Dissertations / Theses on the topic 'Health services and systems not elsewhere classified'

There is an on-going debate among health professionals, policy-makers and politicians, as to the optimal way of delivering sexual health services to young people. There is as yet, no consensus on their best patterns of organisation or configuration. This study uses qualitative and quantitative research methods, to explore both the views of young people accessing sexual health services, expressed through in-depth interview, and variations in client satisfaction with different characteristics of service delivery, expressed through completion of a questionnaire. The key research questions are:  How does young people’s satisfaction with sexual health services vary with the age-dedication of the service; that is, whether it serves young people only, or all ages?  How does young people’s satisfaction with sexual health services vary with the integration of the service; that is, whether family planning and genito-urinary services are offered separately, or together?  How does young people’s satisfaction with sexual health services vary with the location of the service; that is, in community or hospital based services? In the qualitative component, in-depth interviews were conducted with 25 young people recruited from a purposively selected sample of young people’s services. In the survey, a total sample of 1166 was achieved. Of these, 36% were attending an integrated contraceptive and STI service and 64% were attending a more traditional ‘separate’ service. 48% attended a service dedicated to young people and 52% an all-age service. 50% attended a hospital-based service and 50% a service located in the community. Of the total sample, 22% were male and 78% female. The analysis has been done not on a comparison of services in their entirety, but on a comparison of key features of their organisation, that is, whether they are provided separately as contraceptive and STI sessions or services, or whether these aspects of sexual health provision are integrated in sessions or services (integration); on whether they are run exclusively for young people or for all ages (dedication); and on whether they are located in the community or in a hospital setting (location). Recommendations are made for future service development and delivery and implications for policy are discussed.

The aims of this paper are to: 1)-Introduce current evaluation framework; 2)- Explore methods/tools used in E-Health evaluation; 3)- Identify research methods/tools used in E-Health evaluation; and 4)- Develop an evaluation plan for a systemic E-Health initiative.

Research into the use of information by health care professionals has generally been conducted in countries dominated by the biomedical model. In these contexts, illness is considered to have a scientifically identifiable physical cause, and treatment practices within the formal health care sector are prescribed and managed in accordance with this definition. Yet there are also contexts where other belief systems inform and guide the way that people think about their health. In comparison to the biomedical model, these contexts have contributed very little to our understanding of how health professionals develop their knowledge. This research investigates how primary health care workers (PHCWs) in one such context, Papua New Guinea (PNG), develop their knowledge about the health services they provide. In order to discover and understand the differing views of these PHCWs, 69 semi-structured interviews were conducted in three culturally and geographically diverse regions of PNG. In explaining the diagnostic and treatment practices they use, these participants provided insights into not only how PHCWs engage with information but also how it informs their professional practice. These data were analysed, interpreted and discussed using a framework consisting of four, primary but interconnecting aspects: the context in which information was provided, the interactions with the sources of information, the processes by which information was understood, and the outcomes realized as a result of the information being used. Findings indicated that the majority of participants in this study acknowledged, if not incorporated, information pertaining to biomedicine, Christianity and Indigenous belief systems into their diagnostic and treatment practices. Even when these belief systems clearly contradicted each other, PHCWs did not in general feel the need to make a conscious choice between them. From their comments it would appear that four factors contributed to this ability to incorporate diverse and often conflicting ideas into the way that patients were cared for. First, all of the belief systems were considered legitimate by at least one group of people connected to the community in which the PHCW worked. Second, although varying in degrees of availability and accessibility, members of these groups were able to disseminate information pertaining to the belief system they supported. Third, the PHCW had no particular affiliation with any one of these groups but instead regularly interacted with a range of different people. Lastly, the PHCW worked in situations where health practices were not generally well supervised by their employers and therefore they were relatively free to choose between various diagnostic and treatment practices. The qualitative interpretive approach adopted in this thesis contributes to the field of human information behavior by affirming that conflict is in the eye of the beholder. When a number of belief systems coexist and all are considered legitimate, information about them is freely available, and the recipients actions are neither constrained by their own dogma, nor imposed upon by others, individuals may quite comfortably embrace diverse beliefs. These findings may also contribute to a better understanding of health management practices in developing countries by suggesting that health professionals are not merely personifications of a biomedical model. Instead, the study demonstrates that multiple belief systems can be combined by PHCWs, and that in turn this benefits the formal health care sector through increased treatment options that are both appropriate and effective in such circumstances.

The dynamic nature and rapid evolution of Information and Communications Technology (ICT) in the last decade (which is also referred to as the digital revolution or industrial revolution 4.0) has given little time for organisations to evaluate the nature of the technological change to their business. This research project aims to identify if there is a disconnection between organisational strategic intent and ICT use, such as, analyze ICT adoption and use issues from various perspectives concerning digital evolution, strategic outcomes and long-term objectives of the organisation, and report findings. The study also aims to identify the alignment factors for technology use with strategic intent. In today's digital age, the healthcare industry has been undergoing a transformational change in patient care pathways and patient safety with the help of digital technologies. Digital technologies such as electronic medical records, mobile applications, telehealth, assisted diagnosis, and prevention have been changing the ways healthcare services are being delivered to patients. But little success has been achieved in implementing these transformations due to the complexity of ICT requirements in healthcare. This challenge in achieving successful digital transformation has given rise to a knowledge gap requiring further research. Until now, a review of the literature reveals few studies have been undertaken to understand connections and disconnections between strategic intent and technology use in healthcare. Therefore, this study aims to understand if there is a disconnect between organisational strategic intent and technology used in the digital age. The primary audience for this research is senior policy and decision-makers in healthcare and senior ICT staff. This research is designed to understand the technology use and its impact on organisational strategic intent from the perspective of clinical staff, non-clinical staff, and executive management. The multi-stage mixed-method design has been used in this study. The findings indicate that technology should be part of strategic intent, and technology adoption should flow from the edge inwards. The findings will enhance the delivery of digital transformation initiatives in healthcare and enable more successful digital transformations with lesser technology adoption, and use issues.

The purpose of this thesis is to analyse the attitude, intention and behaviour of Queensland nurses towards computerisation in their workplace using quantitative and qualitative survey methods. It also identifies possible mediators and moderators of this relationship using the Theory of Reasoned Action in a path model. Other moderating variables such as age group, previous computing experience, computing ability, computer usage, educational levels and gender were used in this study.

The Theory of Reasoned Action is used by Fishbein and Ajzen to predict volitional behaviour and to assist in understanding psychological determinants. One thousand questionnaires were distributed to registered nurses in Queensland and 330 (33%) valid responses were received. A qualitative telephone survey (n = 40) was also employed to validate the quantitative survey. The results of this study found that positive attitudes were found to influence the intention of nurses to use computers in the workplace.

Although normative beliefs and motivation to comply were found to have a direct influence on subjective norm, subjective norm was not found to be significantly associated with one's intention to perform the behaviour. However, a positive outcome evaluation and behavioural beliefs were found to be directly associated with one's behaviour which were mediated through positive attitudes. It was also demonstrated that all positive intentions produced positive behaviour (action of using computers at work).

The study demonstrated the positive effect of prior computing experiences before starting nursing and the effect of high computer usage frequency on one's intention. An inverse effect was demonstrated between nurses who had good experiences with computer and their intention to use computer. In addition, the study found that older, less educated female nurses demonstrated a higher intention to use computers in the workplace. The qualitative study also supported the quantitative study. The qualitative study provided the researcher with reasoning as to why nurses behave a certain way towards computerisation in the workplace. It was used as a reasoning tool to confirm some of the respondents' actions.

This research has its own limitations. It was conducted in late 1999 and computerisation has since then penetrated Australian hospitals to a greater extent than ever before. In addition, the survey tool could also be tested for its construct and criterion related validity. This would improve the sensitivity of the survey tool. Notwithstanding that, the results from this study would significantly benefit management in the identification of groups of nurses who are likely to resist the computerisation process in the workplace.

When a pregnancy-capable person is assaulted, abused, or killed, it is usually at the hands of a male partner or family member. Fatal and non-fatal injuries, chronic health conditions and risky behaviours are all outcomes of gender-based violence (GBV); furthermore, GBV can often lead to unplanned pregnancies. Abortion is, therefore, a predictable outcome for this population. Nurses and midwives are intrinsically involved in the care of pregnant people victimised by GBV. They could be instrumental in providing reproductive justice outcomes such as early intervention, support, and coordination of support services. However, limited research exists to explain how this occurs within abortion care. Effective GBV responses often require a multiagency approach; therefore, services across a range of Australian sectors such as health, women’s safety, and law enforcement could benefit from understanding how nurses and midwives provide abortion care to people victimised by GBV. To address this gap, I aimed to 1) explain the process through which Australian nurses and midwives provide abortion care to people victimised by GBV and 2) explore how the elements of the broader healthcare situation affect the provision of abortion care to people victimised by GBV. I approached the research with a third-wave feminist lens, designing a two-phased multiple methods study combining constructivist grounded theory and situational analysis—such an approach located research participants’ actions in the larger social and power contexts. To assist readers in understanding the scope of the research topic, I commenced the thesis with a scoping literature review of the role and scope of nurses and midwives in the provision of abortion care. The review demonstrates that abortion care is a common procedure performed across many healthcare settings and shows that nurses and midwives provide technical and psychosocial care within their roles. However, the review also highlights that the scope of practice of nurses and midwives within abortion care is probably unnecessarily restrictive. Notably (and foreshadowing the findings of this thesis study), it exposes a lack of person-centred models of abortion care. My research reveals that the Australian abortion arena is expansive and contains multiple sites of power and contested action, which contributed to the research participants’ belief that people seeking abortions in the context of GBV were mostly uncatered for. Participants described a workforce unprepared to provide abortion care generally, or a GBV safety-net more specifically. Pro-life colleagues were seen to centre conscientious objection over patient care, and the workplace environment placed clinicians’ and patients’ safety at risk. Consequently, participants underwent a process I labelled working with or against the system contingent on the degree to which the system was person-centred. When participants encountered barriers to person-centred abortion care, they bent or broke the law, local policy, and cultural norms to facilitate timely holistic care. Though many participants felt professionally compromised, their resolve to continue working against the system continued. They were aided by larger social groups – Smugglers, Navigators, Marie Stopes Australia, and the Family Safety Framework – which came together to resist systemic oppression in an attempt to achieve reproductive/social justice. I used the theoretical conceptualisation of resistance in health and healthcare to unify the findings of the thesis project. My thesis findings support a cultural shift and reorientation of health services to support reproductive justice. First and foremost, my findings support the involvement of nurses and midwives in the creation of healthcare policy, programming, and legislation. This includes their involvement in pro-choice hiring policies, design and facilitation of GBV and abortion care training, and the implementation and evaluation of comprehensive abortion care frameworks, that cater for diversity and offer trauma-informed and flexible care. Furthermore, expanding the scope of nurses and midwives to provide medical abortion, particularly in primary care, would address the current service gap, which compels these clinicians to undermine the current system. Many of these changes could be achieved if health services adopted the World Health Organisation’s technical and policy guidelines for abortion care. However, this will require amendments to regulatory structures, funding models and relaxation of prescribing and abortion procurement restrictions. My findings also highlight a dual loyalty issue between the Nursing and Midwifery Board of Australia’s (NMBA) requirement for clinicians to provide person-centred care and comply with legislation, regulations, policies, and guidelines. A key recommendation is that the NMBA reconsider their position where such complicity would lead to human/reproductive rights violations. This thesis has made a significant contribution to the body of knowledge concerning abortion care of marginalised people. Looking forward, the thesis findings and recommendations could be implemented at the practice level and beyond to improve reproductive justice outcomes for people in Australia.

Preterm birth is the leading cause of newborn mortality, with 15 million babies born premature worldwide every year. Children that do survive early delivery are more likely to develop cognitive abnormalities, motor deficits, heart disease, cerebral palsy, and more. While little is known about the pathophysiology of preterm birth, several pregnancy-related complications are related to preterm birth, namely cervical insufficiency and preeclampsia. In the former, premature cervical remodeling and softening can result in the shortening of the cervix, increasing a woman’s risk of preterm birth; this condition is called cervical insufficiency (CI), which is the inability of the cervix to remain closed as a result of weakened tissues. CI is currently measured by a one-dimensional sonographic cervical length, where < 25 mm indicates shortening. Preeclampsia is a disorder that can be explained through the Page kidney phenomenon: compression of the left renal vein (LRV) causes renal venous outflow obstruction, leading to elevated intrarenal pressure and hypertension. The supine pressor test (SPT) is a diagnostic tool for preeclampsia where a positive test is defined by an increase of 20 mmHg in diastolic blood pressure (BP) when shifting from the left lateral recumbent to the supine position. Due to the intense risk of morbidity and mortality for both the mother and the fetus, the need to monitor BP changes is critical. Currently, there is an unmet clinical need to characterize the hemodynamic and geometric properties of the female reproductive organs throughout gestation. Utilizing ultrasound imaging can increase our knowledge about the 3D anatomy and systemic changes during pregnancy, unravel risk factors, establish preventative methods, and standardize treatment plans. In this thesis research, we developed a murine model to 1) examine the pathophysiology of renal vein stenosis, and 2) investigate the effects of stenosis on various cervical dimensions. Renal vein stenosis was found to greatly impact blood flow velocities, as well as cervical width (p<0.05). LRV and cervical area and height also trend towards significance, and there is negative damage to the left kidney and placentae within the stenosed cohort. We also conducted a human study that showed reduced change in postural BP in patients with higher body mass index (BMI). Systolic and diastolic BP in the supine position was significantly greater than in the lateral position for all BMIs with a baseline increase in BP of approximately 9-14 mmHg. These findings suggest that therapeutic positioning and close monitoring of BP could mitigate the risk of developing related disorders in pregnancy.

Widespread use of prescription opioids has been a major public health concern since 1999. Many consequences are associated with the problem, such as opioid misuse, abuse, and drug overdose deaths. Opioids are not the only medications involved with drug overdose deaths. Due to stricter control of prescription opioids, those who misused opioids are associated with initiation of another illicit drug abuse. This results in increased drug overdose death involving heroin and semisynthetic/synthetic opioids. Another risk factor for increased overdose death is concurrent use of opioids with other central nervous system (CNS) depressants and some anticonvulsants. Concurrent use of opioids and benzodiazepine, z-drugs (zolpidem and zaleplon), gabapentin, and/or pregabalin is associated with increased risk of respiratory depression and drug overdose death. To combat problematic opioid use, many mitigation strategies were introduced. However, opioid-related problems remain.

Competency to practise has become an essential part of a health professional’s lifelong journey. It is defined in many ways to encompass the intellectual and experiential elements of training along with a person’s efforts to keep up-to-date. Many would describe competency as ‘fit for purpose’ to do the job, ensuring that the public are protected and given the professional service that meets their expectation. One of the conundrums of the regulators of pharmacy practice is how the competency of pharmacists can be measured and monitored to fulfil their statutory obligations to the public. Many agree that the best way of determining competency would be to observe people in their day-to-day practice. However, this would be a prohibitively costly exercise. This thesis originated from the question of how competency could be assessed in a form that would give regulators confidence and that was cost effective. Most assessment methods used are de facto methods of measurement. However, regulators need to have confidence that the assessments are able to accurately measure the standard of a person’s professional practice.

The objective of research is to develop a computer simulation modeltoprovide a means to effectively and efficiently reduce medication errors associated with points of distribution sitesby identifying and manipulating screeners with a high probability of generating errors.Points of distribution sites are used to rapidly distribute chemoprophylaxis to a large population in response to a pandemic event or a bioterrorism attack. Because of the nature of therapid response, points of distribution sites require the use of peer-trained helpers who volunteer their services.The implications are that peer-trained helperscould have a variety of experience or education levels. Thesefactors increase the risk of medical errors. Reducing medical errors is accomplished through changing the means in which healthcare providers are trained and focusing on a team approach to healthcare delivery. Computer simulations have been used in the past to identify sources of inefficiency and potential of error. Data for the model werecollected over the course of two semesters. Of the 349 data points collected from the first semester, only 137 data points were usable for the purposes of modelbuilding. When the experiment was conducted again for the second semester, similar results werefound. The control simulation was run 20 times with each screener generating errors with a probability of 0.101 following a Bernoulli distribution. The variable simulation was run 30 times with each screener generating the same probability of errors; however, the researcher identified the screeners generating the errors and immediately stopped them from processing additional agents once they reached five errors. An ANOVA was conducted on the percent errors generated from each simulation run. The results of the ANOVA showedsignificant difference between individuals within the groups. A simulation model wasbuilttoreflect the differences in medical error rates between screeners. By comparing the results of the simulation as the screeners are manipulated in the system, the model can be used to show how medical errors can be reduced in points of distribution sites

"Research highlights the increasing burden of physical inactivity and chronic disease ... The overall purpose of this research was to explore the utility and effectiveness of internet delivered physical activity behaviour change programs in primary and secondary prevention ... The second step was to examine predictors of website usage within a current publicly accessible physical activity website (10,000 Steps) aimed at primary prevention "--Abstract.

Background: Falls and fall-related injury among older people are a major public health burden. Exercise-based fall prevention programmes are effective in reducing falls in older community-dwelling people. However, this effectiveness is hampered by low participation and adherence. Digital technologies are a novel and potentially effective method for delivering tailored fall prevention exercise programmes to older people. Aims and objectives: This thesis aims to evaluate the effectiveness, acceptability and cost-effectiveness of technology-driven fall prevention programmes in older community-dwelling people. The following research questions were examined: Are eHealth-delivered exercise programmes effective at improving balance in people aged 65 years and older living in the community compared to a control? Is a home-based balance exercise programme delivered through a tablet-based technology acceptable to older people living in the community? Is an e-Health balance exercise programme a cost-effective way to reduce falls and injurious falls in community-living older people compared to usual care? Methods: A series of related studies were conducted to answer these questions, including: a systematic review with meta-analysis, a qualitative study, and a health economic evaluation. The systematic review and meta-analysis evaluated randomised controlled trials of eHealth-delivered exercise programmes for community-dwelling people aged 65 years and over, published in English. The primary outcomes were static and dynamic balance. Secondary outcomes included fall risk and fear of falling. The standardised mean differences (SMDs, Hedges’s g) were calculated with 95% confidence intervals from random effects meta-analyses. The qualitative study recruited 50 participants from StandingTall, a large randomised controlled trial which delivered a home-based fall prevention programme via a tablet-computer. Participants were selected using purposive sampling and to ensure maximum variability. Data was collected via one-on-one interviews by qualified research staff at one of three different time points (1 month, 6 months and 12 months) over 12 months. Interviews were transcribed verbatim, verified for accuracy and then analysed thematically. The economic evaluation was a within-trial evaluation of StandingTall. Five hundred and three people aged 70 years or over participated. Cost-effectiveness was measured as the incremental cost per fall, and per injurious fall, prevented. General linear models were used with a gamma distribution for costs and a Poisson regression for rates of falls and injurious falls. Incremental Cost-Effectiveness Ratios (ICERs) were calculated to assess the additional expenditure required to generate an additional unit of benefit. One-way sensitivity analysis and sub-group analyses were performed. Results: The systematic review and meta-analysis identified nine trials of 498 participants. Eight trials measured static balance, with the pooled effect indicating that eHealth-delivered exercise programmes have a significant effect on static balance (eight trials; SMD = 0.40; 95% CI 0.14 to 0.67). All nine trials measured dynamic balance to find there was no effect on dynamic balance (nine trials; SMD=0.22; 95% CI -0.09 to 0.54). Three trials measured fall risk to find there was no evidence of an effect of eHealth-delivered exercise programmes on fall risk compared to control (SMD=0.28, 95% CI -0.06 to 0.63; I2 = 42.9%, p = 0.173). Three trials measured fear of falling to find there was no evidence of an effect of eHealth-delivered exercise programmes on fear of falling compared to control (SMD = -0.07, 95 % CI -0.34 to 0.20; I2 = 0.0%, p = 0.950). The qualitative study identified eight themes, which fall into two categories: experiences of using StandingTall and the design of StandingTall. Overall, participants appreciated the flexibility of StandingTall’s tablet-based online delivery, and described an improvement in physical awareness and confidence with everyday activities. Participants also reported various challenges with the technology, and determined that computer literacy is essential for successful engagement. Despite this participants found the overall design of StandingTall as user-friendly, clear, and easy-to-understand. The economic evaluation found the total programme delivery and care resource cost was $8,321 (standard deviation, SD 18,958) to intervention participants and $6,829 (SD 15,019) to control participants. The incremental cost per fall prevented was $4,785 and per injurious fall prevented was $6,585. Discussion and conclusion: Falls present a major age-related health challenge for society, and one which is likely to grow in significance as life expectancy increases. This body of research has provided preliminary evidence to demonstrate that balance exercise programmes delivered using technology are an effective, cost-effective and acceptable way of improving balance in older people. This, in combination with the ubiquitous availability of technology, could allow rapid scale-up and implementation of eHealth fall prevention programmes to large populations.

Increasing numbers of Australian older people are living with chronic disease. Their ability to effectively self-manage their conditions is an important issue, not only for their own health but also for the government, who are concerned with spiralling healthcare costs. CDSM is informed, in part, by an individual’s health literacy which are non-disease-specific skills relating to finding, appraising and using health information, and encompass factors such as communicating with health care providers, navigating complex health systems and having social support to engage in managing health. New technologies provide the opportunity to deliver healthcare in innovative ways. However, there is a paucity of evidence on their use, particularly in community care. The purpose of this study was to: (1) understand what home-based group videoconference (VC) interventions have been developed for the e-health setting; (2) identify the mechanisms of delivering group education and social support by VC for older people; and (3) examine the impact of such a program in delivering patient education on health literacy, chronic disease self-management (CDSM) and social support. E-health, an umbrella term which includes telehealth, provides healthcare from a distance using telecommunications techniques. The Australian Government considers e-health as a key component in the future delivery of healthcare. E-health and telehealth are emerging vehicles to provide health information on CDSM as well as the opportunity to develop innovative patient education methods. Telehealth disrupts usual care, for example, using videoconferencing (VCing) for a consultation can negate the need for health professionals and patients to be physically in the same space. A particularly underexplored area is the use of group videoconferencing (VCing) for CDSM and health literacy patient education that is delivered into the patients’ homes. Group work is an effective method for providing CDSM knowledge and skills. However, there are known barriers for patients in accessing groups; these include timing, mobility, transport, and fear of meeting new people. Group VCing may provide the opportunity to overcome some of these barriers to enable wider access to group settings. iii This study, the Telehealth Literacy Project (THLP) was situated in the real world setting, working in collaboration with an aged care industry partner provider with community-dwelling older people aged between 49 and 90. It was nested within a wider telehealth remote monitoring study and explored the methodology of using group VCing to engage with older people. In order to answer the research questions, an intervention was developed specifically to test the methodology of group VCing. This thesis is focused on answering the research questions on the methodology of using group VCing and not on critiquing the intervention. In addition it reports only data from the THLP. A mixed method research design was employed during the study, including a systematic review, co-creation of the intervention with health professionals and participants and for the program evaluation, pre- and post-intervention quantitative measures (with control and intervention groups) and qualitative interviews. An evaluation framework was developed from the literature comprising overarching concepts of feasibility, acceptability and effectiveness In the THLP there were two groups, an intervention group comprising 52 participants who opted-into the weekly VC group intervention and a control group of 60 participants who chose not to take part in the intervention but who completed a baseline questionnaire. Following baseline data analysis those who opted-in to take part in the intervention were grouped by similar levels of health literacy. Each week intervention participants would meet in a virtual room and take part in discussions with the researcher on different health literacy and generic CDSM issues. Slides and videos were used to facilitate discussion with an emphasis on participants being engaged in conversation with each other to promote social support.

This research explored the experience of parents who have a child with newly diagnosed food allergies in regional Queensland. The findings add to the knowledge of strategies that parents can adopt to manage their child's medical, nutritional, and psychosocial needs and how healthcare professionals can support them during this time.

Gamblers are known to engage in an array of cognitive distortions that fuel poor gambling decisions. Dual process theory suggests that people have preferences for either intuitive or analytical thinking; and these preferences can predict or influence the choices they make. This thesis explored the interplay between a gambler’s cognitive style (their preference for intuitive vs. analytical thinking), their gambling beliefs, and their consequent gambling behaviour. In order to demonstrate the protective nature of analytical thinking, a measure of protective gambling beliefs was developed that was then incorporated into three additional studies designed to assess how an intuitive cognitive style contributes to poor gambling decisions, and conversely the potential for increased analytical thinking to generate safer gambling. The main findings showed that 1) preferences for intuitive (and lack of analytical) thinking contributes to beliefs about gambling that fuel problem gambling and greater gambling consumption; 2) Using general analytic primes at point of play is counterproductive in generating safer gambling, and counter to expectations, resulted in an increase in positive expectations regarding gambling outcomes; 3) Ongoing analytical training that is specific to gambling, in contrast, resulted in protective belief changes and a reduction in time spent gambling. These findings have implication for generating effective interventions and clinical tools that help demystify the decision-making process for gamblers who may be experiencing harm because of intuitive thinking that contributes to poor gambling choices.

As globalization continues to increase, the demand for culturally intelligent employees is central for navigating everyday intercultural business interactions. For college students preparing to enter the workforce, cultural intelligence is trained at universities through cultural training courses and study abroad experiences. Although cultural training courses and study abroad experiences are recognized as important factors in developing cultural intelligence, their effects are often assumed. Additionally, research indicates that international travel alone does not enhance a person’s overall cultural intelligence. This research examined a university program designed using Bandura’s Social Learning Theory to increase undergraduate students’ cultural intelligence through an on-campus cultural training course followed by a study abroad experience. Study 1 compared the effectiveness of a university program consisting of a cultural training course with a study abroad experience against a comparison control group. Multi-level modeling analyses suggest that students who participated in the cultural training course followed by a study abroad experience significantly increase in motivation, cognitive, metacognitive, and behavior CQ. Furthermore, interaction analyses examined the relationship between the two study groups, students’ self-assigned cultural development goals, the quality of their reflective journal entries, and an examination of any potential cultural mentor effects. None of these variables was associated with CQ growth. Study 2 compared two study abroad groups who either spent 3- or 6-weeks abroad after completing a shared cultural training course. Both groups experienced a statistically significant increase in all four CQ domains relative to a comparison group. When comparing the 3- and 6-week study abroad groups, there were no differences in motivation, cognitive, or behavior CQ; however, in metacognitive CQ, the 3-week group experienced a statistically significant increase compared to the 6-week group. No student-level predictors (age, gender identity, ethnicity, year in school, previous overseas experience, and grade point average) or program-level predictors (cultural mentor, number of countries visited) had a significant relationship with CQ development. These results demonstrate that a university intercultural development program that combines a cultural development training course with an instructor-led study abroad experience can help students improve their cultural intelligence, regardless of a student’s background, and that students can experience significant CQ growth in as little as 3-week abroad.

Skin cancer screening clinics were introduced into a number of towns throughout Queensland as part of the Melanoma Screening Trial (MST), a study investigating the efficacy of screening for melanoma. The MST requires 60% of these towns' populations aged over 30 years to be screened for

melanoma within a three year intervention phase. The aim of this case study is to assess the relationship between Rogers' (1995) diffusion of innovations and the health promotion strategies implemented to encourage attendance at skin cancer screening clinics.

Data were obtained from a number of sources, including administrative files, progress reports, interviews and focus groups and were positioned within a comparative theory/practice matrix. Pattern matching logic was used to

assess the relationship between the health promotion strategies and the theoretical construct of diffusion of innovations.

All components of diffusion of innovations (Rogers, 1995) were addressed by the health promotion strategies encouraging attendance at the skin cancer screening clinics. The delivery of the skin cancer screening clinics was in accordance with principles identified by past diffusion research. The skin cancer screening clinics conformed to most predictors of diffusion success and were delivered within a "real" environment, as suggested by past community -based interventions. A number of changes to existing health promotion strategies and the addition of some new strategies have been suggested to improve the rate of diffusion of skin cancer screening clinics in

the future.

One way to reduce the lifecycle cost and environmental impact of a product in a circular economy is to extend its lifespan by either creating longer-lasting products or managing the product properly during its use stage. Life extension of a product is envisioned to help better utilize raw materials efficiently and slow the rate of resource depletion. In the case of manufacturing equipment (e.g., an electric motor on a machine tool), securing reliable service life as well as the life extension are important for consistent production and operational excellence in a factory. However, manufacturing equipment is often utilized without a planned maintenance approach. Such a strategy frequently results in unplanned downtime, owing to unexpected failures. Scheduled maintenance replaces components frequently to avoid unexpected equipment stoppages, but increases the time associated with machine non-operation and maintenance cost.

Recently, the emergence of Industry 4.0 and smart systems is leading to increasing attention to predictive maintenance (PdM) strategies that can decrease the cost of downtime and increase the availability (utilization rate) of manufacturing equipment. PdM also has the potential to foster sustainable practices in manufacturing by maximizing the useful lives of components. In addition, advances in sensor technology (e.g., lower fabrication cost) enable greater use of sensors in a factory, which in turn is producing greater and more diverse sets of data. Widespread use of wireless sensor networks (WSNs) and plug-and-play interfaces for the data collection on product/equipment states are allowing predictive maintenance on a much greater scale. Through advances in computing, big data analysis is faster/improved and has allowed maintenance to transition from run-to-failure to statistical inference-based or machine learning prediction methods.

Moreover, maintenance practice in a factory is evolving from equipment “health management” to equipment “wellness” by establishing an integrated and collaborative manufacturing system that responds in real-time to changing conditions in a factory. The equipment wellness is an active process of becoming aware of the health condition and of making choices that achieve the full potential of the equipment. In order to enable this, a large amount of machine condition data obtained from sensors needs to be analyzed to diagnose the current health condition and predict future behavior (e.g., remaining useful life). If a fault is detected during this diagnosis, a root cause of a fault must be identified to extend equipment life and prevent problem reoccurrence.

However, it is challenging to build a model capturing a relationship between multi-sensor signals and mechanical failures, considering the dynamic manufacturing environment and the complex mechanical system in equipment. Another key challenge is to obtain usable machine condition data to validate a method.

A goal of the proposed work is to develop a systematic tool for maintenance in manufacturing plants using emerging technologies (e.g., AI, Smart Sensor, and IoT). The proposed method will facilitate decision-making that supports equipment maintenance by rapidly detecting a worn component and estimating remaining useful life. In order to diagnose and prognose a health condition of equipment, several data-driven models that describe the relationships between proxy measures (i.e., sensor signals) and machine health conditions are developed and validated through the experiment for several different manufacturing-oriented cases (e.g., cutting tool, gear, and bearing). To enhance the robustness and the prediction capability of the data-driven models, signal processing is conducted to preprocess the raw signals using domain knowledge. Through this process, useful features from the large dataset are extracted and selected, thus increasing computational efficiency in model training. To make a decision using the processed signals, a customized deep learning architecture for each case is designed to effectively and efficiently learn the relationship between the processed signals and the model’s outputs (e.g., health indicators). Ultimately, the method developed through this research helps to avoid catastrophic mechanical failures, products with unacceptable quality, defective products in the manufacturing process as well as to extend equipment service life.

To summarize, in this dissertation, the assessment of technical, environmental and economic performance of the AI-driven method for the wellness of mechanical systems is conducted. The proposed methods are applied to (1) quantify the level of tool wear in a machining process, (2) detect different faults from a power transmission mini-motor testbed (CNN), (3) detect a fault in a motor operated under various rotation speeds, and (4) to predict the time to failure of rotating machinery. Also, the effectiveness of maintenance in the use stage is examined from an environmental and economic perspective using a power efficiency loss as a metric for decision making between repair and replacement.

"When compared to other women Australia Aboriginal women are considered the most socially and economically disadvantaged and have the poorest health status. Aboriginal women in Rockhampton, Central Queensland are not excluded from this lived reality. This research has explored Aboriginal women's perceptions and experiences of health and health services in Rockhampton. Drawing on these experiences, and centring the voices of these women, the study reports on findings concerning cross-cultural issues, communication, policy, practice and service delivery. Importantly, the study has built new knowledge identifying the complex relationship between identity, body and well-being." -- abstract.

This study of four domestic abattoirs in South Australia with Quality Assurance programmes in place established the size of bacterial populations that could be expected on pig carcasses on entry to abattoir dressing floors at pre-evisceration, the extent of contamination occurring during carcass dressing, and the effect of chilling on these populations. Analysis was conducted for salmonellae, Escherichia coli, Total Viable Count, and pseudomonads. Exterior swabbing was compared to swabbing of corresponding interior sites which are sterile initially. The interior swabbing sites were found to be a more reliable measure of contamination during the dressing process than the swabbing of already contaminated exterior sites. During the identification of some of the points of carcass contamination, the effectiveness of end-of-work foam cleaning programmes used at abattoir dressing floors and their relationship to the potential for airborne contamination of carcasses was examined and found to be positive. Operators' work tools and hands were identified as sources of interior carcass contamination combined with failure of operators to adhere to Standard Operating Procedures (SOPs) during carcass dressing, especially those related to hand and forearm washing at appropriate times. Foot-operated full-immersion hot water units for operators' knives and steels were designed and installed at two abattoirs to give operators access to physically and biologically clean work tools throughout carcass dressing.
PhD Doctorate

This research explored the notion of rural health equity and the complexities of formulating innovative and equitable health solutions at the small-scale rural and remote settlement level. Outcomes included improved identification of rural determinants of health and development of new rural health equity data-capture approaches, screening tools and rapid assessments.

It is mandated that all Australian hospitals employ a means of detecting patient deterioration, and in doing so, most have chosen to adopt Early Warning Scores (EWS). Over the past three decades, many variations of EWSs have been developed and tested in larger regional/metropolitan hospitals. However, there is a paucity of evidence as to which EWS is most effective in predicting deterioration events in small, poorly resourced regional/rural hospitals. The aim of this study was to inform small, poorly resourced regional/rural hospitals on the selection of the best EWS or class of EWS, to augment patient safety within their context. This multi-phase retrospective case-controlled study compared the efficiency of 12 existing EWSs using patient data from two small regional private hospitals (Phase 1). Outcomes from Phase 1 informed Phase 2 and the development of a new EWS for use in poorly resourced regional private hospitals. The new EWS was then validated using two independent patient cohorts from small, poorly resourced regional/rural public hospitals (n=7) and large, well-resourced public regional/metropolitan hospitals (n=6). Results showed that in small regional private hospitals, the aggregated weighted EWS, called Compass, was most effective in identifying deteriorating patients with an Area under the Receiver Operator Characteristic Curve (AUROC) of 0.747 (CI 0.73-0.76). However, Compass had a low sensitivity of 0.44, meaning that less than 50% of the deteriorating patients achieved an emergency call score. Given the suboptimal efficiency of the 12 EWSs tested, a new, more efficient EWS was developed. The first step in developing a new EWS involved determining the ability of the vital signs in predicting patient deterioration. While vital signs are good indicators of patient deterioration, no single vital sign was found to predict patient outcomes strongly. A rapid heart rate and the need for supplementary oxygen were identified as the best indicators of an impending clinical deterioration event in this patient cohort. Based on these findings, a new combination EWS, called MOD-6 was then developed. This was achieved by adding a single trigger component to Compass, extending the existing vital sign trigger threshold ranges and incorporating a graduated weighted scale for supplementary oxygen use. The new combination EWS, MOD-6, was 20% more effective than Compass when used in poorly resourced regional private hospitals. However, when validating the new MOD-6 using two independent patient cohorts from the public sector, the MOD-6 EWS was no more effective than existing EWSs. This study has produced evidence that EWSs are used differently in large, well-resourced regional/metropolitan hospitals compared to poorly resourced regional/rural hospitals. In the well-resourced hospitals, there is evidence that the EWSs are being used to identify clinical deterioration events, reactively using the EWS scores to guide the escalation of patient care. At the small, poorly resourced hospitals, the EWSs appear to be used proactively to predict patient deterioration and prevent adverse patient events. At these small regional/rural hospitals, staff appear to respond early to changes in the patients’ vital signs, transferring patients out to a better resource facility before triggering an emergency threshold score on the EWS. In conclusion, an aggregated weighted EWS, such as Compass, or a combination EWS such as the new MOD-6 EWS should be considered for implementation in the small, poorly resourced private hospitals. The best indicators of patients requiring transfer out to a higher level of care in this patient cohort are the use of supplementary oxygen and those with tachycardia. Findings from this research will inform nursing practice in small, poorly resourced regional/rural hospitals and positively contribute to patient safety.

Listening (Janusik, 2002; Miller, 2018; Wolvin & Coakley, 1996) and eating disorders (EDs; National Centre for Eating Disorders (NCFED), 2018) are often not taught within schools, especially among adolescents. To address this, a school-based brief motivational interviewing (MI) intervention on listening when talking about EDs was created, implemented, and evaluated among adolescents (n = 260) from two middle schools within the Midwestern part of the United States. Specifically, School 1 (n = 100), and School 2 (n = 160) and three teachers (i.e., Teacher 1, Teacher 2, Teacher 3) allowed the researcher to present and collect data. In other words, three total teachers between the two schools, and one teacher, Teacher 1 (n = 100), was from School 1, and the other two teachers, Teacher 2 (n = 120) and Teacher 3 (n = 40) were from School 2. Participants were randomly placed into either the 1) the EDs listening intervention (education-plus) with an MI component (n = 6 classes) or 2) an education-plus Q&A intervention (n = 7 classes). All the participants were involved in the guest lecture and the pre-test and post-test survey, but data was only saved and analyzed from participants that had guardians/parents who consented (n = 75). The methodology for this dissertation project was a 2 (pre/post, unmatched) X 2 (condition) subject’s design. This dissertation project had two independent variables: (1) experimental condition (e.g., education plus MI and education plus Q&A), and (2) time (e.g., pre and post). This dissertation project had five dependent variables: (1) knowledge of listening, (2) knowledge of EDs, (3) listening self-efficacy, (4) knowledge of OARS, and (5) knowledge of the righting reflex. This dissertation project also had the random factor of schools (e.g., School 1 (A) and School 2 (B), and the fixed factor of gender identity (e.g., male and female). The results revealed a promise of efficacy and increased knowledge regarding EDs and aspects of listening, specifically through MI (e.g., OARS). Other areas of knowledge improved but not significantly. In other words, there were no significant differences in knowledge gains between MI and Q&A, but MI compared to Q&A showed a more extensive influence on self-efficacy. The main limitation of this study was the limited guardian/parental consent, resulting in a small sample size.

Victorian Public Hospitals have operated under a burden of several different financial reporting requirements for several years. The research sought to examine the duplication of mandatory financial reporting requirements applicable to an atypical small Non -Metropolitan Victorian Public Hospital.

Previously published research as undertaken by Arthur Anderson, 1995, commissioned by OHS provided a basis of this research. The Anderson research was broad and encompassed the reporting requirements as applicable to both the largest and smallest Victorian public Hospitals. The research sought opinion of a qualitative nature, but did not examine the duplication of requirements from a

quantitative perspective.

The research is based on a case study of a single hospital and the three major financial reporting requirements, as applicable to this hospital. These reporting requirements were compared not only for duplication of mandatory reporting requirements, but also any anomalous reporting requirements were investigated.The initial benefit of the research being that with identified duplication of data, scope may exist for a reduction in either the content or number of reporting requirements.

Enrollment in post-secondary education for individuals with autism spectrum disorder (ASD) is increasing; however, students with ASD are less likely to complete a degree than students with other disabilities. Classroom performance requires attending to course-related information while filtering distractions. These attentional functions are critical for academic achievement. However, ASD is associated with pervasive impairments in attentional filtering. The present study used visual search, a task in which individuals with ASD excel, to investigate filtering of irrelevant social and non-social auditory information in college students with and without ASD. Results of the present study suggest a filtering deficit for individuals with ASD and indicate that this filtering impairment is present for both social and non-social information. Importantly, these deficits are present on a task in which individuals with ASD excel. Our findings suggest that irrelevant social and non-social sounds may adversely affect performance in college-aged students with high-functioning ASD and highlight the importance of minimizing competing background noise for these students.

Background: Male contraceptive options are limited to condoms or vasectomy and have lacked significant developments for about a century, suggesting the value of exploring male hormonal contraceptives (MHC). In October 2018, a transdermal gel method entered Phase 2 clinical trials, indicating MHC may soon be available. However, eventual uptake of potentially contentious innovations, like MHC, requires informed marketing and promotional strategy. Consumer behavior research methodologies can aid in determining consumer perspectives, providing a framework for effective marketing to encourage MHC adoption upon market introduction.

Methods: Phases 1 & 2. Focus groups (n=29) and individual, in-depth interviews (n=20) among college-aged men and women aged 18-26 years were conducted using a semi-structured approach. Techniques from expanded grounded theory were used, allowing for a constant comparative approach to data contextualization and theme identification. Ads were created based on focus group results and tested in the interviews. Content analysis served as the data analysis strategy, allowing for a constant comparative approach to data contextualization and theme identification. Phase 3. College-aged men and women (n=1,997) aged 18-26 years participated in a web-based survey. Multiple linear regression was used to examine significant predictors of attitudes toward, interest in, and intention to use or encourage use of MHC. A conjoint analysis procedure was also used to assess the relative importance of attributes on ad effectiveness and preference.

Results: Phase 1. Three primary themes emerged from focus group discussions: 1) openness to MHC; 2) resistance to MHC; and 3) MHC gel innovation characteristics. Men and women were generally interested in the idea of an MHC method. Hesitance about MHC surrounded the social acceptance of a novel contraceptive product, resistance to changing current contraceptive routines, and fear of health consequences. Participants shared insights about promotional strategies which fell within the diffusion of innovations (DOI) characteristics of relative advantage, complexity, compatibility, and observability. Phase 2. In-depth interviews offered insight into perceptions of message development for MHC. Four themes emerged: 1) humor, 2) information, 3) relatability, and 4) credibility. Message testing in interviews yielded an understanding of elements participants responded most strongly to, including: 1) ad sentiment, 2) trustworthiness, and 3) visual appeal. Phase 3. Regression analyses revealed being sexually active (p=0.001) and having prior knowledge of potential MHC methods (p=0.031) aligned with positive MHC attitudes, interest, and intention. Conservative political views (p=0.002) and being satisfied with current male birth control offerings (p=0.000) were associated with negative MHC attitudes. Conjoint analysis identified informational messages as most important (56.62%). Informational (p=0.000) and aspirational messages (p=0.003) paired with relatable characters were the most highly preferred ads.

Conclusions: Findings revealed college-aged men and women express a general interest in the idea of MHC, with hesitance stemming from social acceptance of a novel contraceptive product, resistance to changing current contraceptive routines, and fear of potential side effects and long-term health consequences. Promotional strategy for MHC, or similar novel health products, must focus on stratifying consumers based on their readiness to accept a potential innovation and use tactics like aspirational marketing, social norms marketing, and informational marketing to confirm benefits and address concerns. Qualitative formative research also illuminated salient concepts for MHC advertising. Message testing revealed informational ads with elements of credibility may be most useful for promoting MHC, along with ad concepts audiences feel they can relate to or trust, and practical messaging or imagery meant to increase agency in use. The quantitative survey further supported these findings among a broader, university audience, indicating informational messages or aspirational messages paired with trustworthy, relatable characters are the most effective ad attributes to incorporate into marketing strategy when promoting a novel contraceptive product, like MHC.

 The aim of this qualitative research project is to develop insight into and an interpretation of, the lived experiences of preceptors in clinical preceptorship programs for undergraduate nursing students. A framework based on hermeneutic phenomenology has been selected as the methodology to facilitate this research process. In depth interview technique is used for data generation from four selected preceptors from the same health care agency. Information shared by these preceptors is analysed within the hermeneutic framework. Evolving theme generation is documented and discussed with a view to enhanced insight into the phenomenon. Nurse educators, nurse managers, preceptors and students may use findings from this study to stimulate satisfying preceptorship experiences in an environment of collaborative nursing education. Other benefits relate to enhanced preceptor, preparation professional leadership programs that will engender positive professional attitudes and improved abilities of preceptors.  

This qualitative thesis uses discourse analysis to examine parental resistance towards medical treatment of critically ill children. It is an investigation of the 'mobile and transitory' discourses at play in instances of resistance between parents, physicians and nurses within health care institutions, and an examination of the consequences of resistance through providing alternative ways of perceiving and therefore understanding these disagreements. The philosophical perspectives, methodology and methods used in this thesis are underpinned by selected ideas taken from the works of Michel Foucault and Pierre Bourdieu and supported by relevant literature in the fields of media, law, children, parenting, caring, serious childhood illness, medicine and nursing. The thesis obtains information from a variety of texts that includes established literature (such as medical, sociological, legal, academic and philosophical), newspaper articles, radio or television interviews, internet sources, court reports and proceedings, legal experts and other commentators - and 15 interview based texts, where the focus is on analyses of narratives of parents, doctors and nurses. In the texts gathered for this thesis, there are noticeable differences between the personal experience discourses of parents, the 'in-between' discourses of nurses, and the disciplined discourses of physicians. This thesis brings these discourses into conversation with each other suggesting that parental resistance does not occur because of an infrequent and unusual set of circumstances where a few socially isolated and/or 'difficult' parents disagree with the treatment desires of paediatric physicians. Instead, it is argued that from an examination of interview based texts, parental resistance is an omnipresent but transitory occurrence that affects many of the interactions between the parents of seriously ill children and clinical staff. It is maintained that within these interactions, the seeds of this resistance are sown in both critical decision making situations and in everyday occurrences between doctors, nurses and parents within healthcare institutions. Contributing factors to parental resistance include the use of power games by staff, the language of medicine, forms of symbolic violence, the presence or absence of trust between parents and medical staff, the effects of medical habitus, and challenges to the parental role and identity. Overall, it is proposed in this thesis that parents who resist treatment for their seriously ill child are not exceptions to the normative patient-physician relationship. Instead an analysis of their discourses and practices is able to illuminate the complex interactions between patients and medical conventions. It is therefore possible to see parents who resist medical advice not as peripheral to the medical encounter but as examples of how patient-physician relationships come to be codified, constructed and crafted through everyday discourses and practices within health care settings.

Objectives The study will assess patterns of known individual, interpersonal, and community-level circumstances leading to suicide to understand how these factors can co-occur. These patterns will help focus on prevention strategies.

Methods Data was collected from the Iowa Violent Death Reporting System, Census data from the American Community Survey, and 2010 rural-urban commuting area codes from the Economic Research Service. The study consisted of three steps. The first step latent class analysis was conducted on data from suicide deaths from Iowa in 2016-2018 to create classes of patterns of circumstances leading to suicide. The second step maximum probability assignment was used to assign the sample of 1,276 to the created latent classes. Finally, in the third step bivariate regressions were ran to understand the relationship between the created latent classes and the rurality variable (nonmetropolitan vs metropolitan).

Results Five latent classes of distinct patterns of suicide factors emerged. Class 1 is physical health problems living in areas that are average on all community-level variables. This class 1 is seen to happen with higher odds in nonmetropolitan areas. Class 2 is interpersonal problems in areas where living alone is high. This class 2 happened with higher odds in nonmetropolitan areas. Class 3 is mental health problems or depressed mood with no legal problems in areas that had lower educational attainment. This class 3 did not indicate greater odds based on rurality. Class 4 is history of mental health treatment in well-off areas. This class 4 was seen to happen with higher odds in metropolitan areas. Class 5 is substance abuse problems in poorer areas. This class 5 did not indicate greater odds based on rurality. All the classes shared a common theme of experiencing mental health issues or being in a depressed mood.

Conclusions Suicide is a complex concern that could be classified into several classes that have distinct patterns of suicide factors. These classes and patterns help with identifying what services and interventions are needed in certain communities. Overall, providing support in regards to mental health as well as intervening in childhood to support positive development may provide substantial mitigation to the odds of committing suicide. In investigating these patterns, future prevention and intervention effort can take into consideration these patterns to tailor to the individual and the environments where they live.