrespect and either engaged in fighting for their rights or removing themselves from situations in which their rights could be violated. Only by having a practical experience of being able to protect their physical and psychological integrity did participants become aware that they had recovered from the legacies of sexual abuse and could proceed with their lives without professional assistance.

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Boshoff, Jacobie. "Towards facilitating change in occupational therapy managers' perceptions of early intervention service delivery in South Australia." Pretoria : [s.n.], 2002. http://upetd.up.ac.za/thesis/available/etd-07082008-161801.

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Kirigia, Doris Gatwiri Public Health &amp Community Medicine Faculty of Medicine UNSW. "Beyond needs-based health funding: resource allocation and equity at the state and area health service levels in New South Wales - Australia." Awarded By:University of New South Wales. Public Health & Community Medicine, 2009. http://handle.unsw.edu.au/1959.4/44733.

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Addressing inequities in health both within and between countries has attracted considerable global attention in recent years. In theory, equity remains one of the key policy objectives of health systems and underpins the allocation of health sector resources in many countries. In practice, however, current evidence demonstrates that only limited progress has been made in terms of bridging the health inequity gap and improving the health of the least advantaged. The persistence of inequities in health and health outcomes raises concerns about how governments and health authorities distribute limited health resources to improve the health of the poor and most vulnerable and thereby promote equity. This thesis is about equity and allocation of financial resources in the health system of New South Wales, one of the eight states of Australia. It investigated the extent to which there has been a movement towards equity in resource allocation to Area Health Services under the NSW Health Resource Distribution Formula and whether this has been reflected in equitable resource allocation within Area Health Services. It considered only resources allocated through the NSW Department of Health. The study employed a combination of qualitative and quantitative methods to gather and analyse data. The qualitative component analysed data gathered through semistructured interviews with policy makers, health executives, managers, and other stakeholders to establish the resource allocation processes and the factors upon which the allocation decisions were based. The quantitative component analysed health expenditure and health needs data to assess the extent to which allocation of resources from the State to Area Health Service levels has been equitable in terms of reflecting the level of health needs. Two indices were constructed and used as proxies for health needs. Principal component analysis was used in the construction of one of the indices, using demographic, socioeconomic and health-related data. The other index was developed using a combination of premature mortality and morbidity data. The quantitative study spans the two decades 1989/90 to 2006/07, with a more detailed analysis of material for the years 2003/04 to 2006/07. The findings of the study show a considerable degree of inequity in resource allocation with several Area Health Services (AHSs) receiving less than a fair share of funding for the years analysed, although some movements towards equity were evident. This contradicts the general impression that the introduction of the resource distribution formula in NSW has significantly improved equity in resource allocation. In general, funding allocation at the State level correlated significantly with population size but not with health needs of the eight AHSs in NSW. Similarly, within the AHSs, allocation of funds was based on programs and services and not on health needs. Key issues that emerged from the qualitative data as affecting the equity with which health funds are allocated in the NSW health system include limited use of the resource distribution formula at the state level, lack of an effective resource allocation tool to guide the distribution of funds within AHSs, and insufficient emphasis on equity at the AHS level. It is crucial that these and several other issues identifies in the study are addressed if current inequities in funding and in health outcomes generally are to be effectively reduced.

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Elders, Vera. "Child and adolescent mental health service provision : from group treatments for emerging personality disorders to clinician perspectives on implementing national referral criteria." Thesis, University of Edinburgh, 2017. http://hdl.handle.net/1842/22880.

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Background: During an age of fiscal constraint and increasing pressure to provide timely access to effective, efficient and evidence based care, there is an increased need for research to develop empirically based prevention and intervention strategies for complex psychological difficulties which often present during childhood and adolescence. Child and Adolescent Mental Health Services (CAMHS) are under significant pressure to deliver timely access to services, with demand frequently outstripping capacity to deliver. These challenges have highlighted the need for services to ensure that planning supports continued improvement in quality and delivers the best possible outcomes for service users. Systematic Review: A systematic review of the literature on the efficacy of group based interventions for adolescents with features or a diagnosis of Borderline Personality Disorder (BPD) was conducted. Seven articles met the inclusion criteria and underwent detailed quality analysis. All included studies reported a significant improvement in psychopathology and symptoms of distress as well as an improvement in quality of life for both group based interventions and treatment as usual. Overall, the results hold promise for current work with adolescents with BPD and highlight the importance for future research in this developing area. However, more rigorous research is required to identify the active ingredients of treatments for BPD in adolescents with a view to developing standardised treatment protocols. Empirical Study: A Delphi study was conducted to explore perceptions on the relevance, practicalities, importance and feasibility of implementing nationally agreed CAMHS referral criteria from the perspective of clinicians working in CAMHS in the North of Scotland. In addition, the study aimed to explore and gain consensus on possible factors which support clinicians working in specialist services. A three round electronic Delphi survey, an iterative structured process used to gather information and gain group consensus, was completed by twenty-eight clinicians working in CAMHS. Eight open ended questions in Round 1, were analysed using content analyses resulting in ninety-eight statements to be rated by the same group of clinicians in Round 2 and fifteen statements in Round 3. Of the ninety-eight statements, eighty-four reached consensus. Results indicate that the guidelines are viewed by many clinicians as both acceptable and important, however, implementation of the guidelines can present services with significant challenges and have highlighted the importance of services having the correct infrastructure before it is possible to implement the referral criteria in a consistent and meaningful way.

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Hanna, Elizabeth Gayle (Liz), and lizhanna@netc net au. "Environmental health and primary health care: towards a new workforce model." La Trobe University. School of Public Health, 2005. http://www.lib.latrobe.edu.au./thesis/public/adt-LTU20061110.152550.

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Public health was once synonymous with environmental health. However, as living conditions improved the two fields diverged. Environmental factors are again re-emerging as hazards human health. Increasing global reliance on agricultural and veterinary chemicals (AgVets) over recent decades has is now a serious public health concern. Evidence of their toxicity has prompted international efforts to minimize, monitor and manage exposure risks. Direct involvement of the primary health care workforce is seen as critical to this process, yet little data exists on the health burden on Australian rural communities imposed by these chemicals. The study presented here attempts to explore the impact of these chemicals on two rural communities in Victoria, and ascertain the how the existing primary heath care system responds to AgVet exposure issues. Health determinants are complex, and inter-related, and the client �provider interface is not an entity acting in isolation from other frameworks. The provider-client service relationship has evolved against a background of legislation and provider training. Many external factors also impinge, such as the structure and focus of the health sector, and Australia�s systematic approach to environmental and chemical management. Examination of this underlying infrastructure in Australia provided the background against which the issue of exposure to agricultural and veterinary chemicals was explored. A brief summary of international developments in this area served to provide insight as to what interventions may be introduced to address the issue of chemical exposure. A CATI (Computer Assisted Telephone Interview) survey of 1050 households sought the perspectives from two Victorian agricultural communities to gather self-reported AgVet exposure patterns and health data, and whether respondents perceived their health problems were linked to exposure. Respondents were also asked to comment on the primary health care service experiences from local providers, and which services they preferred to seek for health advice. Perspectives were then sought from all primary health care providers servicing these communities. Information was sought on their level of expertise in diagnosing, and managing exposure related illness, via face-to-face interviews, focus groups and paper surveys. The study revealed rural communities have a long history of hazardous exposure to toxic AgVets. Awareness of toxicity risks is growing, yet further scope exists to improve safe handling of chemicals. High levels of illnesses known be associated with AgVet exposure exist among rural populations. Many believe their own ill-health is linked to exposure, and express strong dissatisfaction with the apparent lack of environmental health expertise especially among their GPs. Health providers demonstrated limited understanding of the health impacts of AgVet exposure. The lack of environmental health expertise among the existing primary health care workforce means that health conditions associated with exposure to AgVets are not being identified, and the absence of health intelligence hampers health planning. In Australia, the health, environment and primary industries sectors function in effect, as distinct silos, with little cross-fertilisation. The United States has combined its agricultural chemical legislative authority to develop a focus on human health, establish direct links, and biomonitoring programs to protect human heath. The U.S. has also developed environmental health expertise at the primary health care level to address community needs as they arise. Strategies are required in Australia to connect the environment, chemical management and health portfolios, with respect to the emerging environmental issues of chemical exposure. There is a need also in Australia to inject environmental health capacity into the primary health care practice.

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Efstathiou, Nikolaos. "Cancer care services in Greece : a Delphi approach to investigate the views of healthcare providers and users." Thesis, University of South Wales, 2004. https://pure.southwales.ac.uk/en/studentthesis/cancer-care-services-in-greece(872e4840-cd91-44ea-a455-4a89b1392bac).html.

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Cancer is emerging as a major problem globally and effective cancer care services are needed to lessen its burden on the community. In Greece, oncology health service provision is not located efficiently, resulting in only few patients receiving high quality care. Furthermore, shortages of health professionals and underdeveloped services such as primary care, home care and palliative care in the Greek NHS have aggravated the problem. The limited resources for healthcare have led to the absence of a national cancer registry, thus the extent of cancer incidence cannot be evaluated effectively. The dissatisfaction of the population regarding the Greek NHS is well established, despite the numerous reforms proposed by consecutive Greek governments. It remains that limited research exists in the area of oncology, especially on cancer services and cancer care. The aim of this study was to identify the key areas of cancer care and services that needed to be developed or improved in Greece and their prioritisation within the Greek healthcare system. Once identified, these areas of improvement could be used in a policy making context for the provision of effective services to cancer patients and might provide areas for further research A new Delphi technique (Q-Delphi) was introduced as an extension of the classical Delphi and implemented in two settings to collect data from a sample of 30 healthcare providers and 30 healthcare users. This was to reduce the potential subjectivity that may be introduced by the researcher in generating themes as an essential part of a successful Delphi outcome. The Q-Delphi of healthcare providers consisted of three rounds while that of the healthcare users was based on two rounds. The response rates for all rounds in both Q-Delphi studies were over 77%. The priorities for healthcare providers were focused on staff shortages, working conditions, pain management, home care, day units and communication. Healthcare users' highest priorities included the provision of and research on effective treatment, lessening the financial costs involved and the organisation of cancer services. Despite the separate Delphi studies, there were areas that both healthcare providers and users identified and prioritised. However, for the areas that both panels shared, there was a significant difference between their prioritisation. The World Health Organisation (WHO) suggestions for controlling cancer were used to triangulate, explain and discuss the results from this study (WHO 2002). The areas identified by healthcare providers and users were within those recommended by WHO. Based on the priorities provided by the participants and the suggestions by WHO, the establishment of a national cancer registry, the employment of nurses in order to develop primary care, home care, day care and palliative care services, education in communication skills and redistribution of the bio-medical technology are recommended in order to reduce the burden of cancer hi Greece. More research is needed to validate the actual level of cancer services provided in Greece. In addition, Q-Delphi is suggested as a valid and objective research method. For the benefit of Greek researchers, copies of documents used in conducting the research are also presented in Greek (Appendices 3 to 13 and 15).

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Ashiq, Mehmoona. "Exploring the mental health help-seeking experiences of British South Asian women and using these findings in the development of an intervention." Thesis, University of Wolverhampton, 2017. http://hdl.handle.net/2436/621166.

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Research has shown that a high number of South Asian people suffer with mental health problems and that South Asian women specifically, are at high risk of attempting self -harm or suicide. However, there seems to be a low uptake of the mainstream services offered by the South Asian community as a whole, compared to their white counterparts. Furthermore, the existing literature in this area is scarce and focuses on identifying barriers that South Asian women face in accessing help. This mixed methods study explored the mental health help seeking experiences of British born South Asian women. For the first part of the study, six (N=six) women who had successfully accessed therapy were interviewed and the qualitative data was analysed using Braun and Clarke’s (2006) framework for thematic analysis. The main superordinate themes identified included: therapy as a positive experience, perseverance and persistence, need to know basis, fears about being judged, the need for more publicising and awareness, recovery as an ongoing process, medical professionals needing to be more proactive, developing autonomy and putting your own needs first, developing understanding and the importance of the first step. Various subordinate themes were identified for some of these main superordinate themes. The second part of this study involved delivering a psycho educational workshop (which was partly based on the qualitative data generated in the first part of the study) to a group of South Asian women (N=25). Their attitude towards help seeking was measured before, immediately after and four weeks after the workshop using Fischer and Farina’s (1995) Attitudes toward Seeking Professional Psychological Help Scale. An ANOVA Test indicated a statistically significant difference in attitudes to help seeking before, immediately after and four weeks after the workshop. This study helped to get a better understanding of the experiences of a marginalised group and demonstrated how such information can be used to develop new and innovative interventions that can be used with a client group that appear to have low levels of engagement with and referral to mental health services.

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Lee, John. "Purchasing, providing and participating in mental health services." Thesis, University of Bedfordshire, 1999. http://hdl.handle.net/10547/336986.

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This thesis examines the implications of the changes introduced by the NHS and Community Care Act 1990 for mental health services. It focuses on two main issues. Firstly, the impact on mental health services of the 'market' system of purchasers and providers introduced by the 1990 Act. Second.ly, the extent to which the 1990 changes had led to any increase in user participation and involvement in the planning and delivery of psychiatric services. Analysis of the existing theoretical literature found that there had been little research which focused on the specific implications of health care 'markets' for mental health services. In addition, much of the work on the development of psychiatry had not focused on the role of the local context in influencing the nature of mental health service provision. In this thesis these issues are explored through a case study of the mental health services of one English county. Semistructured, qualitative interviews were und.ertaken with managers, professionals and individuals in purchaser, provider and voluntary sector organisations. People using community mental health services in the county were also interviewed. This contrasts with many previous studies which have tended to concentrate exclusively on users of in-patient services. The study found that local circumstances played a significant role in the relationships between those purchasing, providing and participating in mental health services. The imminent closure of a large Victorian psychiatric hospital and the uncertainty about which services would replace it had been a source of tension between the newly formed purchaser and provider organisations in the county under study. The lack of any strong existing groups in the local area representing users of mental health services was also significant. It meant that increased user participation in the county after the 1990 Act was reliant on initiatives by managers and professionals rather than organised pressure from user groups and users themselves. The variety of different local mental health agencies purchasing and providing mental health services in the county called for a degree of cooperation between organisations which conflicted with the competition encouraged by the 'market' system introduced by the 1990 Act. The focus, first, on psychiatric services in the examination of 'markets' and, second, the importance of the local context in mental health service development provides the basis for the study's contribution to theoretical and policy debates both about the 1990 Act and psychiatric services in general.

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Harris, Val. "How not to win friends : a study of participation and community work practice : an examination of the relationships between the local state, community workers, service provision and consumers." Thesis, Loughborough University, 1992. https://dspace.lboro.ac.uk/2134/32530.

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This research examines the concept of participation and its application to the relationship between individuals and the state. It approaches the subject from two angles; firstly by considering the role of community work and community workers employed by the local state, and secondly by investigating the relationships that developed between community based groups and departments of the local state. The research was undertaken within Derbyshire and focuses on its Social Service Department, as the main employer of community workers within the County and because of this Department's relationships with the particular community groups studied.

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Rodriguez-Acosta, Cristina A. "The Impact of Decentralization and New Intergovernmental Relations on Public Service Delivery: A Comparative Analysis of Colombia and Paraguay." FIU Digital Commons, 2016. http://digitalcommons.fiu.edu/etd/2470.

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The purpose of this research is to examine the factors that have influenced political decentralization in Paraguay and Colombia and how the new intergovernmental relations that result in political, fiscal and policy decentralization impact local governments and their capacity to deliver public services. The research, building on institutional theory, places particular emphasis on trying to explain and understand how intergovernmental relations shape the decentralization—and effectiveness—of public service delivery to local and regional governments, particularly in the areas of health and education. The research method is principally a path-dependent within-cases analysis. The analysis traces how the processes of decentralization evolved from 1990 to 2010. Special attention is given to critical junctures, or special political or social circumstances, that have significantly changed the process of decentralization. Data was collected mainly through reviews of documents, journals and newspapers, and most significantly through elite interviews “tailored to the purposes of the study” (Aberbach & Rockman, 2002). Leaders of political parties, unions, non-governmental-organizations and civic movements were interviewed in both countries. The research shows that political parties play a very important role, not only in the design and implementation of decentralization of public service delivery, but also in sustaining and furthering the process. The analysis is based on the assumption that increased decentralization of health and education to local and regional levels should positively impact basic health and education indicators. If decentralization, as argued, helps governments to be more responsive to local needs, and if more health and education programs are decentralized to the local and regional level in response to the demands of many communities, it is predicted that health and education indicators would improve, as people would have easier access to these services. Analysis of health and education indicators in the form of infant mortality rates (deaths of children under one year old, live births) and school enrollment show mixed results for both Colombia and Paraguay.

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Connor, Andrew. "The use of carbon footprinting studies to determine the greenhouse gas emissions associated with the provision of aspects of renal healthcare within the National Health Service." Thesis, University of Warwick, 2011. http://wrap.warwick.ac.uk/46923/.

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Climate change presents a major threat to global health and will further exacerbate the health inequalities that exist internationally. However, the provision of healthcare results in considerable greenhouse gas (GHG) emissions and is therefore contributing to climate change itself. Meanwhile, the integration of strategies to address climate change into global health efforts will realise health co-benefits. Meeting the challenging carbon reduction targets set within the NHS will require an improved understanding of the GHG emissions association with different forms of healthcare. This thesis explores the environmental impact of the provision of renal medicine services within the United Kingdom, placing a particular emphasis upon GHG emissions. The approach required, and the opportunities that exist, to reduce the environmental impact of renal medicine services are first explored through a review of the existing literature and a survey of the current practices of renal services in England, Scotland and Wales. A study, adhering to the principles of PAS2050, of the GHG emissions attributable to an individual renal service is then reported. This is the first assessment of the carbon footprint of an individual specialty service to include both direct and indirect GHG emissions. Consideration is given to how the results might inform carbon reduction strategies. Indicative carbon burdens for outpatient appointments and inpatient admissions are derived in order to facilitate future modelling of the emissions attributable to different clinical pathways of care. A second study, in which the GHG emissions attributable to different forms of an individual treatment (haemodialysis) are determined, is then presented. Finally, four case studies of good environmental practice within renal medicine, identified from the earlier literature search and survey, are presented in the context of the results of these studies.

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Wright, David R. "Accident experience of Commonwealth Government employees in Western Australia : 1 June 1993 to 2 December 1995." Thesis, Edith Cowan University, Research Online, Perth, Western Australia, 1998. https://ro.ecu.edu.au/theses/1444.

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This quantitative study documents, analyses and discusses the accident experience of Commonwealth employees in Western Australia from 1 July 1993 to 2 December 1995 as recorded on 1663 accident report forms. The research addresses the problem of lack of knowledge of accidents in the Commonwealth sector of the Western Australian work force. Its purpose is to identify possible areas of health and safety improvement and highlight where accident frequency may be reduced. Risk management is adopted as a conceptual framework to explore categories of accident related data, including month of year, time of day, day of the week of accidents, number of years of job experience, age and gender of the worker, accident frequency and severity. Where applicable accident related data was subjected to Chi-square statistical tests. Important findings, amongst others, include the identification of the month of August as having a higher frequency of accidents, inexperienced Commonwealth workers incurring 80.5% of accidents, and 64% of accidents involving men. Such findings are of importance to the Commonwealth so that prevention strategies targeted at these areas can be developed. Additional research utilising national data is recommended.

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McConigley, Ruth. "Providing education and support for rural palliative care nurses in Western Australia: An intervention study." Thesis, Edith Cowan University, Research Online, Perth, Western Australia, 2004. https://ro.ecu.edu.au/theses/1655.

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Rural palliative care nurses (RPCNs) in Western Australia (WA) are a small population, who have embraced the specialist palliative care role since the first palliative care service in rural WA began in 1990. However, there are some challenges involved with being a specialist nurse in a generalist health care setting. fu particular, there is a suggestion in the literature that RPCNs may be professionally isolated, may be prone to burnout, and may therefore experience decreased job satisfaction and may consider leaving the palliative care field.

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Tilbrook, Emily. "Male victims of intimate partner abuse: Experiences of disclosure and help-seeking." Thesis, Edith Cowan University, Research Online, Perth, Western Australia, 2015. https://ro.ecu.edu.au/theses/1599.

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Intimate partner abuse is a significant social problem that impacts on the mental health of primary and secondary victims. Despite empirical evidence that there are male victims and female offenders of intimate partner abuse, Australian researchers focus almost exclusively on the needs of female victims and male offenders. The overall aim of this study was to explore the experiences of male victims of intimate partner abuse with reference to the nature of the abuse they report, its impact on them, their support needs and help-seeking behaviour. During Stage One qualitative data were collected from 15 male victims of intimate partner abuse, seven significant others (close family and friends) of male victims, and eight service providers who have experience working with male victims. These data were collected and analysed using a phenomenological approach. The interview data revealed that both male victims and significant others experience negative impacts from intimate partner abuse and yet victims reported many barriers to seeking help and disclosing their abuse experiences , and, those wanting help, reported a lack of appropriate services. A second study was undertaken to examine these findings and during Stage Two, 198 service providers completed a questionnaire, containing both quantitative and qualitative questions, based on the findings of Stage One. The data collected supported and extended the findings of Stage One, in particular the concern that there is a lack of services available to victims. During Stage Three this concern was further explored by examining the internet and telephone services available to victims of intimate abuse in Australia. Quantitative data were collected to ascertain the quantity and nature of the current intimate partner abuse services on offer in Australia and the advertised willingness and readiness of these services to provide services to male victims. The findings highlighted that there are fewer services and types of service available to male victims in Australia than are available to female victims and that those available, to male victims, may not be useful. This research highlights male victims’ need, yet reluctance, to seek help for the impact of intimate partner abuse. The findings also indicate that men’s needs could be better met if there were more services available to male victims and a more empathetic recognition of their abuse experience

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Cheng, Qinglu. "Cost-effectiveness of guideline-based care for venous leg ulcers in Australia." Thesis, Queensland University of Technology, 2019. https://eprints.qut.edu.au/134462/1/Qinglu_Cheng_Thesis.pdf.

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This thesis investigated the cost-effectiveness of guideline-based care to manage patients with venous leg ulcers in the Australian setting. It showed that both the healthcare system and patients affected by venous leg ulcers would benefit from implementing and funding guideline-based care. This research provided important evidence to policy makers on the most efficient use of scarce health resources to manage venous leg ulcers. It is expected that these results will support changes to the reimbursement structure to increase access to guideline-based care for venous leg ulcers in Australia.

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Theiss, Diana L. "Promoting Educational Well-Being for Foster Care Youth in Lucas County, Ohio: Exploring the Impact of Race, Age, and Service Provision on the Development of Human Capital." The Ohio State University, 2010. http://rave.ohiolink.edu/etdc/view?acc_num=osu1268077502.

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Mannan, Haider Rashid. "Development and use of a Monte Carlo-Markov cycle tree model for coronary heart disease incidence-mortality and health service usage with explicit recognition of coronary artery revascularization procedures (CARPs)." University of Western Australia. School of Population Health, 2008. http://theses.library.uwa.edu.au/adt-WU2008.0101.

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[Truncated abstract] The main objective of this study was to develop and validate a demographic/epidemiologic Markov model for population modelling/forecasting of CARPs as well as CHD deaths and incidence in Western Australia using population, linked hospital morbidity and mortality data for WA over the period 1980 to 2000. A key feature of the model was the ability to count events as individuals moved from one state to another and an important aspect of model development and implementation was the method for estimation of model transition probabilities from available population data. The model was validated through comparison of model predictions with actual event numbers and through demonstration of its use in producing forecasts under standard extrapolation methods for transition probabilities as well as improving the forecasts by taking into account various possible changes to the management of CHD via surgical treatment changes. The final major objective was to demonstrate the use of model for performing sensitivity analysis of some scenarios. In particular, to explore the possible impact on future numbers of CARPs due to improvements in surgical procedures, particularly the introduction of drug eluting stents, and to explore the possible impact of change in trend of CHD incidence as might be caused by the obesity epidemic. ... When the effectiveness of PCI due to introduction of DES was increased by reducing Pr(CABG given PCI) and Pr(a repeat PCI), there was a small decline in the requirements for PCIs and the effect seemed to have a lag. Finally, in addition to these changes when other changes were incorporated which captured that a PCI was used more than a CABG due to a change in health policy after the introduction of DES, there was a small increase in the requirements for PCIs with a lag in the effect. Four incidence scenarios were developed for assessing the effect of change in secular trends of CHD incidence as might be caused by the obesity epidemic in such a way that they gradually represented an increasing effect of obesity epidemic (assuming that other risk factors changed favourably) on CHD incidence. The strategy adopted for developing the scenarios was that based on past trends the most dominant component of CHD incidence was first gradually altered and finally the remaining components were altered. iv The results showed that if the most dominant component of CHD incidence, eg, Pr(CHD - no history of CHD) levelled off and the trends in all other transition probabilities continued into future, then the projected numbers of CABGs and PCIs for 2001-2005 were insensitive to these changes. Even increasing this probability by as much as 20 percent did not alter the results much. These results implied that the short-term effect on projected numbers of CARPs caused by an increase in the most dominant component of CHD incidence, possibly due to an ?obesity epidemic, is small. In the final incidence scenario, two of the remaining CHD incidence components-Pr(CABG - no history of CHD) and Pr(CHD death - no CHD and no history of CHD) were projected to level off over 2001-2005 because these probabilities were declining over the baseline period of 1998-2000. The projected numbers of CABGs were more sensitive (compared to the previous scenarios) to these changes but PCIs were not.

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Dickey, Nathaniel. "More than "Modern Day Slavery": Stakeholder Perspectives and Policy on Human Trafficking in Florida." Scholar Commons, 2011. http://scholarcommons.usf.edu/etd/3072.

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In recent years, Florida has acquired a reputation as fertile ground for human trafficking. On the heels of state and federal anti-human trafficking legislation, a host of organizations have risen to provide a range of services. In this thesis, I discuss findings from 26 interviews conducted with law enforcement, service providers, legal representatives and trafficked persons to contextualize the variability in the way anti-trafficking work is conceptualized by stakeholders across the state. Additionally, I explore how conflicting organizational policies on the local, state, and federal levels impact stakeholder collaboration and complicate trafficked persons' attempts to navigate already complex processes of social/health services and documentation. Lastly, I provide policy recommendations that attempt to address the major issues associated with anti-trafficking work identified through the analysis of participant interviews.

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Dissertations / Theses on the topic 'Health service provision (Australia)'

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