Dissertations / Theses on the topic 'Physicians (General practice) Australia Attitudes'

Research available on elder abuse is limited. There continues to be a lack of uniformity in how to define and identify the problem, as well as how to intervene. One group which continues to be excluded from the process of gaining knowledge on the issue of elder abuse is the elderly themselves. As general practitioners are the primary source of health care for older people, their perspectives on elder mistreatment should be explored as well. The first objective of this study was to examine whether differences existed in the perceived severity of potentially abusive situations between three groups of older people and general practitioners. The second objective was to determine if gender differences existed in perceptions of severity of abuse. The sample consisted of 48 general practitioners, 40 independent elderly, 38 elderly caregivers and 36 elderly care-receivers. The participants' perceptions of elder abuse were assessed using a modified version of a questionnaire developed by Moon and Williams (1993). The questionnaire described 10 potential elder abuse scenarios which covered five categories of abuse: physical, psychological, sexual, financial and neglect. Participants were asked to indicate whether or not they perceived each situation to represent an example of elder abuse and, if they answered affirmatively, to rate the severity of the abusive behaviour and identify which aspect of the scenario they considered abusive. Data were analysed using split-plot analysis of variance, as well as contingency tables. The results suggested that significant differences existed in the perceptions of severity of elder abuse scenarios across groups and gender. General practitioners tended to view the scenarios as less severe examples of elder abuse than the older-aged groups. There were similarities within the elderly groups in that all groups perceived the sexual abuse scenarios as examples of more severe forms of abuse than the financial abuse scenarios. Within the elderly groups, caregivers generally perceived the scenarios as less abusive. With regard to gender differences, females generally perceived the sexual abuse scenarios as more severe than males. This was particularly so for female independent elders and female care-receivers. Both the symbolic interaction theory and social exchange theory were adopted to explain why there were differences in the perceived severity of the scenarios. It was argued that how the participants viewed the interactions between the characters in the scenarios, and whether they perceived the interactions as being rewarding or unrewarding for particular characters, would affect participants' perceptions of severity. To conclude, with such differences in views found, the development of effective assessment and intervention strategies will be difficult. However, both the public and professionals alike need to increase their understanding on the topic of elder abuse, lest the abuse continues.

Background: Dissemination of evidence-based mental health clinical practice guidelines had not been studied in Australia prior to the National General Practice Guideline Implementation Program. This naturalistic research reports ten national interventions designed to disseminate the NHMRC 1997 Clinical Practice Guideline Depression in Young People for GPs (GDIYP-GP) through 123 Divisions of General Practice. The guideline covered depression and suicide in young people aged 13 to 20 years. Aim: To evaluate a 'coordinated link agent' and 'enhanced packaged approach' for disseminating a national guideline by engaging 20 Divisions in using 5 dissemination models and to measure Divisions' capacities in performing unfunded local dissemination to GPs. Method: An Implementation Kit was the main national intervention, housing the guidelines and 5 models: Education by the Division; Education by an external provider; 3) Clinical Audit; 4) Segmented Formats and 5) Appraisal. Five studies are reported: 1) an organisational census on guideline-related practices in all topics; 2) a Case Study Database of 3 consecutive interviews of 51 participating Divisions; 3) a Guideline Appraisal study of 9 cohorts of doctors; 4) a Clinical Audit study of 54 doctors involving 1200 patients; and 5) a 'Segmented Formats' documentary analysis of Division communications on GDIYP-GP. Results: Prior dissemination by most Divisions was administrative mail outs rather than planned programs. In all, 70 instead of the pilot 20 organisations participated (57% of the sector) using 10,000 guidelines: 45 participated by 7 weeks and 71 by 35 weeks and the majority used multiple active strategies showing fidelity to the Kit. Education by the Division, Segmented Formats and Appraisal were the most adopted models. GDIYP-GP was acceptable and relevant to the majority of Divisions and to 9 samples of doctors. Conclusion: Divisions are one appropriate system through which evidence-based mental health guidelines can be disseminated to general practitioners. Uptake can be rapid using a flexible enhanced package approach with link-agent support. 3-6 months is needed for organisations to begin effective interventions. Divisions reorient their approach with guidance toward evidence-based dissemination but Division and practice barriers

As the Australian population is expanding and ageing, there is an associated need for a focus to be placed on the Individual rights of elderly people, and for the general populus to be made more aware of areas related to our older generation. Elder abuse, as an area of concern, developed as an offshoot of investigations into child abuse and general domestic violence, and initially surfaced in the 1970s and 80s. Some sections of the medical profession were made specifically aware of the problem initially in 1975, through a letter that was sent to the British Medical Journal. However, throughout some of the literature, GPs have been criticised about their level of awareness of the issue of elder abuse, and for their lack of involvement in this area. The purpose of this study was to explore how General Practitioners and Aged Care workers perceive incidences of elder abuse. Due to the limited amount of research which has been undertaken on elder abuse within Australia, the study looked at exploring the issue rather than trying to measure its cause, or trying to identify the extent of the problem. The study investigated the perceptions of general practitioners (GPs) toward the area of elder abuse, and looked further to explore how general practitioners were perceived by aged care workers. The approach used for data collection consisted of circulating 100 mailed out questionnaires to general practitioners within metropolitan Perth, and follow up face-to-face interviews with some of the respondents to this questionnaire. Additionally, face-to-face interviews were also held with key informants who worked in the aged care industry, to ascertain their perceptions of elder abuse. The mailed questionnaires were analysed by adding the frequencies of responses given to each question. The data from the face-to-face doctor interviews and the key informant interviews were transcribed verbatim from the tape recordings and then assessed by looking for consistent regularities from each response made, therefore using a cross-case analysis. From this analysis, patterns emerged in the data, from which themes were developed. The recommendations from the data suggest that a clear and concise definition of elder abuse needs to be developed, to assist in clearly Identifying the prevalence of the problem. The data further recommended the need for an awareness campaign on the area of elder abuse to be undertaken. This should focus on raising the awareness of the possible characteristics of individuals who are vulnerable to being abused, as well as the characteristics of likely perpetrators of abuse. This study also recommended that a coordinated approach to dealing with the area of elder abuse should be developed, which should include the development of specific roles that should be undertaken by professional and non-professionals. Training of people across the Human Services field in the area of elder abuse, and in particular, GPs, social workers and paraprofessionals who work with elderly people, was identified as a recommendation of the study. Areas of training should include: awareness of the problem's existence; providing people with the required skills to detect cases of abuse; providing insight to referral agencies who may be able to assist; having a clear and exhaustive list of interventions to use to assist with addressing the problem; and having knowledge of the characteristics that abused individuals, and perpetrators are likely to have. This study also Identified that more research is required to ascertain if the amount of time which GPs spend with elderly people, is sufficient for them to identify cases of elder abuse, and if the allocated time from Medicare is adequate for GPs to Identify elder abuse.

Thesis (M.D.)--University of Adelaide, Dept. of General Practice, 2005.
Includes publications published as a result of ideas developed in this thesis, inserted at end. "April 2005" Includes bibliographical references (leaves 210-242).

Includes publications published as a result of ideas developed in this thesis, inserted at end.
"April 2005"
Includes bibliographical references (leaves 210-242)
242 leaves :
Title page, contents and abstract only. The complete thesis in print form is available from the University Library.
Examines goal setting in people with diabetes as part of chronic disease management in a rural setting. The studies were performed in Eyre Peninsula with a significant (10-20%) Aboriginal population.
Thesis (M.D.)--University of Adelaide, Dept. of General Practice, 2005

Includes publications published as a result of ideas developed in this thesis, inserted at end.
Includes bibliographical references (leaves 210-242)
242 leaves
Examines goal setting in people with diabetes as part of chronic disease management in a rural setting. The studies were performed in Eyre Peninsula with a significant (10-20%) Aboriginal population.
Thesis (M.D.) -- University of Adelaide, Dept. of General Practice, 2005

Mini-dissertation'submitted in partial compliance with the requirements for the Master's Degree in Technology: Homoeopathy, Durban Institute of Technology, 2005.
Homoeopathy in South Africa is a relatively new health profession, and there seems to be limited awareness of homoeopathy amongst the public and healthcare authorities. The national health care system in South Africa is currently undergoing major restructuring, with the focus on primary health care. The homoeopathic community needs to reflect on its role in public health care. However, in order to gain acceptance and understanding from other health care professions, meaningful research needs to be conducted. There is an urgent need to investigate the views of conventional health care professionals towards homoeopathy. A survey method was employed to investigate the perceptions of homoeopathy of two major groups in the medical community in the Greater Durban area: General Practitioners (GPs) and pharmacists. The study was carried out by using a questionnaire as a measuring tool. The sample of GPs was drawn from the medical pages of the Durban Telephone Directory (October 2003/2004) and the sample of pharmacists was drawn from the Durban Yellow Pages (October 2003/2004). A total of 484 questionnaires were distributed and a total of 155 responses were received. The percentage of return of questionnaires was 32,02%. The original sample size was 370 for GPs and 114 for pharmacists. A total of 97 GPs and 58 pharmacists responded. The response rate was 26,22% for GPs and 50,87% for pharmacists.
M

Submitted in fulfillment of the requirements for the Degree in Masters of Technology in Chiropractic, Durban University of Technology, Durban, South Africa, 2018.
Background: There have been an increased number of patients using complementary alternative medicine (CAM), including chiropractic care. All population age groups are utilising chiropractic treatment for various ailments. Research has shown that general practitioners have limited knowledge and perception about chiropractic in many countries. Their perception towards other health care professionals is important, particularly in their role as gatekeepers in the health care system. The current perception in Zimbabwe is thought to be no referral of patients between general practitioners and chiropractors and a low degree of knowledge amongst general practitioners about chiropractic. Aim: The aim of this study was to determine the knowledge, utilisation and perceptions of general practitioners in Harare, Zimbabwe. Objectives: • To establish the knowledge about chiropractic amongst general practitioners in Harare, Zimbabwe. • To determine perceived role and utilisation of chiropractic by general practitioners in Harare, Zimbabwe. • To determine the relationships, if any, between knowledge, perception, and utilisation of chiropractic by general practitioners in Harare, Zimbabwe. Methods: The study was a descriptive, quantitative, cross-sectional study using a structured questionnaire adapted from similar studies. The questionnaire was validated by means of a focus group discussion. The survey was conducted on a random sample of 72 general practitioners practising in the Avenues area of Harare, Zimbabwe. A single stage sampling techniques was used to select participants from a list of 88 registered general practitioners from the Medical and Dental Practitioners Council of Zimbabwe who met the inclusion criteria. Questionnaires were provided to general practitioners who were in private practice in the Avenues area of Harare, Zimbabwe at the time of the study by the researcher. The data collected was analysed using the Statistical Package for Social Science (SPSS)® 2.4 (IBM, Armonk, NY. USA) software at a statistical significance of p<0.05. Pearson’s correlation was used to assess the relationship between continuous variables, while the t test was used to copmare the mean scores between independent binary variables. Results: Many of the participants had some kind of knowledge regarding chiropractic modalities, areas of chiropractic specialisation but only a few had adequate knowledge and a good perception of it. General practitioners who were knowledgeable about chiropractic tended to have a positive perception and were more likely to refer patients to a chiropractor. A response rate of 54.5 percent was achieved. Most of the respondents tended to be in the age group of 35-54 and most were female (54.2 percent). Over 90 percent of the participants referred patients with musculoskeletal complaints to physiotherapists while only 16.67 percent referred to chiropractors. More than 65 percent of the participants responded that they knew something about chiropractic, and of these almost 50 percent obtained their information from the media. Over 80 percent of the participants who knew something about chiropractic thought that extremities, neuro-musculoskeletal system, rehabilitation and sports injuries were areas chiropractors can specialise in. Almost all the participants who knew something about chiropractic were aware of adjustments or manipluation of joints as modalities of chiropractic treatment. Majority (75.8 percent) of the participants who knew something about chiropractic thought that chiropractic could help selected conditions, while only 3 percent felt it was not effective and 21.2 percent felt they were not informed enough to comment. GP’s surveyed considered chronic back pain (91 percent), sports trauma (85 percent), shoulder/knee problems (79 percent), arthritis (76 percent), back and pelvic problems during pregnancy (70 percent), nerve root entrapment (70 percent) and carpal tunnel syndromme (70 percent) as some of the appropriate conditions for chiropractors to treat. Forty two percent of the GP’s referred patients to chiropractors mostly on both the patient’s request and their own judgment. The main reason for not referring patients to chiropractors cited by most (70 percent) of the GPs was limited knowledge about chiropractic care. There was a statistically significant and moderately high positive correlation between knowledge and perception scores (r=0.668). This study suggests that GP’s who have a higher degree of knowledge about chiropractic tend to have a positive perception of chiropractic. There was a non-significant difference in knowledge between those who refer patients and those who do not (p=0.425). In this study knowlegde about chiropractic did not significantly influence referral to chiropractors. There was however a statistically significant difference in perception between those who refer patients and those who do not (p=0.006). The perceptions were higher in those who refer patients compared to those who do not refer patients. Perceptions were found to determine utilisation rather than knowledge even though there was a correlation between the two.
M

Over the last seven years the recruitment of overseas trained doctors (OTDs) has formed a significant part of Australia’s policy to address the medical workforce issue of geographic maldistribution to ensure that communities in rural and remote Australia have access to adequate general practice (GP) services. This policy has not been without problems, particularly in the areas of assessment of skills and qualifications, appropriate orientation and integration into Australian communities, and retention of these doctors within rural and remote communities. To date there has been little evidence-based research on the role of OTDs in the medical workforce in Australia. This study explores the service provision and quality of care provided by OTDs using the 5 Year OTD Scheme as the case study. In doing so, it assesses the adequacy of this strategy and discusses the implications for future workforce policies and programs. A mixed method design was used in the study. The quantitative component involved secondary analysis of Medicare Australia data for all OTDs participating in the 5 Year OTD Scheme in 2002 and all Australian trained doctors (ATDs) practising in rural and remote Australia in the same year. A log Poisson regression model was used to assess the interactive effect of the various GP characteristics, such as age, sex, experience and practice location with OTD/ATD status on the rate of a particular service item per patient, adjusted for patient age and sex. The qualitative component involved two focus groups with OTDs which were used to help explain the relationships between variables found in the quantitative component of the study. Template analysis was used to identify themes from the focus group. Significantly different rates per patient between OTDs and ATDS were found across most service items and GP characteristics examined. The greatest variation was found among items relating to in-surgery consultations and non-surgery consultations such as nursing home visits. Fewer differences were found between groups relating to pathology, imaging or procedural services. Analysis of surrogate quality items identified few differences between OTDs and ATDs. The focus group identified a number of other factors that influenced their patterns of service and accounted for some of the differences identified in the quantitative analysis. These factors included knowledge of the health care system in Australia, cultural and communication influences, health conditions of patients, patient and community attitudes, remuneration influences and training influences. These had varying degrees of influence on their patterns of service. The reasons for the differences found between OTDs and ATDs are partially explained by the characteristics of the GPs examined and partially explained by other external influences that relate to the particular circumstances of the OTDs, such as knowledge of the Australian health care system and cultural and communication issues. Understanding the nature of practice is central to ensuring appropriate professional support measures. The study findings highlight the need for a targeted training program for OTDs that address the areas that have the greatest influence on patterns of service to ensure that rural and remote communities receive the same quality of service from OTDs as provided by ATDs.
http://proxy.library.adelaide.edu.au/login?url= http://library.adelaide.edu.au/cgi-bin/Pwebrecon.cgi?BBID=1320385
Thesis (Ph.D.) - University of Adelaide, School of Population Health and Clinical Practice, 2008

Over the last seven years the recruitment of overseas trained doctors (OTDs) has formed a significant part of Australia’s policy to address the medical workforce issue of geographic maldistribution to ensure that communities in rural and remote Australia have access to adequate general practice (GP) services. This policy has not been without problems, particularly in the areas of assessment of skills and qualifications, appropriate orientation and integration into Australian communities, and retention of these doctors within rural and remote communities. To date there has been little evidence-based research on the role of OTDs in the medical workforce in Australia. This study explores the service provision and quality of care provided by OTDs using the 5 Year OTD Scheme as the case study. In doing so, it assesses the adequacy of this strategy and discusses the implications for future workforce policies and programs. A mixed method design was used in the study. The quantitative component involved secondary analysis of Medicare Australia data for all OTDs participating in the 5 Year OTD Scheme in 2002 and all Australian trained doctors (ATDs) practising in rural and remote Australia in the same year. A log Poisson regression model was used to assess the interactive effect of the various GP characteristics, such as age, sex, experience and practice location with OTD/ATD status on the rate of a particular service item per patient, adjusted for patient age and sex. The qualitative component involved two focus groups with OTDs which were used to help explain the relationships between variables found in the quantitative component of the study. Template analysis was used to identify themes from the focus group. Significantly different rates per patient between OTDs and ATDS were found across most service items and GP characteristics examined. The greatest variation was found among items relating to in-surgery consultations and non-surgery consultations such as nursing home visits. Fewer differences were found between groups relating to pathology, imaging or procedural services. Analysis of surrogate quality items identified few differences between OTDs and ATDs. The focus group identified a number of other factors that influenced their patterns of service and accounted for some of the differences identified in the quantitative analysis. These factors included knowledge of the health care system in Australia, cultural and communication influences, health conditions of patients, patient and community attitudes, remuneration influences and training influences. These had varying degrees of influence on their patterns of service. The reasons for the differences found between OTDs and ATDs are partially explained by the characteristics of the GPs examined and partially explained by other external influences that relate to the particular circumstances of the OTDs, such as knowledge of the Australian health care system and cultural and communication issues. Understanding the nature of practice is central to ensuring appropriate professional support measures. The study findings highlight the need for a targeted training program for OTDs that address the areas that have the greatest influence on patterns of service to ensure that rural and remote communities receive the same quality of service from OTDs as provided by ATDs.
Thesis (Ph.D.) - University of Adelaide, School of Population Health and Clinical Practice, 2008

"June 2002"
Bibliography: p. 347-360.
xiii, 360, [200] p. : ill. ; 30 cm.
Title page, contents and abstract only. The complete thesis in print form is available from the University Library.
Thesis (M.Med.Sc.)--University of Adelaide, Dept. of Public Health, 2002

Bibliography: p. 379-394.
xi, 394 p. ; 30 cm.
Title page, contents and abstract only. The complete thesis in print form is available from the University Library.
Thesis (Ph.D.)--University of Adelaide, Dept. of Public Health, 1988

This thesis empirically examines the impact of economic changes on: i. the health of the general Australian population, and ii. the claim incidence experience of the Australian Disability Income Insurance (DII) business. Changes in economic conditions have been captured via movements in the unemployment rate. Changes in health by the following two indicators: a. mortality rate, and b. per capita general physician (GP) visits. In many countries it has been established that short-run cyclical patterns in mortality are associated with economic fluctuations. In Chapter 2, an aggregate state level panel data analysis is used to investigate the general pattern of cyclical mortality in Australia for the period 1985-2008. Employing a fixed effects regression methodology, we show that there is a significant counter-cyclical pattern of mortality (mortality increases during economic contractions) in the general Australian population. Evidence in the literature suggests that the pattern of cyclical mortality experienced in other countries is varied. Drawing from this literature, it is argued that one reason for the observed counter-cyclical mortality in Australia is the relatively high level of social security expenditure. In Chapter 3, a poisson fixed effects analysis shows that, in Australia, over the period 1994-2010, per capita GP visits increase with economic expansions. This may indicate that self-perceived morbidity in Australia is pro-cyclical in nature. At first glance, while this result appears to be in contradiction with counter-cyclical mortality (established in Chapter 2), it is argued that the various financial and psychological factors that cause a reduction in GP visits during economic downturns may be a factor in explaining the increase in mortality observed in Chapter 2. Practitioners of DII commonly believe that DII claims experience is highly correlated with economic movements. In Chapter 4, using claims incidence data from Australian DII business for the period 1986-2001, and a conditional model, it is found that the incidence of claims significantly increases with increasing unemployment, illustrating a counter-cyclical pattern of claims incidence. Moreover, a multinomial logit analysis on cause of claim shows that the probability of a new claim arising from accidents significantly increases with increasing unemployment. The results suggest that the counter-cyclical pattern of claim incidence may stem from increasing claims for minor causes amongst the insured population. Our results are important from the perspective of policy makers and insurance companies. For example, to a policy maker, evidence of counter-cyclical mortality and pro-cyclical GP visits provides insights on the impact of economic changes on health. This may lead to further research in order to isolate the causes of these relationships and quantify the social costs associated with tackling the issues. From the perspective of an insurer, the counter-cyclical patterns of mortality and DII claims may help them to incorporate appropriate premium loadings and capital reserves in anticipation of economic downturns.

Background: In South Africa there data is lacking on the health of the older population. This study aims to report on actions taken by general practitioners on abnormal blood pressure, blood glucose and osteoporosis screen identified by registered nurses, conducting home based visits to older clients. Methods An agency piloted the Comprehensive geriatric assessment (CGA) tool in an urban affluent population. In this cross sectional secondary study analysis, 465 participants aged 60 years and over had a nurse visit in their homes and a subsequent General Practitioner (GP) visit. The prevalence of specific geriatric problems was assessed as well as the frequency of initiated procedures by the GP. This study will focus on initiated actions by the General Practitioners in response to abnormal blood pressures, blood glucose, and osteoporosis screen. Results Frequency tables were utilised to identify prevalence of the abnormal blood pressures, blood glucose and osteoporosis screen. . Abnormal blood pressures were detected (230/465, 49%) of the subjects , the GP initiated actions on only 15/465 (3.2%) of clients. Abnormal blood sugars were detected 106/465 (23%) of the GP initiated actions on 23/465 (5%) of clients. Clinical risk factors for the development of osteoporosis were detected in 252 /465 (54%) subjects GP initiated actions on 11/465 (3%) Conclusion This study explored the relationships between comprehensive geriatric assessment and subsequent GP actions and found using the CGA in this population will be successful in identifying abnormal health findings which will enable intervention. However, due to challenges in the communications and marketing of this service, GP’s were not well informed of their role and did not act on majority of the abnormal findings detected by nurses
Thesis (M.N.)-University of KwaZulu-Natal, Durban, 2011.

Within Australia, General Practitioners (GPs) are the cornerstone of the healthcare system. As the first port of contact, GPs consult a large number of patients presenting with a range of both physical and psychological ailments, potentially resulting in excessive demands on the GP. The workload of a GP is exacerbated by the responsibilities of referral writing and other administrative duties. The increased demands of general practice can be the basis of work-family conflict (WFC), resulting in further stress for the GP. Due to the increasing prevalence of chronic health conditions, the ageing population, and recent government reforms, the role of a GP is becoming increasingly demanding, potentially leading to burnout, increased medical errors, decreases in GP-wellbeing, and reduced retention rates. Resilience is hypothesised to reduce the influence that the demands of general practice can have on the GP, ultimately reducing burnout and intention to quit the profession. Yet there is currently no model to adequately measure this proposition. Extending the integrated job stress model, this study proposes a model to measure the influence of resilience on perceived job demands, burnout, and an intention to quit the profession, as reported by GPs. This study used an exploratory mixed-methods research design to develop a holistic understanding of the situation. The sample includes GPs practicing in the metropolitan areas of New South Wales, Queensland, Victoria, and South Australia (n=221). Participants were invited to complete a survey comprised of established scales to measure the lessening influence that resilience has on GP burnout. Following this, a small number of participants were invited to participate in a semi-structured interview (n=10), to gain further insight into the lived experiences of GPs, thus complementing the survey results. Following the structural equation modelling of the survey data, it was apparent that despite being associated with lower levels of WFC, resilience did not have the anticipated benefits in reducing GP burnout. A thematic analysis of the qualitative interview data suggests this might be due external factors that are not within the immediate control of GPs, such as the attitudes of difficult patients and the changing roles of a GP. This study suggests that the primary way to influence job demands and decrease burnout is via the provision of job resources. Job resources have been shown to reduce job demands. Job demands are suggested to exacerbate burnout directly (by intensifying the demands of work) and indirectly (by generating work-family conflict). Therefore, through the increased provision of job resources, GPs are likely to: experience lower levels of burnout, experience improved wellbeing, deliver better patient care, and remain in their profession. Given the current challenges facing Australian GPs, it is important to improve the capacity of the primary care workforce. Through its theoretical contribution, this thesis demonstrates ways to bolster this capacity.

Patient-doctor relationships between same-sex attracted women and general practitioners (GPs) have been presented as problematic in the literature. The problems arise from women’s concerns about the potential for negative attitudes amongst GPs. They also relate to GPs’ concerns about offending patients if they ask about sexual orientation due to the stigmatised nature of minority sexual orientation. As a result, disclosure of sexual orientation can be difficult and the patient-doctor relationship can be compromised. The aim of this study was to explore the nature of patient-doctor relationships in this context and how optimal relationships can be achieved.
Using a critical hermeneutic approach, I conducted in-depth interviews with 33 same-sex attracted women and 28 doctors. This included 24 pairs of people in a current patient-doctor relationship. I found that women commonly experienced silencing of their minority sexual orientation within general practice settings, but that this was occasionally desired and not problematic for some women and most GPs. For other women and for many GPs, the silence resulting from a lack of disclosure was a response to perceived risks to women’s personal identity and GPs’ professional identity. Few GPs asked directly about sexual orientation, placing the burden of responsibility for disclosure on same-sex attracted women. Building reciprocal trust could overcome the perceived risks inherent in revealing minority sexual orientation. I initially defined optimal patient-doctor relationships in terms of existing models of cultural competence and patient-centredness; however I found that such relationships were built on cultural sensitivity rather than cultural competence, and relationship-centredness rather than patient-centredness.
I developed a new model of sexual identity disclosure that demonstrated the key influences on disclosure of sexual orientation to GPs for same-sex attracted women. These influences were women’s sexual identity experience, risk perceptions, and the level of knowing within the patient-doctor relationship. The model depicts women’s range and fluidity of sexual identity experiences and challenges current assumptions that disclosure is essential for effective health care. The model has transformative potential for general practice education and research. It could assist GPs to understand that not all women desire disclosure, but that the majority of women are happy to disclose if asked. GPs would be encouraged to take note of the socio-political environment in which women live and its influence on women’s fears and actual experiences of discrimination. Finally, understanding the role of trust and reciprocal knowing in mitigating perceived risks would encourage GPs to focus more on relationship building. This could also assist GPs to overcome their own perceptions of risk and encourage them to broach the subject of sexual orientation, ultimately enhancing the patient-doctor relationship.

The body of work presented in this portfolio addresses the research question: “What is best practice in training and support for General Practitioners in Aboriginal and Torres Strait Islander health?” My 13 papers and monographs describe general practice training and related research conducted from 1998-2018, using a range of methodologies. The research is grounded in partnerships with Aboriginal and Torres Strait Islander peoples and organisations, and rigorous, evidence based research approaches. In this portfolio I discuss the rationale for training health professionals as a strategy for addressing Indigenous health inequity and provide an organisational context in the Australian general practice training setting. My discussion of the papers and monographs is informed by a comprehensive review of the current literature. Reflecting on my research and the current literature, six themes are identified as framing best practice in general practice training in Aboriginal and Torres Strait Islander health, and recommendations for best practice are described under each. The themes are Indigenous leadership and partnerships; organisational commitment; systemic approach; learning approaches; learning content; and assessment and evaluation.

Introduction Since the 1994 change in power in South Africa, there have been many necessary changes in health legislation (HL), in accordance with the principles enshrined in the Constitution, Such changes have been recognized as being both complex and fraught with stakeholder interests. There is a perception that private family practitioners (FP) generally harbour negative attitudes towards HL that has been brought into effect in recent years. It is also possible that FP, in general, lack knowledge regarding HL. The aim of the study was to assess the knowledge and attitudes of private family practitioners (FP) to health legislation (HL) within a localized geographical area of the eThekweni Metro, KwaZulu-Natal Province. The specific objectives were: To determine family practitioners’ knowledge of health legislation. To determine family practitioners’ attitudes towards health legislation. To assess the correlation between family practitioners’ knowledge and attitudes. To compare the self-reported knowledge of health legislation with the objective assessment of knowledge and attitudes. To establish practitioners’ perceptions of the future of the profession, and of family practice in particular. Methods A cross-sectional descriptive and analytical study was performed, using a pre-tested, validated, structured questionnaire. This instrument was personally hand-delivered to each of a group of private family practitioners practising within a confined geographical area. The sample comprised of 101 family practitioners. Data were analysed using SPSS version 15.0 (SPSS Inc., Chicago, Illinois). Results The study revealed that private FP possess limited knowledge about HL and have a negative attitude in general towards HL. The mean knowledge score was 55% (standard deviation 12.2%). The mean score for attitudes towards health legislation was 46,3% (standard deviation 4.2%). The correlation coefficient between knowledge and attitudes was 0.244 (p=0.022). Therefore, there was a weak positive, but statistically significant, correlation between knowledge and attitudes. Thus, in general, as knowledge increased, so did attitudes improve and become more positive. The self reported knowledge and attitudes of FPs seemed to show some unexpected though non-statistically significant anomaly, in that FPs who considered themselves “well aware” of certain parts of HL, together with those who were “not aware”, reporting a more negative attitude towards HL than those who considered themselves to be “aware”. FPs’ perceptions of the future of the profession, and of family practice in particular, were generally reported as being reasonable to poor. Financial viability and sustainability of FP, in particular, were reported as being reasonable to poor. The attractiveness of the profession to the youth of today was reported as being poorer than in the past. However, the majority of FP held the perception that medicine as a profession was distinct as it responds to a calling to serve society at large, giving this aspect of the question a ranking of “reasonable to good”. Conclusion and Recommendations The study revealed that this group of FPs attained an overall mean knowledge score of 55% with respect to HL. FPs’ knowledge of HL requires improvement, which can be achieved through effective education and training programmes. Private FPs need to embrace the change process, but also need to be more pro-active in vocalizing their opinions. The Health Ministry and relevant authorities and policymakers need to play a greater role in creating an atmosphere that embraces and facilitates change by involving iii relevant stakeholders. Lastly, it is recommended that this study serve as a template for a broader research project involving larger numbers of participants and a wider geographical area. In addition, an intervention tool should be devised. Such a tool could take the form of a structured education programme on HL, with an associated monitoring and evaluation aspect, which would enable an assessment of the intervention programme in terms of its value and the influence it has on improving knowledge and attitudes.
Thesis (M.Med.Sc.)-University of KwaZulu-Natal, Durban, 2011.