Dissertations / Theses on the topic 'Public services policy advice and analysis'
To see the other types of publications on this topic, follow the link: Public services policy advice and analysis.
Create a spot-on reference in APA, MLA, Chicago, Harvard, and other styles
Consult the top 30 dissertations / theses for your research on the topic 'Public services policy advice and analysis.'
Next to every source in the list of references, there is an 'Add to bibliography' button. Press on it, and we will generate automatically the bibliographic reference to the chosen work in the citation style you need: APA, MLA, Harvard, Chicago, Vancouver, etc.
You can also download the full text of the academic publication as pdf and read online its abstract whenever available in the metadata.
Browse dissertations / theses on a wide variety of disciplines and organise your bibliography correctly.
1
Kabinga, Makondo. "Commercialising Zambia's urban water services : a critical analysis." Master's thesis, University of Cape Town, 2012. http://hdl.handle.net/11427/3786.
Full textAbstract:
This research critically analyses reforms undertaken in Zambia's water sector. Its main focus however, is on the corporatisation of Zambia's urban water services. The objective is to apply some selected indicators of water services improvement to establish whether the commercialisation of urban water services has improved water service delivery. The research uses qualitative and quantitative literature and generally relies on secondary data. Therefore, it is an exhaustive literature review of the available electronic and hard copy sources. Of particular relevance to the research are the National Water and Sanitation Council's (NWASCO) sector reports, which are comprehensive records of the performance of Zambia's Commercial Water Utilities (CUs).
2
Roe, Miranda, and manroe@aapt net au. "FAMILIES AT RISK � A CRITICAL ANALYSIS OF IMPLICATIONS FOR POLICY AND SERVICES." Flinders University. Politics and International Studies, 2006. http://catalogue.flinders.edu.au./local/adt/public/adt-SFU20061025.100933.
Full textAbstract:
This thesis examines policy and service delivery issues in the development of health and support for families at risk. The research focuses on families with children less than 7 years of age living in some of the most disadvantaged neighbourhoods of metropolitan Adelaide. The thesis draws on evidence of (a) barriers to service support perceived by these families and (b) their strengths and resources in order to identify and develop arguments related to key issues of policy and service delivery.
3
Liston-Garcia, Barbara Christine. "A Document Analysis of Two States' Child Protective Services Agency Permanency Policies." ScholarWorks, 2017. https://scholarworks.waldenu.edu/dissertations/4305.
Full textAbstract:
U.S. Child Protective Services Agencies (CPSA) have had mixed success in achieving stable, permanent placements for foster care children. To address the adverse effects of unstable placements on foster care children's emotional well-being and physical development, the Adoption and Safe Families Act of 1997 was enacted to better ensure permanency, safety, and well-being of children in foster care. Using Stone's policy paradox as the framework, the purpose of this qualitative document analysis was to explore whether policy constructs contributed to the success or failure of promoting permanency for foster care children. Data was used from 2 states, representing those most and least successful in terms of decreasing foster care populations during federal fiscal years 2011 to 2014. Data for this study consisted of publicly available documents, including statues, policies, and official publications. These data were analyzed using an inductive coding approach and then subjected to a content analysis procedure. Key findings indicated the states differed in 3 critical policy areas: incentives to achieve progress towards reunification; facts used to change behaviors among policy actors to achieve the goal of recruiting adoptive and foster care parents; power in terms of how authority was delegated to service providers. The findings of this research may enhance policymakers' and advocates' knowledge of policy issues critical to achieving permanency for children. It is recommended that future policy changes focus on the needs of the children and the alignment of statutes, policies, and publications so they promote adequate incentives, utilization of factual information, and consistent policy interpretation at the federal and local levels.
4
Miles, Mary Alice, and n/a. "A critical analysis of the relationships between nursing, medicine and the government in New Zealand 1984-2001." University of Otago. Faculty of Education, 2006. http://adt.otago.ac.nz./public/adt-NZDU20061024.145605.
Full textAbstract:
This thesis concerns an investigation of the tripartite arrangements between the government, the nursing and the medical sectors in New Zealand over the period 1984 to 2001 with a particular focus on primary health care. The start point is the commencement of the health reforms instituted by the Fourth New Zealand Labour Government of 1984. The thesis falls within a framework of critical inquiry, specifically, the methodology of depth hermeneutics (Thompson, 1990), a development of critical theory.
The effects of political and economic policies and the methodologies of neo-liberal market reform are examined together with the concept of collaboration as an ideological symbolic form, typical of enterprise culture.
The limitations of economic models such as public choice theory, agency theory and managerialism are examined from the point of view of government strategies and their effects on the relationships between the nursing and medical professions.
The influence of American health care policies and their partial introduction into primary health care in New Zealand is traversed in some detail, together with the experiences of health reform in several other countries.
Post election 1999, the thesis considers the effect of change of political direction consequent upon the election of a Labour Coalition government and concludes that the removal of the neo-liberal ethic by Labour may terminate entrepreneurial opportunities in the nursing profession. The thesis considers the effects of a change to Third Way political direction on national health care policy and on the medical and nursing professions. The data is derived from various texts and transcripts of interviews with 12 health professionals and health commentators.
The histories and current relationships between the nursing and medical professions are examined in relation to their claims to be scientific discourses and it is argued that the issue of lack of recognition as a scientific discourse is at the root of nursing�s perceived inferiority to medicine. This is further expanded in a discussion at the end of the thesis where the structure of the two professions is compared and critiqued. A conclusion is drawn that a potential for action exists to remedy the deficient structure of nursing. The thesis argues that this is the major issue which maintains nursing in the primary sector in a perceived position of inferiority to medicine.
The thesis also concludes that the role of government in this triangular relationship is one of manipulation to bring about necessary fundamental change in the delivery of health services at the lowest possible cost without materially strengthening the autonomy of the nursing or the medical professions.
5
Benson, Lucky. "An examination of e-government in the delivery of public services in Nigeria : a policy transfer analysis." Thesis, University of Manchester, 2018. https://www.research.manchester.ac.uk/portal/en/theses/an-examination-of-egovernment-in-the-delivery-of-public-services-in-nigeria-a-policy-transfer-analysis(bfb4d5b8-60c4-44f4-abf3-5061d36a4f0b).html.
Full textAbstract:
Policy transfer has been the dominant approach by both local policy actors and international donors to domestic policy development in less developed countries across Africa. Key to this type of policy transfer is the adoption of New Public Management (NPM) reform ideas and e-government strategies. Many of the existing studies on policy transfer focus on transfer between developed countries, ignoring transfer activities across Africa. As a result, transfers in the context of Africa are under-theorised and empirically there is a lacuna in extant empirical studies. Currently, the literature suggests that policy transfer across Africa a) originates from the global north and that pressures from international donors are the major causes of the transfer of e-government strategies in that continent, and b) governments in Africa implement the transferred policies for fear of losing loans, and other forms of benefits that come as a condition for policy transfer. This study seeks to demonstrate that both international pressures and domestic factors are responsible for policy transfer in less developed countries across Africa, and not all transfers originated from the global north. In addition, the use of coercive modalities by donor organisations and countries to impose policy transfer on African governments may not necessarily lead to a successful transfer. This is the case because local factors such as economic conditions, infrastructural deficits, bureaucratic resistance and lack of sufficient political support not international pressures shape the outcomes of implementation of transfer across Africa. But donors in many cases have overlooked the domestic contextual factors, and only coerce political office holders to transfer without engaging other critical domestic policy actors before the transfer. Two empirical cases: the Independent National Electoral Commission (INEC) and the Nigeria Immigration Service (NIS) are used in this study to examine the dynamics of the transfer of e-government strategies to Nigeria. The study looks at the origin of the transfer, the causes of the transfer, the actors involved and the modalities used for the transfer of e-government to Nigeria. Others include the factors that determine the outcomes of implementation and the lessons learnt in the transfer of e-government reform strategies from the international arena to Nigeria. A multi-level framework of policy transfer was used to study the dynamics of policy transfer at the international arena, national level and at the level of the implementing institutions. By using this approach, the study makes a range of both empirical and theoretical contributions to the debate on policy transfer in the context of Africa that have been ignored by the previous studies.
6
Herrrera, Elmer Ivan. "The Mental Health Services Act of 2004 and its impact on transitional age youth served in Los Angeles County| A policy analysis." Thesis, California State University, Long Beach, 2016. http://pqdtopen.proquest.com/#viewpdf?dispub=10046246.
Full textAbstract:
The Mental Health Services Act (MHSA) of 2004 was analysed using David Gil’s (1992) analytic framework. The strengths and weaknesses of the Act were assessed and special attention was placed on transitional age youth (TAY) who are consumers of Full Service Parternship (FSP) services in Los Angeles County. This analysis found that there have been some improvements in the provision of services to TAY as a result of the MHSA (2004). However, TAY continue to be a group that remains underserved despite the availability of MHSA (2004) funds. The lack of infrastructure of Department of Mental Health to oversee MHSA (2004) funded projects is likely one of the main reasons why new programs for TAY have not been developed. This analysis did find that TAY, who have been served under MHSA (2004) funded programs, have lower rates of incarceration and hospitalization. The recommendations for social work practice, policy and research are discussed.
7
Hill, Elizabeth B. "Comprehensive services for students with serious emotional disturbance: An analysis of state legislation and policy." W&M ScholarWorks, 1996. https://scholarworks.wm.edu/etd/1539618502.
Full textAbstract:
The purpose of this study was to examine state legislation and policy related to comprehensive, integrated services for students with serious emotional disturbance. Legislation and policy documents from nine states, Virginia (the pilot study), Indiana, Maryland, New Jersey, North Dakota, Oklahoma, Utah, Vermont, and Wisconsin, were examined. These documents were compared to a set of components extracted from the literature as recommended practice. The document analysis was confirmed through telephone interviews with state-level policymakers in each state's department of education, department of mental health, and/or department of children's services. Support documents were also examined to establish a history for each initiative and describe the model of service delivery created by each state's legislation.;Results indicated a core set of four components common to all 9 states studied: family focused services, full array of services, individualized services and an interagency collaborative structure. Two additional components were found to be present in the legislation of many of the states studied. Community-based services was found in seven states and flexible funding was found in six states. Three components were not found in the legislation of any of the nine states studied: co-location of services, unconditional care, and wraparound services. The degree of congruence between each state's legislation and the set of components ranged from 61% for New Jersey to 30% for Vermont.
8
Li, Yuen-yee Angel. "Trading funds : an analysis of developments and results /." Hong Kong : University of Hong Kong, 1996. http://sunzi.lib.hku.hk/hkuto/record.jsp?B17508344.
Full text
9
Sams, Lois K. "Discovering and Assessing Desired Student Financial Services at East Tennessee State University." Digital Commons @ East Tennessee State University, 2007. https://dc.etsu.edu/etd/2037.
Full textAbstract:
The purpose of this study was to discover and assess student financial services delivered to students enrolled at East Tennessee State University. The research was undertaken for institutional self-improvement. The research explored changes that have occurred in student financial services in the dynamic higher education market. The research revealed universities pursued best practices for the delivery of student financial services through expanded employee knowledge, restructured organizations, and integrated information technologies.
The research was conducted during October and November, 2006. The data were gathered from an online student survey of student financial services. The areas researched included: the Bursar office, the Financial Aid office, and online services. The results of the data analysis revealed problems with the students' perceived quality of existing financial services and the additional services students desire.
The research focused on student perceptions of the quality of financial services by age and gender classifications and response categories. Although no statistically significant difference was found between the age-gender classifications on the perception of the quality of the financial services studied, the research adds to our understanding of student financial services at East Tennessee State University. Recommendation for continued research included annual surveys of segmented student populations that include ethnicity, age, gender, and educational level. The research would be used for continuous improvement efforts and student relationship management. Also additional research was recommended for employee learning in relation to the institution's mission, goals, and values.
10
Parker, Dennis. "An Analysis of the Perceptions of African American Churches in their Delivery of Health and Human Services in Southeast DC." VCU Scholars Compass, 2012. http://scholarscompass.vcu.edu/etd/2846.
Full textAbstract:
President Bush’s Executive Order 13279 (December 12, 2002) encouraged the government to work with faith-based organizations to provide human services (i.e., Temporary Assistance for Needy Families, employment, homelessness services, and health care) to serve America’s low-income populations. Faith-Based Initiatives, and now President Obama’s Faith and Neighborhood Partnerships Initiative have created the foundation for further partnerships between faith-based organizations and local, state, and federal governments. Limited information exists regarding the overall effectiveness of the programs in encouraging churches, specifically African American churches, to engage in services delivery. This study explores the perceptions of church leaders that influence faith-based organizations, specifically African American churches in the southeast region of Washington, DC, to provide human services. The District of Columbia has eight local wards: southeast Washington encompasses Wards 7 and 8, and has a high concentration of poverty and African Americans. The District of Columbia Department of Human Services (2010) reports that in the year 2009, 97% of Ward 7 residents were African American with 26% residing in poverty; 94% of Ward 8 residents were African American with 35% residing in poverty. The work of early sociologists, W. E. B. Dubois and Franklin Frazier is utilized to frame the theoretical background (Ethnic Identity Model) for this study. Additionally, this study relies on an African American church analysis by Lincoln and Mamiya (1990) to highlight the historical and current role of the African American church. The purpose of this study was to examine the churches of southeast Washington, DC and the level of human services provided between 2000 and 2010, during both the Bush and Obama Administrations, to understand the perceptions of the factors that influenced the level of human services during the same time frame. The study utilized a qualitative design with descriptive statistics to shed light on human service delivery of faith-based organizations in the African American community. A semistructured interview was performed on a convenience sample of 20 pastors/church leaders of churches in southeast Washington, DC. These 20 churches were identified through the District of Columbia’s yellow pages and, additionally, other data sets including advocacy organizations and community groups. This study found that neither President’s Bush’s or Obama Faith Based Initiative significantly influenced the level of provision of human services by African American Churches located in Wards 7 and 8 of southeast Washington DC. Also this study found that the majority of African American churches in wards 7 & 8 in Washington DC are more flexible and able to determine the types of services they provide by the presenting community needs. The study results will inform policymakers about whether, and how, the churches’ role in service delivery changed after the implementation of President Bush’s Faith-Based Initiative. Presidents Bush and Obama view churches and community-based organizations as strong frontline resources to address desperate challenges related to poverty, but little is known about the effectiveness of their initiatives. The results of this analysis will assist churches, community organizations, and policy formulators in providing information that will help policymakers to make more informed decisions about the potential impact of churches for service delivery in the African American community. It will also provide information about barriers to participating as partners with the government.
11
Li, Yuen-yee Angel, and 李婉兒. "Trading funds: an analysis of developments and results." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 1996. http://hub.hku.hk/bib/B31965015.
Full text
12
Mouraviev, Nikolai. "An analysis of governance policy and practice in public-private partnerships in transitional economies : a case study of Kazakhstan and Russia." Thesis, University of Northampton, 2013. http://nectar.northampton.ac.uk/7250/.
Full textAbstract:
This research examines management of public-private partnerships (PPPs) in the two transitional countries of the former Soviet Union - Kazakhstan and Russia. The study focuses on how key PPP actors in Russia and Kazakhstan perceive and adapt to contract regulation, risk allocation and dispute resolution challenges in PPP management. The qualitative study draws on data from 30 in-depth semi-structured interviews with the respondents from four partnership projects, national and regional PPP centres, law firms and the government. Through a qualitative analysis of the interview data, four principal themes have emerged including partner opportunistic behaviour in a PPP; partner interaction; risk management in a PPP; and constraints and impediments to effective PPP governance. Utilising the PPP governance concept as the guiding theoretical framework, the research highlighted partners' opportunistic behaviour. A private partner exhibited its opportunism in a tariff setting and cost increases, whilst the public sector partners demonstrated their opportunistic behaviour by shifting public acceptance risk to a private party, exerting pressure in order to achieve results faster than contracted and framing a private partner's management flexibility. The findings revealed that partners from both sectors tend to downplay the significance of governance structures that would permit them to effectively interact and resolve all kinds of issues including those of risk management. Investigation of tools for dispute resolution between partners showed that this area of collaboration is virtually non-existent. Partners largely disregard formal mechanisms for dispute resolution and excessively rely on informal relations. The research identified a large number of commonalities in PPP management and no major discrepancy between Kazakhstan and Russia with regards to partnership management and PPP critical success factors. In the latter, managing public-private relationship during the entire project term is the principal factor. The study developed a model for more deeply understanding PPP governance in the two countries, which is the thesis' original contribution to knowledge. The model's core is the emergent PPP policy paradigm that the governments in both countries use. The study delineated the paradigm's principal elements and dynamics that contribute to PPP management changes in Kazakhstan and Russia. The research also contributes to knowledge by enhancing opportunism's definition and its application in the PPP setting.
13
Beatty, Kate, Kristin D. Wilson, Amanda Ciecior, and Lisa Stringer. "Collaboration Among Missouri Nonprofit Hospitals and Local Health Departments: Content Analysis of Community Health Needs Assessments." Digital Commons @ East Tennessee State University, 2015. https://dc.etsu.edu/etsu-works/6827.
Full textAbstract:
Objectives. We identified the levels of joint action that led to collaboration between hospitals and local health departments (LHDs) using the hospital’s community health needs assessments (CHNAs).
Methods. In 2014, we conducted a content analysis of Missouri nonprofit hospitals (n = 34) CHNAs, and identified hospitals based on previously reported collaboration with LHDs. We coded the content according to the level of joint action. A comparison sample (n = 50) of Missouri nonprofit hospitals provided the basic comparative information on hospital characteristics.
Results. Among the hospitals identified by LHDs, 20.6% were “networking,” 20.6% were “coordinating,” 38.2% were “cooperating,” and 2.9% were “collaborating.” Almost 18% of study hospitals had no identifiable level of joint action with LHDs based on their CHNAs. In addition, comparison hospitals were more often part of a larger system (74%) compared with study hospitals (52.9%).
Conclusions. The results of our study helped develop a better understanding of levels of joint action from a hospital perspective. Our results might assist hospitals and LHDs in making more informed decisions about efficient deployment of resources for assessment processes and implementation plans.
14
Lymon, Aleta Marie. "An Analysis of Employee Motivation After Metamorphose, Conglomerated Public Health Care Systems." ScholarWorks, 2019. https://scholarworks.waldenu.edu/dissertations/6350.
Full textAbstract:
A global epidemic of metamorphosed, conglomerated health care systems changed the face of public health care organizations. The problem is, public health care organizations merge into new systems, but the culture for each merged organization has not been formed under the new system. Public administrators, health care workers and the Department of Health and Human Services are affected when there are issues in health care behavioral practices and performance outcomes. Research found that employee motivation is hard to achieve when there are issues within the internal structure of a new system. Using Herzberg's motivation-hygiene and Tajfel and Turner's social identity theories as the foundation, the purpose of this correlational study was to examine the statistical relationship between growth opportunities, organizational culture, monetary compensation and employee motivation. Secondary data were used from a sample of 3,033 health care workers from 2 English hospitals in the United Kingdom. The data were examined using Point-Biserial Correlation Coefficient model statistical t test. The study's results concluded that growth opportunities, organizational culture, and monetary compensation significantly correlate with employee motivation. Recommendations included implementing systematic changes to the internal organizational structure by identifying and developing effective strategies to improve internal organizational practices and performance outcomes. Further research is needed for demographic comparisons. The study affects social change by informing the Department of Health and Human Services, health care organizations and public health administrators of various strategies that can be used to improve internal organizational practices performance outcomes.
15
O'Neil, Dara Veronica. "Predicting public managers' readiness for contracting of professional services in a changing State Government Agency." Diss., Available online, Georgia Institute of Technology, 2007, 2007. http://etd.gatech.edu/theses/available/etd-06282007-154406/.
Full textAbstract:
Thesis (Ph. D.)--Public Policy, Georgia Institute of Technology, 2008.Dr. Hans Klein, Committee Member ; Dr. Diana Hicks, Committee Member ; Dr. Barry Bozeman, Committee Member ; Dr. Gordon Kingsley, Committee Chair ; Dr. Michael Meyer, Committee Member.
16
Beatty, Kate, Jeffrey Mayer, Michael Elliott, Ross C. Brownson, Safina Abdulloeva, and Kathleen Wojciehowski. "Barriers and Incentives to Rural Health Department Accreditation." Digital Commons @ East Tennessee State University, 2016. https://dc.etsu.edu/etsu-works/6826.
Full textAbstract:
Context: Accreditation of local health departments has been identified as a crucial strategy for strengthening the public health infrastructure. Rural local health departments (RLHDs) face many challenges including lower levels of staffing and funding than local health departments serving metropolitan or urban areas; simultaneously their populations experience health disparities related to risky health behaviors, health outcomes, and access to medical care. Through accreditation, rural local health departments can become better equipped to meet the needs of their communities.
Objective: To better understand the needs of communities by assessing barriers and incentives to state-level accreditation in Missouri from the RLHD perspective.
Design: Qualitative analysis of semistructured key informant interviews with Missouri local health departments serving rural communities.
Participants: Eleven administrators of RLHDs, 7 from accredited and 4 from unaccredited departments, were interviewed. Population size served ranged from 6400 to 52 000 for accredited RLHDs and from 7200 to 73 000 for unaccredited RLHDs.
Results: Unaccredited RLHDs identified more barriers to accreditation than accredited RLHDs. Time was a major barrier to seeking accreditation. Unaccredited RLHDs overall did not see accreditation as a priority for their agency and failed to the see value of accreditation. Accredited RLHDs listed more incentives than their unaccredited counterparts. Unaccredited RLHDs identified accountability, becoming more effective and efficient, staff development, and eventual funding as incentives to accreditation.
Conclusions: There is a need for better documentation of measurable benefits in order for an RLHD to pursue voluntary accreditation. Those who pursue accreditation are likely to see benefits after the fact, but those who do not pursue do not see the immediate and direct benefits of voluntary accreditation. The finding from this study of state-level accreditation in Missouri provides insight that can be translated to national accreditation.
17
DeCarlo, Matthew P. "Implementation of Self-Directed Supports for Individuals with Intellectual and Developmental Disabilities: A Political Economy Analysis." VCU Scholars Compass, 2016. http://scholarscompass.vcu.edu/etd/4138.
Full textAbstract:
Self-directed supports, as a method of service delivery, have grown from small pilot programs in a handful of states to at least one program in every state. For individuals with intellectual and developmental disabilities (IDD), self-direction presents unique opportunities to engage in self-determined behavior and shape the services upon which they rely. Although the evidence base for self-direction is relatively robust, there is a significant lack of information on how implementation of self-direction is faring on the national level. The purpose of this study is to understand how the political and economic factors within and across states have impacted the implementation of a self-directed service delivery system.
18
Tashev, Azamat. "Understanding Ecosystem Services through Organizational Analysis: Application to the Truckee-Carson River System." Ohio University / OhioLINK, 2018. http://rave.ohiolink.edu/etdc/view?acc_num=ohiou1515072255449453.
Full text
19
Crudup, Deborah Kay. "A comparative analysis of the California Regional Center: Fair hearing process for individuals with developmental disabilities." CSUSB ScholarWorks, 2000. https://scholarworks.lib.csusb.edu/etd-project/1631.
Full text
20
Gay, Renaud. "L'Etat hospitalier : réformes hospitalières et formation d'une administration spécialisée en France : (années 1960 - années 2000)." Thesis, Université Grenoble Alpes (ComUE), 2018. http://www.theses.fr/2018GREAH014.
Full textAbstract:
L’étatisation libérale du système hospitalier français est un paradoxe bien établi que notre recherche propose de réinterroger par deux détours. Le premier est historique. Il s’agit d’ouvrir la focale temporelle en s’intéressant à un réformisme gestionnaire qui apparaît dès les années 1960, alors que la littérature sur la politique hospitalière se concentre sur la période postérieure aux années 1980. Le second est organisationnel. L’étatisation est moins appréhendée à travers la multiplication de normes et de procédures dans les hôpitaux que comme une mise en administration se traduisant par l’apparition et la stabilisation d’organisations publiques spécialisées. Au croisement de la sociologie de l’action publique et de l’étude de l’administration, notre questionnement porte sur la façon dont les réformes hospitalières successives peuvent contribuer à la définition, à l’affirmation et à la reconnaissance d’un centre politico-administratif dans une perspective sociohistorique. Nous avançons l'hypothèse générale que ces réformes cristallisent trois processus étroitement imbriqués participant à l'institutionnalisation d'une organisation administrative spécialisée que l'on appelle l'Etat hospitalier. Premièrement, elles soutiendraient une redistribution et une concentration des prérogatives administratives en matière hospitalière au sein d'une seule organisation (processus de monopolisation). Deuxièmement, elles favoriseraient l'accumulation par cette organisation de capacités administratives nouvelles qui lui donneraient une plus grande autonomie à l'égard des groupes extérieurs (processus d'autonomisation). Troisièmement, elles produiraient et seraient éclairées par un ensemble de savoirs spécialisés qui fonderaient la légitimité des interventions étatiques (processus de légitimation). Notre observation historique des activités réformatrices permet de dégager trois séquences temporelles qui montrent l’inégale continuité de ces processus et leur plus ou moins forte articulation en fonction des périodes historiques. Si les réformes contribuent à forger un Etat hospitalier relativement autonome, ses frontières organisationnelles et ses principes de légitimation ne sont pas définitivement arrêtés. Notre enquête s’appuie sur un protocole combinant travail archivistique, entretiens semi-directifs avec des conseillers ministériels, des hauts fonctionnaires et des experts du ministère de la Santé, lecture de la littérature grise (rapports administratifs et experts, publications ministérielles), de la presse professionnelle et généraliste, étude des débats parlementaires et analyse biographique du personnel administratif d'encadrement du ministère de la SantéThe « neoliberal statization » of French hospital system is a well-established paradox that our research reexamines through two ways. The first one is historical. It consists in studying managerial reformism which emerged in the 1960s, whereas most investigations are focused on policies implemented after the 1980s. The second one is organizational. The statization is to be understood less as proliferation of norms and procedures in hospitals than as the formation and the stabilization of public specialized organizations. At the intersection of the policy analysis and the sociology of administration, this study focuses on how hospital reforms can contribute to the definition, the consolidation and the recognition of a political-administrative center in a sociohistorical perspective. Our main hypothesis is that hospital reforms crystallize three interconnected processes which underpin the institutionnalization of a specialized administrative organization called the Hospital State. Firstly, reforms support the redistribution and concentration of administrative prerogatives on hospitals within one single organization (process of monopolization). Secondly, they help increase the capacities of this organization that in turn strengthen its autonomy from other agents (process of autonomization). Thirdly, they generate and rely on specialized knowledge that justifies state interventions (process of legitimation). Our historical observation of reform activities leads to outline three temporal sequences. These reveal an uneven continuity of these processes and their unequal articulation depending on historical periods. If reforms contribute to forging a relative autonomous Hospital State, its organizational boundaries and its principles of legitimation are far from being stabilized. Our investigation is based on various materials : records from administrative and private organizations ; interviews with minister’s advisers, senior civil servants and experts of the Ministry of Health ; grey literature (administrative and expert reports, ministerial publications) ; national newspapers and professional journals ; parliamentary debates ; biographies of supervisory staff members at the Ministry of Health
21
Lievaut, Jeanne. "Le "maillon faible" de la régulation des dépenses de santé en France : les comportements inattendus des médecins libéraux : quatre approches micrométriques longitudinales." Thesis, Paris 10, 2010. http://www.theses.fr/2010PA100140.
Full textAbstract:
L’objectif central de cette thèse est d’appréhender « le maillon faible » du système français de régulation et de contrôle des dépenses de santé, entendu comme un élément résiduel, « caché », qui empêche le système de parvenir aux objectifs ciblés. Nous mettons en œuvre les outils économiques et économétriques pour tester l’hypothèse selon laquelle les comportements dépensiers et inattendus des médecins sont liés aux politiques publiques. Pour appréhender le phénomène recherché nous menons quatre études micro–économétriques (qui sont économiques, quantitatives et sociologiques) de l’évolution du comportement du médecin omnipraticien libéral français. Nous nous sommes intéressés aux choix volontaires des praticiens portant sur les pratiques tarifaires et sur l’organisation du travail. Dans le cadre de l’approche économétrique, nous utilisons les données d’un panel non-cylindré de 8131 médecins libéraux différents observés durant la période 1979-2000 et représentatifs de la population concernée, ainsi que les méthodes économétriques appropriées à chaque cas étudié selon sa nature. Outre la validité de l’hypothèse, les résultats obtenus apportent des éléments de compréhension du type de rationalité du médecin, de ses motivations, des facteurs qui guident ses choix et des pistes d’explication de l’inefficacité des dispositifs politiques mis en œuvre. Ils fournissent également des réflexions sur les recommandations à faire en matière de mesures politiques et suggèrent de nouvelles pistes de rechercheThe main aim of that doctoral dissertation is to comprehend "the weak link" in the French system of regulation and control of health expenditure, understood us a residual, "hidden" element, which prevents the system from reaching the targets. We use the economic and econometric methods to prove the hypothesis that unexpected and wasteful medical behaviour can be caused by the public policy. There are four micro-econometric studies (which are economic, sociological and quantitative) of the French general self-employed practitioner’s behavioural evolution. We focus on the practitioner’s voluntary choices of the pricing practices and on the medical practice organisation. In the econometric studies, we use an unbalanced panel data comprising 8131 self-employed physicians who were observed over the 1979-2000 period and who are representative of the medical population, and different econometric methods depending on the analysis. Our results offer an empirical understanding of an unexpected medical behaviour phenomenon; they offer information about the practitioner’s rationality kind, the practitioner’s motivations, the factors exerting influence on their choices; and they offer clarification of the public policy’s inefficiency. Also, our results propose observations about a recommendation for policy measures and new approaches for the future research
22
Perrin, Faouzia. "Les réformes en santé en 2004 et en 2014 : nouvelle grammaire du discours ou re-fondation du système de santé français?" Thesis, Université Grenoble Alpes (ComUE), 2019. http://www.theses.fr/2019GREAH009/document.
Full textAbstract:
L'inscription perpétuelle sur l'agenda politique des problèmes récurrents liés à la « crise du système de santé » français depuis les années 1970-1990 justifie l’intérêt de la science politique.Tandis que l’affirmation forte d’un État, seul responsable légitime de la politique de santé, était la marque de la réforme en 2004, les discours de la réforme de 2014-2016 sont emprunts d’une nouvelle grammaire conjuguant territorialisation et gouvernance.La territorialisation comme réponse à la crise de l’État providence et la nouvelle gouvernance comme réponse à la crise de la gouverne de l’État sont des phénomènes décrits par les analystes des politiques publiques dans d’autres secteurs.Cependant, la « crise du système de santé » se présente comme étant de nature économique, fonctionnelle et organisationnelle et non pas politique. La rhétorique de la réforme promeut des solutions en tant que réponses à des problèmes décrits à l’aune de ces motifs.Nous nous proposons d’étudier non pas les problèmes justifiant la mise sur l’agenda, mais la fabrique de la réforme, l’étiquetage des problèmes, les solutions mises en mots dans les discours, les éléments de légitimation des solutions, la trame cognitive et les éléments normatifs constitutifs du discours de la réforme.Nous montrerons qu’une approche pluridisciplinaire associant courant cognitif de l’analyse des politiques publiques empruntant à la théorie de Kuhn, démarche pragmatique en référence à John Dewey, et théorie politique, ainsi qu’épistémologie de la santé croisée avec la connaissance en santé publique, permet de renouveler l’analyse de cette politique publique finalement singulière.La première étape de notre travail sera de procéder à une généalogie de l’ère de la réforme ayant débuté dans les années 1970, en intégrant deux oubliés, politique de santé publique et décentralisation en santé. Puis, nous nous attacherons à une déconstruction des deux notions communes de la rhétorique de la réforme : « santé » et « système de santé ». Enfin, nous analyserons cette dernière à l’aide des outils théoriques empruntés à la sociologie.Ayant ainsi repéré le cadre cognitif et normatif de la politique de santé en France et défini les thèmes-clefs qui la constituent, nous aborderons par une étude de contenu les discours des moments 2004 et 2014.À l’issue de cette étude, nous approfondirons notre étude par l’analyse du fondements de la crise et des éléments les plus signifiants constitutifs des derniers discours étudiés : gouvernance et démocratie en santé.Notre enquête met en évidence le motif central de la réforme : la fabrique d’une réforme perpétuelle comme processus de légitimation de l’État républicain. Au-delà de la réforme, se manifestent, un public en démocratie ainsi qu’un problème public, la question des principes de la politique de santé ainsi que de sa finalitéThe repeated and persistent appearance of issues related to the Health System crisis on every political agenda justifies the interest of political science in this field of research.As the 2004 reform’s bottom line was a strong affirmation that only the government can be legitimately responsible for health policy -a statement still favored by recent reforms- numerous official speeches about the last year’s reform contain a new language, using the “ territorialisation” and “gouvernance ” words.In fact, “territorialisation” as an answer to the Welfare State crisis, and “gouvernance” as an answer to the crisis in the ways of State governing, are both well-known Political Science subjects.Yet, the health crisis is not purported to be a political issue, but due to economics rather, mainly a functional and organizational one. As a consequence, matching solutions are usely thought in an economic and administrative way.Using cognitive and pragmatic approaches, our study neither aims at defining the terms of said crisis, nor justifying its presence on the political agenda. Rather, it addresses the solutions that are brought forward in the so-called ‘reform factory’ that are political speeches, as they have the power to legitimate deciding actors or their action.The first step taken in our method will consist in reporting bibliographic references for a political and historical deconstruction of the French health system, as well as analyzing the ‘health’ concept, in order to describe the cognitive framework of health policy. Special attention vill be paid to decentralization et public health.Then, these categories should prove to be helpful to study the current trends in the 2004 and 2014 periods of health reform in a discursive analysis, as we intend to do.To further investigate health reform manufacturing, we will focus on the new themes observed in these speeches : « gouvernance » et health democracy.Our thesis is that, through the language at play among these actors, there is a semantic fight loaded with power challenges to the State role in health Policy and therefore in the place ought to be given to the various actors in health public Policy. Finally, throw reforms, a new public for democracy came forward and new issues, that are principles and goals of health policy, appeared
23
Lucas, D. Pulane. "Disruptive Transformations in Health Care: Technological Innovation and the Acute Care General Hospital." VCU Scholars Compass, 2013. http://scholarscompass.vcu.edu/etd/2996.
Full textAbstract:
Advances in medical technology have altered the need for certain types of surgery to be performed in traditional inpatient hospital settings. Less invasive surgical procedures allow a growing number of medical treatments to take place on an outpatient basis. Hospitals face growing competition from ambulatory surgery centers (ASCs). The competitive threats posed by ASCs are important, given that inpatient surgery has been the cornerstone of hospital services for over a century. Additional research is needed to understand how surgical volume shifts between and within acute care general hospitals (ACGHs) and ASCs. This study investigates how medical technology within the hospital industry is changing medical services delivery. The main purposes of this study are to (1) test Clayton M. Christensen’s theory of disruptive innovation in health care, and (2) examine the effects of disruptive innovation on appendectomy, cholecystectomy, and bariatric surgery (ACBS) utilization. Disruptive innovation theory contends that advanced technology combined with innovative business models—located outside of traditional product markets or delivery systems—will produce simplified, quality products and services at lower costs with broader accessibility. Consequently, new markets will emerge, and conventional industry leaders will experience a loss of market share to “non-traditional” new entrants into the marketplace. The underlying assumption of this work is that ASCs (innovative business models) have adopted laparoscopy (innovative technology) and their unification has initiated disruptive innovation within the hospital industry. The disruptive effects have spawned shifts in surgical volumes from open to laparoscopic procedures, from inpatient to ambulatory settings, and from hospitals to ASCs. The research hypothesizes that: (1) there will be larger increases in the percentage of laparoscopic ACBS performed than open ACBS procedures; (2) ambulatory ACBS will experience larger percent increases than inpatient ACBS procedures; and (3) ASCs will experience larger percent increases than ACGHs. The study tracks the utilization of open, laparoscopic, inpatient and ambulatory ACBS. The research questions that guide the inquiry are: 1. How has ACBS utilization changed over this time? 2. Do ACGHs and ASCs differ in the utilization of ACBS? 3. How do states differ in the utilization of ACBS? 4. Do study findings support disruptive innovation theory in the hospital industry? The quantitative study employs a panel design using hospital discharge data from 2004 and 2009. The unit of analysis is the facility. The sampling frame is comprised of ACGHs and ASCs in Florida and Wisconsin. The study employs exploratory and confirmatory data analysis. This work finds that disruptive innovation theory is an effective model for assessing the hospital industry. The model provides a useful framework for analyzing the interplay between ACGHs and ASCs. While study findings did not support the stated hypotheses, the impact of government interventions into the competitive marketplace supports the claims of disruptive innovation theory. Regulations that intervened in the hospital industry facilitated interactions between ASCs and ACGHs, reducing the number of ASCs performing ACBS and altering the trajectory of ACBS volume by shifting surgeries from ASCs to ACGHs.
24
"Implementation of the National Skills Development Strategy (NSDS) with special reference to the Department of Correctional Services." University of the Western Cape, 2019. http://hdl.handle.net/11394/6997.
Full textAbstract:
Magister Artium - MAYouth unemployment has become a national crisis in South Africa. The South African government has put policies in place to combat this challenge. Among the policies that have been implemented to address the problem of unemployment, is the National Skills Development Strategy (NSDS). The purpose of this study is to analyse the implementation of the NSDS by using the Department of Correctional Services (DSC) as a case study. The study explores the importance of public policy monitoring and evaluation within the DCS. This study analysed the implementation of the NSDS by looking at the Five C’s approach to implementation. The Five C’s (content, context, commitment, clients and coalitions, capacity) which also formed part of the literature review and theoretical framework. The Five C’s will form the basis of selection and assessing the implementation of the NSDS in the DCS and its subsequent monitoring and evaluation. The researcher used a triangulation approach as a research technique, which means that the researcher utilized different methods in collecting data. The research used DCS as a case study, and also made use of academic journals, government reports and policies.
25
Xabendlini, M. T. "An examination of policy implementation of water and sanitation services in the city of Cape Town: a case study of the informal settlements in the Khayelitsha area." Thesis, 2010. http://hdl.handle.net/11394/3469.
Full textAbstract:
Masters in Public Administration - MPAThe focus of the study is on the implementation of public policies through provision of basic services such as water and sanitation in the City of Cape Town. The case study of the research is the informal settlements of Khayelitsha area which falls under the jurisdiction of the City of Cape Town. The study identified and analysed the socioeconomic conditions of the people living in the informal settlements of Khayelitsha and the impact of such conditions to their lives. The study emphasizes the role of all spheres of government in the implementation of public policies.The study identified various challenges faced by government in the implementation of public policies, particularly at local government level. Among the challenges is the lack of communication, lack of public participation and lack of capacity. The study emphasizes the importance of intergovernmental relations and cooperate governance in order to achieve the objectives of good governance and effective and efficient service delivery. The study reveals that civil society plays an important role in the implementation of public policies and also holds the government accountable to the people. It is important to indicate that government cannot achieve the goals and objectives of providing clean water and adequate sanitation facilities if communities do not form part of the structures that implement projects and programmes of development in their respective areas.Hence, the study emphasizes the importance of communication and consultation of communities on issues that directly affect them. The study emphasizes the fact that communities need to take control of the resources and infrastructure provided to them in order to avoid unnecessary expenditure of replacing and repairing resources damaged and destroyed by the very same community.
26
Choi, Sugy. "Examining the state policies and external organizational ties that affect women’s access to and engagement in substance use disorder treatment services." Thesis, 2021. https://hdl.handle.net/2144/42582.
Full textAbstract:
Women’s access to substance use disorder (SUD) treatment is affected by their social status and policies that present both opportunities and barriers to treatment. Motherhood, including pregnancy, tends to increase participation in health care and thus opportunities for referral to and engagement in SUD treatment. However, the multiple challenges of motherhood along with the social and legal sanctions that may be visited on mothers who use alcohol or drugs may impede access to treatment. Moreover, motherhood and drug use lie at the focus on great public and policy concerns due to the ways it has been construed in health policy discourse. There is a moral connotation regarding the criminalization of substance use during pregnancy. Mothers’ pathways to SUD treatment are complex, at turn they may be positively supported or seek to avoid opprobrium. Moreover, the opportunities and barriers continue to evolve. This dissertation sought to elucidate the contemporary settings in which mothers access SUD treatment, focusing on women’s use of health and social services and macro-level public policies, particularly the expansion of Medicaid with the Affordable Care Act and state laws that specifically criminalize drug use by mothers.
In Study 1, I reviewed the literature on access to SUD treatment services among pregnant women and women who have children. I found that women have unique opportunities and barriers to access treatment services. I built a conceptual model of women’s pathways into care according to the type of barriers that may encounter by each “gateway.” Gateways are formal institutions or settings that may act as “gates” between pathways and may refer patients to treatment, but not all gateways may be actively referring patients. These sources became the foundation for Study 2, in which I empirically tested whether women’s engagement in gateways identified in Study 1 would be an effective mechanism for promoting SUD treatment. The findings suggest that Medicaid eligibility and criminal justice involvement increased women’s access to SUD treatment services. In Study 3, I examined the effects of Medicaid Expansion on medications for opioid use disorder (MOUD) and treatment completion as it relates to state laws that criminalize substance use during pregnancy among pregnant women. I found that criminalization policies prevented Medicaid expansion from realizing its full effect on increasing access to MOUD for pregnant women. Altogether, these studies elucidated the need for women-centered and life-course adjusted approaches in engaging women in treatment.2023-05-14T00:00:00Z
27
Mungai, Gladys Caroline Njeri. "Tacit knowledge management in public institutions in Kenya: a case of the Kenya Institute for Public Research and Analysis (KIPPRA) Nairobi." Diss., 2014. http://hdl.handle.net/10500/14382.
Full textAbstract:
Tacit Knowledge is critical in an organization's ability to sustain a long-term competitive advantage. The systematic process for acquiring, organizing, sustaining and renewing tacit knowledge of employees has enabled organizations to survive in a robust economy. This study investigates the management of tacit knowledge at the Kenya Institute for Public Policy Research and Analysis (KIPPRA). The objectives of the study were: to identify the sources and types of knowledge at
KIPPRA; identify the enabling resources for tacit knowledge sharing; determine how tacit knowledge can be reused for innovation and competitive advantage; establish the role of management in creating
a conducive environment for tacit knowledge; identify the challenges experienced in the management of tacit knowledge; give recommendations and propose a model/framework for tacit knowledge
management at KIPPRA.
The study adopted a qualitative research method. Interviews and observation were used as primary data collection methods. The study targeted 60 employees of KIPPRA consisting of Researchers,
Young Professionals, Heads of Division, a Knowledge Manager and Administrative staff.
Qualitative data collected was organized, categorized and reported in verbatim. Pie charts and tables were used to give a graphical representation of the bio data of respondents.
The study found that: KIPPRA values knowledge as an asset but does not practice tacit knowledge management, both tacit and explicit knowledge exists however, no real effort has gone into the
management of tacit knowledge. The study also found that KIPPRA had tacit knowledge sharing, capture, transfer and storage avenues that have not been capitalized on. ICT infrastructure is available
however it does not support tacit knowledge sharing. No Communities of Practice exist at KIPPRA but tacit knowledge is reused for innovation, development and competitive advantage. KIPPRA’s
management has provided a conducive environment for tacit knowledge to thrive but trust, knowledge asymmetry, and hierarchical challenges have hindered tacit knowledge harnessing. No tacit knowledge related incentives are offered at KIPPRA. The study also revealed that employees experienced challenges such as identification and understanding of tacit knowledge, access of tacit
knowledge sharing platforms, and access to individuals with specific tacit knowledge, tacit knowledge hoarding, individualism and ICT related challenges in accessing tacit knowledge. Even thought the necessary elements required to facilitate Tacit Knowledge Management are available, no effort has been made to customize them to harness tacit knowledge.
The study concluded that for KIPPRA to have a competitive advantage it is important that the Knowledge Manager, with the Support of KIPPRA’s Management, have concerted efforts for harnessing tacit knowledge. Key recommendations include: establishment of Communities of Practice at KIPPRA that bring together like minded individuals and also enable the building of relationships based on trust among the employees, and investment in ICT mechanisms specific to
tacit knowledge management to enhance the harnessing and codification of captured tacit knowledge.
Employees should also be trained on the value of tacit knowledge sharing and individualism should be discouraged. The study also recommends the adoption of a proposed framework for managing tacit
knowledge at KIPPRA.Information Science
28
Klepac, Pogrmilovic Bojana. "A Critical Assessment of Physical Activity and Sedentary Behaviour Policies." Thesis, 2020. https://vuir.vu.edu.au/41819/.
Full textAbstract:
It is well established that physical inactivity is one of the main behavioural risk factors for noncommunicable diseases (NCDs). Research on sedentary behaviour (SB; i.e., sitting or reclining with low energy expenditure during waking hours) has grown rapidly in the past two decades, after epidemiological evidence indicated that high levels of sitting may pose a health risk. Research on physical activity (PA) and SB policies is considered underdeveloped, compared with other areas of PA and SB research. This thesis, therefore, aimed to: (1) map the evidence on indicators, development, and content of national PA and SB policies globally (Study 1); (2) develop a new conceptual framework for PA policy analysis – the Comprehensive Analysis of Policy on Physical Activity (CAPPA) framework (Study 2); (3) identify and critically assess available instruments for the analysis of national-level PA and SB policies (Study 3); and (4) analyse the availability, comprehensiveness, implementation, and effectiveness of current national-level PA and SB policies globally (Study 4). To achieve the aim of Study 1, a systematic scoping review of indicators, development, and content of national PA and SB policies was conducted. The achieve the aim of Study 2, an extensive review of literature, an open discussion between the authors, three rounds of a Delphi process, and two-rounds of consultations with PA policy stakeholders were employed in the development of the CAPPA framework. To achieve the aim of Study 3, a systematic review of instruments for national-level PA and SB policies was conducted, and the identified instruments were assessed against the CAPPA framework. To achieve the aim of Study 4, a survey was developed based on Study 3 findings and according to the CAPPA framework. PA policy experts from 173 countries (n = 76; response rate = 44%) were then asked to provide data on their national PA and SB policies by completing the survey. Study 1 found that PA policy research is much more developed than it was considered several years ago and that research on SB policies is still in its infancy. The following research gaps were identified: (i) there is a lack of PA and SB policy research in low- and middle-income countries; (ii) the definitions of PA and SB policies varied significantly across studies; (iii) most studies did not rely on any conceptual or theoretical framework; and (iv) studies have used a variety of methods to analyse PA and SB policies which may cause problems with comparability. The CAPPA framework, developed in Study 2, provides a novel definition of PA policy, which, if widely adopted, will help to standardise the scope and language used in future research. The CAPPA framework developed in Study 2 specifies 38 elements of a comprehensive analysis of PA policies in the following six categories: purpose of analysis; policy sector; type of policy; stage of policy cycle; and scope of analysis. It can be used to guide future studies related to PA and SB policy and provide a context for the analysis of its specific components. Study 3 found 16 instruments for PA policy analysis. Only two instruments include questions about SB policy and none of the instruments allows for the analysis of all the relevant components of national PA and SB policy. Therefore, developing new instruments or adapting existing ones is needed to enable a more thorough analysis of national PA and SB policies. Study 4 found that most countries have formal written PA policies, guidelines for PA, quantifiable national targets for PA, and PA surveillance or monitoring. However, the levels of comprehensiveness, implementation, and effectiveness of national PA policies are largely low-to-moderate. Compared with P A policies, SB policies are less available, comprehensive, implemented, and effective. Both PA and SB policies are more developed in high- income countries, compared with low- and lower-middle-income countries, and in countries of the European and Western-Pacific regions, compared with other world regions. Future studies should aim to focus more on low- and middle-income countries and countries from the African and Eastern Mediterranean regions. Comprehensive analyses of PA and SB policy, considering all elements specified in the CAPPA framework, are needed to facilitate PA and SB policy research, and the development and implementation of comprehensive and effective PA and SB policies.
29
Chislett, Wai-Kwan. "Perceptions of health professionals and parents of children undergoing weight-management therapy: childhood obesity management, treatment and policy implications." Thesis, 2019. https://vuir.vu.edu.au/40724/.
Full textAbstract:
Background: Childhood obesity is a global phenomenon and public health problem. It is a chronic health condition associated with a body composition of excessive fat impacting on a child’s physical and social development.
Public health initiatives addressing childhood obesity have had little success in reducing the prevalence of obesity or of returning children to a ‘normal’ BMI. Clinical guidelines recommend that health professionals from primary, secondary and tertiary settings should manage paediatric obesity. However, little is known about the current landscape of childhood obesity management: who is involved, what approaches are used, or what the main enablers or barriers to effective management are. Research has focused on the perceptions and practices of Australian general practitioners, but little is known about the experiences of other health professionals who manage childhood obesity.
The purpose of the study was to explore and describe how Australian health professionals and parents experience and perceive childhood obesity management. The aim was to access information that related particularly to facilitators and barriers of management.
Methods: Interpretative phenomenological analysis was used as an approach to examine and describe factors that influenced the ways in which health professionals and parents experienced and perceived the phenomenon of childhood obesity management. Semi- structured interviews were undertaken with health professionals and parents. The research comprised two studies.
Study 1 involved health professionals from private practice, weight-management clinics, hospital and community services in three Australian states. Participants were dietitians, paediatricians, psychologists, physiotherapists and endocrinologists.
Study 2 presents four case studies of parents who had attended a paediatric weight management clinic.
Findings: Health professionals described childhood obesity as a body size that put children at risk of poor health outcomes; the psychological impacts were particularly of concern. They discussed their perceptions of their role in diagnosis, assessment and treatment; and shared their experiences of carrying out these roles. Each perceived role was described in the context of barriers that presented both internal and external to the clinical management setting. This included a paucity of services to refer children with obesity, insufficient resources to support treatment and their inadequate knowledge/training to engage families and effectively implement prescribed changes to health behaviours. Furthermore, health professionals believed changes made during clinical interventions were unsustainable because of the impact of the wider environment, particularly ease of access to calorie-dense foods, sedentary activities and family circumstances.
The implications of the obstacles health professionals faced in treating childhood obesity were evident in parents’ interviews. Parents reported: difficulties accessing services due to limited availability and work hours; problems getting the whole family to attend sessions; resistance from other family members, including the children themselves. They believed health professionals played an integral role in gaining the entire family’s support. Parents wanted better strategies that would help their family more readily accept changes; however, they also acknowledged ensuring every meal for children was healthy was difficult due to the impact of an obesogenic environment. Ultimately, parents felt more in control of their family environment but were not confident these changes could be sustained, particularly when children were out of their direct care.
Conclusion: Childhood obesity management may benefit from a systems approach. This includes having a health infrastructure and training that supports the practices of health professionals so that optimal management can be achieved. Additionally, policies that address the environmental and social determinants of childhood obesity are required to support sustainable behaviour change initiated by clinical management.
30
Saldias, Rodrigo. "Effects of formal credit market and decisions to participate in off-farm activities on agricultural production of Small Farmers in Chile." Doctoral thesis, 2008. http://hdl.handle.net/11858/00-1735-0000-0006-B051-1.
Full text