Dissertations / Theses: 'Health service provision'

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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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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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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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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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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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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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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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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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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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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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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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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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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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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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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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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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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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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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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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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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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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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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Al-Hosan, Ibraheem. "Patients' views on the service quality of primary health care services : a comparative study of PHC services provision by the security forces and general public sectors in Riyadh City, Kingdom of Saudi Arabia." Thesis, University of Bristol, 2005. http://hdl.handle.net/1983/dbcd28e9-9e27-4579-88b5-9e4e11b3d8b5.

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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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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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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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Taylor, Anne D. "How people affected with laryngeal cancer source and use different types of information over time : a longitudinal qualitative study." Thesis, University of Stirling, 2011. http://hdl.handle.net/1893/3701.

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Due to changes in UK and Scottish policy and NHS directives, there have been many changes and improvements in the way information is provided to patients affected by cancer and their families over the last decade. The information provided should be accurate, detailed and tailored to the individual’s needs across the whole of their cancer trajectory. People affected by laryngeal cancer could be classed as a “Cinderella” group as there is a lack of research with this group of patients and their families, in comparison to other types of cancer, even though the impact of treatment can have a profound and debilitating effect on the individual and their family’s quality of life. How this group of patients and their families use and source information to help them make sense of their experiences across their trajectory is unknown, therefore this study explored the role of information based on the experiences of people affected by laryngeal cancer across their cancer trajectory. The study adopted an interpretive prospective longitudinal approach, using two in-depth qualitative interviews with twenty patients and eighteen carers from across the main treatment pathways associated with this type of cancer. The data were analysed using Framework Analysis and influenced by Dingwall’s Illness Action Model. Four broad thematic headings were developed to explain the role of information: “Search for Normality”, “Illusion of Certainty”, “Reality of Uncertainty” and “Culture of Caring”. Relationships were identified between these headings at four key stages across the cancer trajectory. The ii broad theme “Search for Normality” overarched the whole of the cancer trajectory explaining how information was sourced and used to help this group understand their experience of symptoms. The main findings from the study show that two broad categories of information are used: information from health professionals and experiential information from one’s own and others’ experiential knowledge of health and illness. Both categories of information are sourced and used in different ways at different stages over the course of the trajectory and become inextricably linked over time. The study shows that information is not an entity that can be studied on its own but needs to be studied and explained in the ways it is situated, used and experienced within the context of the complex needs and experiences of this group of patients and their families. This study is the first longitudinal study to provide an explanation of the role of information with people affected by laryngeal cancer across their cancer trajectory. The findings show how the different types of information used from the various sources influence how people affected by laryngeal cancer perceive and understand their diagnosis, treatment and the outcome of treatment. The study findings suggest that health professionals need to situate information in the context of the individual’s understanding and prior knowledge of health and illness to ensure that it does not set unrealistic expectations, with a clear need for continuity and supportive care identified in the post-treatment and follow-up phases.

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Cordingley, Justine E. "Ecosystem service provision in dynamic heath landscapes." Thesis, Bournemouth University, 2012. http://eprints.bournemouth.ac.uk/20984/.

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Conservation policy and management is undergoing a step-change, moving from focusing conservation resources on individual sites such as protected areas, to include the wider landscape. Landscape-scale initiatives may focus on either managing the entire landscape or they may focus on managing particular sites but attempt to address landscape-scale patterns and processes, such as habitat fragmentation. Whilst there is a vast body of research investigating the impacts of habitat fragmentation on individual species, much less is known about the impacts of habitat fragmentation on ecological processes, for example woody succession. Woody succession is an ecological process which has particular implications for conservation management as it drives ecosystem dynamics which can alter the value of the habitat for species of conservation concern. At the same time there is a move to incorporate ecosystem service protection into conservation policy. Understanding the synergies and trade-offs that exist between biodiversity conservation and ecosystem service provision is therefore an important priority. Few studies have examined the influence of habitat fragmentation on woody succession and, in turn, the impact of woody succession on the value of the habitat for both biodiversity conservation and ecosystem service provision. In addition, there is still very little evidence suggesting to what extent areas managed for biodiversity conservation also provide ecosystem services. There is a need to understand how management approaches aimed at increasing the biodiversity value of conservation areas will impact ecosystem services, particularly at the level of the landscape. This thesis aimed to explore all these themes in the Dorset lowland heathlands, UK. The Dorset lowland heathlands are highly fragmented and a priority habitat for nature conservation because they are rare and threatened and support a characteristic flora and fauna. The main threat to this habitat is now woody succession. Without conservation management, the characteristic dwarf shrub heath undergoes succession and is replaced by scrub and woodland. The objectives of this thesis were to (1) assess the impact of fragmentation on the process of succession on lowland heathlands and quantify lowland heathland vegetation dynamics; (2) determine biodiversity and ecosystem service values of major cover types along a successional gradient on lowland heathlands and assess how trade-offs and synergies between biodiversity and ecosystem service provision vary along this gradient and (3) explore how alternative management approaches aimed at increasing the biodiversity value of lowland heathlands impact ecosystem service provision. Fragmentation was found to promote succession with smaller heaths undergoing succession faster than larger heaths. Trade-offs were found between biodiversity value and ecosystem service provision. Biodiversity value was highest in heath habitats and lowest in woodland. Carbon storage, aesthetic value and timber value were highest in woodland. However, recreation value was associated with heathland habitats and not woodland. Conservation management for biodiversity increased the biodiversity value of lowland heaths but not the provision of ecosystem services.

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Riebe, Jason D. "The provision of mental health services in schools." Menomonie, WI : University of Wisconsin--Stout, 2005. http://www.uwstout.edu/lib/thesis/2005/2005riebej.pdf.

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Al, Magrabi Katibah Saad Aldean. "Geographical aspects of health and use of primary health care services in Jeddah, Saudi Arabia." Thesis, University of Strathclyde, 2001. http://oleg.lib.strath.ac.uk:80/R/?func=dbin-jump-full&object_id=21426.

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This thesis examines the contribution that geographical analysis can make to the study of the variation in the patterns of human health and subsequently to the discussion on the type and level of use of the public health service in a rapidly developing country. The current study was conducted in Jeddah Governorate, Kingdom of Saudi Arabia during the period 1994 and 2000. One of the main aims was to examine the pattern of health services provided in Saudi Arabia and this aim was achieved by investigating the provision and use of the Public Healthcare services. An attempt was made to clarify the complex web of relations that existed between, on the one hand, the different socioeconomic and geographic factors and on the other, the distribution of common ailments together with the level of utilization of health services. Shortcomings in the nature of the official health statistics regarding socioeconomic conditions of the patients were remedied through the use of a questionnaire. A tot al of 1000 patients from the eight PHCCs were surveyed for their use of the public health service. Data was collected from the same patients on their socio-economic, education and habitation details. This sample was used to supplement the data collected from the official government health statistics. These two data sets permitted an evaluation of the occurrence of different ailments and the variations in geographic distribution among the eight selected PHCCs. Difficulties persisted in the availability of official 1992 census data until publication of census data became available in 1999. In contrast to the problems of the census data, the availability of accurate and up-to-date patient records compiled by Ministry of Health staff was of considerable benefit to this research project. Use was made of Geographic Information Systems software for the analysis of data collected at the level of the PHCC. This allowed visual identification of the spatial variation in the use of the different health services and also allowed the identification of gaps in healthcare provision. The study showed that a density of habitation index used as a prime indicator of socio-economic status could be used as an indicator of the occurrence level for a number of common diseases. A pattern of disease was observed that suggested that the number of visits to PHCCs was substantially higher in low socio-economic districts compared to medium and higher socio-economic districts. It can be shown that the most common ailment was Upper Respiratory Tract Infections followed by Dental and Gingival diseases. Persons aged between 15 and 44 years made most visits to PHCCs although children under 15 years made proportionately greater use of PHCC facilities. No difference could be found between Saudi and Non Saudi as regards the occurrence of the most common ailments and diseases. The lack of difference was probably due to the close integration of the two population groups and the sharing of the same local environment. This similarity occurred despite considerable differences in income levels and socio-economic status. The level of utilisation of health centers in the selected districts showed differences, being higher in those districts categorized as low socio-economic in the south of Jeddah when compared to higher socio-economic districts in the north of the city. It was evident that the difference in socio-economic factors had an impact on the occurrence of some frequently occurring diseases e.g. URI, Dental, Ophthalmic, musculoskeletal and skin diseases. Although not primarily concerned with private health care facilities, for completeness sake some information was collected on the use of private health care in conjunction with public health care facilities. The author was surprised to discover that greatest use of private facilities occurred among women and children patients from Al Nuzla al Yamaneyyah and Al Thaalebah, districts that were characterised by low socio-economic conditions. The use of traditional folk healing was also briefly studied as this form of treatment remains important for some patients. Results showed that there was no difference between the educational standards of patients and their use of traditional folk healers. Again, children and women constituted the majority (86.6%) of users of traditonal healing with Saudi users (18.9%) higher than non Saudi (11.4%). There remains the supposition that alternative medicine may be of far greater importance than the sparse official data suggests. The unquantified illegal immigrant population may be totally reliant on unofficially operating alternative medicine centres. The thesis concludes by recommending a number of improvements to the existing public health care system. Some changes in the policy and practice of PHCC services will inevitably require more financial resources. These include an extension of the opening times of PHCCs and an increase in the number of specialist facilities such as dental surgeries. Other changes may not require more finances. These include a strengthening of communication and co-operation between PHCCs and hospitals to improve the referral of patients. Expansion of the existing computer network connecting PHCCs with hospitals should be given high priority.

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Rahman, Shams-Ur. "Location-allocation modelling for primary health care provision in Bangladesh." Thesis, University of Exeter, 1991. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.280652.

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Rees, Lois. "The provision of disease prevention services from community pharmacies." Thesis, University College London (University of London), 1994. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.339279.

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Krankowski, Edward. "School Psychology Service Provisions Within a Public Health Model." Thesis, University of Oregon, 2013. http://hdl.handle.net/1794/12963.

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The purpose of this study was to explore specific activities school psychologists performed related to both testing and placing within a medical model and prevention within a public health model. Spurred by landmark legal mandates, school districts are moving toward preventative practice within a framework consistent with tenets of a public health model or Response to Intervention (RtI) framework. These activities are counter to traditional test-and-place activities performed by school psychologists associated with a medical model of service delivery. School psychologists assigned to 41 elementary schools in the northwest corner of Oregon completed a survey that included activities associated with testing-and-placing students typified by a medical model and those activities akin to a public health model. All schools participating in this study implemented Positive Behavioral Interventions and Supports (PBIS). PBIS is a widely implemented evidence-based practice in education that emphasizes prevention, and is a reflection of RtI or the public health model. Although PBIS was a common denominator across all schools, there were differences in overall implementation effectiveness as measured by the School-wide Evaluation Tool (SET). This study investigated the degree to which activities performed by school psychologists impacted PBIS implementation in their buildings. School psychologists estimated the frequency devoted to these activities. Frequency served as a proxy for priority and also defined the service models that guided their practices. In addition to this descriptive statistical analysis, inferential statistics were used to measure the correlation between the School Psychologist Survey, the SET-General Index scores, and the SET-Behavior Expectations Index scores. A multiple-regression analysis was also conducted to determine which variable (i.e., SET-General Index or SET-Behavior Expectations Index) was the best predictor of outcome data from the School Psychologist Survey. These data were also entered into scatterplots to provide interpretations of meaningful statistical significance for an in-depth analysis of the School Psychologist Survey, SET-General Index, and SET-Behavior Index scores. This study is important because it potentially provides school psychologists with specific preventative activities they can perform within a public health model of service delivery to make contributions for improving the overall school environment for students.

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Kabakian-Khasholian, Tamar. "Improving women's health postpartum : the impact of provision of written information." Thesis, London School of Hygiene and Tropical Medicine (University of London), 2002. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.269771.

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46

Wittchen, Hans-Ulrich, and Frank Jacobi. "Die Versorgungssituation psychischer Störungen in Deutschland." Saechsische Landesbibliothek- Staats- und Universitaetsbibliothek Dresden, 2013. http://nbn-resolving.de/urn:nbn:de:bsz:14-qucosa-105207.

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Nach Befunden des Bundes-Gesundheitssurveys 1998/99 (Zusatzsurvey „Psychische Störungen“) litten im Jahr der Erhebung 32% (=15,6 Millionen) der erwachsenen deutschen Bevölkerung im Alter von 18–65 unter einer oder mehreren psychischen Störungen. Jeder dritte Betroffene (36%) steht oder stand im Jahr vor der Erhebung wegen der psychischen Störung in Kontakt mit ambulanten oder stationären psychiatrisch/psychotherapeutischen Diensten oder seinem Hausarzt. Der Anteil von Betroffenen, die eine im weitesten Sinne adäquate Therapie nach modernen wissenschaftlichen Kriterien erhalten, kann konservativ auf ca.10% geschätzt werden. Die niedrige Versorgungsquote betrifft dabei nicht alle spezifischen Störungsgruppen in gleichem Ausmaß; niedrige Versorgungsraten ergaben sich insbesondere für somatoforme und Suchterkrankungen. Ferner ergaben sich zum Teil markante regionale Unterschiede (z.B. besonders schlechte Versorgungslage in Regionen, die weder über eine nahe Universität noch über psychotherapeutische Weiterbildungsinstitutionen verfügen).Ungeachtet unterschiedlich weiter oder enger Definitionen des Begriffs Behandlungsbedarf, zeigt sich eine gravierende Unterversorgung von Personen mit psychischen Erkrankungen. Quantitativ bedeutsame Hinweise auf eine Fehl- oder Überversorgung von Betroffenen lassen sich nicht aufzeigen
Data from the German Health Interview and Examination Survey, Mental Health Supplement (N=4181) reveal that 32% (15,6 million people) of the adult population between 18 and 65 years of age suffer from one or more mental disorders. Among those only 36% receive treatment which also varies in type, duration, and adequacy. The proportion of cases receiving “adequate evidence- based treatments” was estimated to be about 10%.Lowest treatment rates were found for somatoform disorders and substance abuses, highest for psychotic disorders, panic disorder, generalised anxiety disorder, and dysthymia. The data reveal substantial regional differences with regard to treatment rates (e.g. lower rates in regions without universities or institutions offering postgraduate mental health education).The paper concludes that, depending on the diagnosis, a considerable degree of unmet medical needs exist for the majority of people affected by mental disorders. No evidence was found for an excessive supply of health care for the patients suffering from mental disorders or for treatments without an existing clinical need

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Greenwood, Penelope Nan. "Marginalised groups and health services : provision, experiences and research issues." Thesis, Kingston University, 2010. http://eprints.kingston.ac.uk/20342/.

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This commentary is a reflective account of research published over the last eleven years. It highlights the themes underlying the publications and tracks the development of the author's research skills while simultaneously showing the impact of the publications on knowledge in the areas covered. Three themes from the research are highlighted. The first relates to the research participants in the publications who include detained and voluntary psychiatric patients, minority ethnic groups and carers. Members of these groups can all be described as marginalised or disadvantaged and are known to sometimes have poorer experiences of health and health services. Their experiences are the second theme. The commentary then highlights some issues in the research as the third theme, in particular the often unrecognised impact of the methods used and concepts employed on the research findings. Although some limitations of these are described, the commentary demonstrates the complexity of the concepts and issues and suggests that these should be acknowledged more widely. A possible way forward is by greater involvement of service users and altering the research perspectives. The next section discusses the impact of being a contract researcher during a period of greater recognition of the importance of listening to patients and their carers. This has had a bearing on both the research and the author's development as a researcher. The commentary then provides reflections on the individual publications submitted detailing the roles played by the author and recent research in the area. Some overarching ethical issues are also discussed. The ultimate aim of all the research presented here has been to improve the experiences of health service users and it is concluded that in each case it has contributed, even if only in a small way, to this aim whether to the academic literature or more directly to service improvement.

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Wooff, K. "A comparison of the work of community psychiatric nurses and mental health social workers in Salford." Thesis, University of Manchester, 1987. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.378797.

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Khoury, Dalia. "Considerations in the provision of mental health services toward Arabs." VCU Scholars Compass, 2016. http://scholarscompass.vcu.edu/etd/4110.

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Existing evidence suggests that disparities exist in the use of mental health services by Arabs in the U.S. While there are likely many factors that contribute, lack of cultural competence of mental health providers is one potentially important barrier for mental health service use among racial/ethnic minorities, including Arabs. The primary purpose of this study was to identify and examine factors related to the development and existence of cultural competence toward Arabs. Variables measuring demographics, professional characteristics, familiarity with Arabs, prior experience and knowledge of Arabs, and readiness for change were tested with a randomly selected sample of mental health providers in Northern Virginia. In order to assess baseline levels of cultural competence toward Arabs, as well as further define the potential relationships of these variables to cultural competence, a new measure of cultural competence toward Arabs [CC-A] was developed and initially validated through a focus group and pilot test. It was subsequently administered to a group of mental health providers in Northern Virginia to further assess the validity of the underlying constructs being tested and to explore relationships between this measure and other key factors. Factor analyses revealed that a unidimensional construct of cultural competence toward Arabs was being measured. Bivariate and multivariate analyses examined the way this measure related to these constructs. Regression analyses revealed that higher levels of cultural competence were significantly related to higher readiness for change, higher prior levels of knowledge toward Arabs, a greater degree of familiarity with Arabs, and utilizing books as a source of knowledge about Arabs. A model inclusive of these factors explained 19% of the variance in mean scores on the CC-A. Implications of these findings for research, clinical practice, and graduate training are discussed. These include consideration of alternative models for cultural competence, an assessment of additional methodologies to measure cultural competence, and the development and implementation of cultural competence interventions.

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Hundley, Vanora. "Determining success in the provision of maternity care." Thesis, University of Aberdeen, 2001. http://digitool.abdn.ac.uk/R?func=search-advanced-go&find_code1=WSN&request1=AAIU137217.

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This thesis explores the benefits and limitations of traditional evaluations of maternity care, looking specifically at one innovation in service provision, a midwife managed delivery unit. The research undertaken in this thesis can be described in terms of three developmental phases. In phase one, care in a midwife-managed delivery unit is compared with care in a consultant-led labour ward within the framework of a randomised controlled trial. 'Success' is measured in terms of both the clinical aspects of care and as viewed by the women who received this care. Care of women at low obstetric risk in a midwife-managed delivery unit is shown to result in less intervention, greater continuity of carer, more involvement in decision making and greater women's satisfaction with how care was managed. There were no differences in overall satisfaction and the limitations of satisfaction as an outcome measure are discussed. Phases two and three build on the work of the randomised controlled trial. In phase two, perinatal mortality and morbidity data are reviewed through an independent case review of the perinatal deaths and further analysis of the morbidity data. In phase three, the thesis utilises techniques from the discipline of health economics to go beyond the traditional measure of women's views, satisfaction. Willingness to pay and conjoint analysis are used to determine women's preferences, and the strength of these preferences, for different models of maternity service provision.

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Dissertations / Theses on the topic 'Health service provision'

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