Dissertations / Theses: 'Rural doctors'

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Skorupa, Sandra. "Development of a screening instrument to identify risk for the white coat effect in rural and non-rural patients." Diss., Online access via UMI:, 2007.

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2

Sutherns, Rebecca Lee. "Women's experiences of maternity care in rural Ontario, do doctors matter?" Thesis, National Library of Canada = Bibliothèque nationale du Canada, 2002. http://www.collectionscanada.ca/obj/s4/f2/dsk3/ftp05/NQ65835.pdf.

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3

Blue, Ian A. "The professional working relationship of rural nurses and doctors : four South Australian case studies." Title page, table of contents and abstract only, 2002. http://web4.library.adelaide.edu.au/theses/09PH/09phb6582.pdf.

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4

Somo, Tlou. "Job satisfaction amongst doctors working at rural hospitals of Waterberg District in the Limpopo Province." Thesis, University of Limpopo (Turfloop Campus), 2007. http://hdl.handle.net/10386/887.

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Thesis (MBA) --University of Limpopo, 2007
If medical doctors are expected to function effectively and efficiently to provide the highest quality of care to the largest number of patients in rural hospitals, it is imperative that they derive job satisfaction from their work and thus perform well. The present study aimed to investigate whether the doctors in the target population have job satisfaction. The doctors were selected from the rural hospitals of the Waterberg District of the Limpopo Province. An exploratory qualitative research design was used, which included a self administered questionnaire enquiring about the demographic and work situation variables. Content analysis was used to analyse qualitative data. The main findings that emerged from the study were that the respondents were dissatisfied with their work environment. The most common theme that emerged was related to the bad working conditions, lack of support from management, lack of proper equipment, and the salary or incentives in proportion to the workload. These findings highlighted the issues that can be addressed by the employing organisation.

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5

Marinus, Thurston Walter. "The role of communities in the recruitment and retention process of medical doctors for rural South Africa." University of Western Cape, 2013. http://hdl.handle.net/11394/3933.

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Magister Commercii - MCom
The purpose of this research study is to explore the variables that contribute to improving the process of recruiting and retaining rural doctors within the South African context. The aim is to explore rural doctors’ perceptions of the role which the rural community can and ought to play in respect of the latter process. A basic recognition is that the emphasis on the Mainstream Approach (which elevates health workforce planning and management as well as market-related interventions and solutions) cannot exclusively achieve the desired result of effective and efficient recruitment and retention of rural doctors. The ‘active’ role which communities can and ought to play in the recruitment/ retention process, is an overlooked and neglected aspect within the South African research and healthcare service-delivery context. Even though the notion of collaborative management and governance of human resources within the health sector is generally mandated from a policy and legislative perspective, the practical manifestation and implementation thereof remain limited or at best piece-meal. An alternative governance model with reference to the humanresources- in-health system outlines the Partnership Approach advocating the need for the establishment of practical working relationships, amongst an identified range of multiple-stakeholders. This study examines the notions of ‘passive’ vis-à-vis ‘active’ community participation equated to the Utilitarian and Community Empowerment/ Development Perspectives continuum. The study introduces the ‘Principle of Balancing Model’ as well as the notion of a ‘hybrid perspective’ as key underpinnings of an efficacious rural-doctor recruitment and retention process.

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Salins, Swarthick E. "Primary health care delivery in rural India : examining the efficacy of a policy for recruiting junior doctors in Karnataka." Thesis, St Andrews, 2008. http://hdl.handle.net/10023/630.

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7

MacLeod, Hugh. "Recruiting and retaining doctors in remote and rural British Columbia, --sticking together band-aids or creating a systemic solution?" Thesis, National Library of Canada = Bibliothèque nationale du Canada, 1999. http://www.collectionscanada.ca/obj/s4/f2/dsk1/tape8/PQDD_0005/MQ41808.pdf.

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8

Jasiukėnas, Aurimas. "Gydytojų motyvavimo dirbti rajoninėse sveikatos priežiūros įstaigose vertinimas." Master's thesis, Lithuanian Academic Libraries Network (LABT), 2013. http://vddb.laba.lt/obj/LT-eLABa-0001:E.02~2013~D_20130604_151744-96284.

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Darbo tikslas. Atskleisti gydytojų požiūrį į motyvavimą dirbti rajoninėse sveikatos priežiūros įstaigose. Uždaviniai. 1. Išskirti pagrindinius veiksnius, susijusius su gydytojo darbo rajono sveikatos priežiūros įstaigoje pasirinkimu. 2. Atskleisti problemas, su kuriomis susiduria gydytojai, neseniai pradėję dirbti rajoninėse sveikatos priežiūros įstaigose. 3. Išsiaiškinti gydytojų nuomonę apie priemones, kurios yra taikomos arba galėtų būti taikomos siekiant pritraukti ir išsaugoti gydytojus dirbti rajonuose. Tyrimo metodika. Taikant kokybinį tyrimo metodą, giluminio interviu būdu, apklausti 8 Lietuvos rajonų sveikatos įstaigose dirbantys gydytojai rezidentai ir 3 neseniai (iki 3 metų) rajonų gydymo įstaigose pradėję dirbti gydytojai. Rezultatai. Dirbti į rajonines sveikatos priežiūros įstaigas vykstama dėl mažesnės konkurencijos darbo rinkoje, didesnių atlyginimų. Gydytojai apie darbo vietas sužino skambindami patys į ligonines arba per turimus ryšius. Rajoninės įstaigos motyvuoja gydytojus atvykti dirbti į rajoną finansinėmis ir nepiniginėmis priemonėmis, siūlant didesnį atlyginimą, rezidentūros apmokėjimą, palankų darbo grafiką atvykstančiam gydytojui. Universitetų priemonės vertinamos negatyviai, nes yra netiesioginis dėstytojų ir gydytojų nuteikimas prieš darbą rajone, nėra sudaromos sąlygos studijų metų padirbti rajone. Gydytojas rajone įgauna žinių ir praktinių įgūdžių atlikdamas įvairesnių procedūrų, kartais srityse, kurios yra už jo kompetencijos ribų. Rajoninėse... [toliau žr. visą tekstą]
Aim of the study. To identify and analyze the doctors’ motivation aspects to work at hospitals in the rural areas. Objectives. 1. To identify the main factors that influence the doctors’ decision to work at hospitals in the rural areas. 2. To determine the problems that doctors are facing in their beginning at work in the rural areas. 3. To investigate the doctors’ opinion about the instruments that were used or could be adopted in practice to attract and retain doctors in rural hospitals. Methods. Qualitative study was used to get the information which contains motivating factors for doctors to work at the rural hospitals. Using in-deph semistructured questionnaires were asked 8 residency students and 3 doctors at rural hospitals. Respondents were selected using short (less than 3 years) working period in rural hospital criteria. Results. Lower competition in labor market and higher salaries are the push factors for doctors to choose the rural workplace. Most of the doctors request the hospitals directly for the vacant positions or get the information about available positions from people they know. Rural hospitals attract doctors with higher wages, refund the payment of residency studies and adjust a better working schedule. The incentives of universities should be better developed because there is lack of rural practice possibilities for the students. There is indeed strong influence made by lecturers who spread negative and inadequate approach about rural hospitals... [to full text]

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9

Woods, Joana Francisca. "A descriptive analysis of the role of a WhatsApp clinical discussion group as a forum for continuous medical education in the management of complicated HIV/TB clinical cases in a group of doctors in the Eastern Cape." University of the Western Cape, 2018. http://hdl.handle.net/11394/6589.

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Master of Public Health - MPH
Background: As South Africa’s HIV programme increases in size, increasingly complex HIV/TB cases occur that are often beyond the clinical scope of primary health care clinicians. In the Eastern Cape (EC) province, health facilities are geographically widespread, with a discrepancy of specialist availability outside of academic/tertiary institutions. The use of WhatsApp, a Mobile Instant Messaging (MIM) application, could facilitate learning and mentoring of primary healthcare clinicians in peripheral facilities. The aim of this study is to describe this app and its use as an alternative learning tool to improve clinician access to specialized management of complicated HIV/TB cases, as part of Continuing Medical Education (CME). Method: A an observational, descriptive cross-sectional study was conducted among a group of clinicians from the EC province that formed part of a Wits RHI WhatsApp HIV/TB clinical discussion group from January 2016 to July 2017. Data was collected using a structured anonymous internet questionnaire, distributed to the clinicians that formed part of the WhatsApp group, informed consent being obtained from participants prior to completion. Data was analysed with Epi Info, using descriptive and analytic statistics. Frequency distributions and cross tabulations were generated and bi-variate analysis was done to determine significant associations between relevant variables.

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10

Fitzpatrick, Lesley Maria Gerard. "Inventing cultural heroes : a critical exploration of the discursive role of culture, nationalism and hegemony in the Australian rural and remote health sector." Thesis, Queensland University of Technology, 2006. https://eprints.qut.edu.au/16371/1/Lesley_Fitzpatrick_Thesis.pdf.

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Rural and remote areas of Australia remain the last bastion of health disadvantage in a developed nation with an enviable health score-card. During the last ten years, rural and remote health has emerged as a significant issue in the media and the political arena. This thesis examines print media, policy documents and interviews from selected informants to ascertain how they represent medical practitioners and health services in rural and remote areas of Australia, why they do so, and the consequences of such positions. In many of these representations, rural and remote medical practitioners are aligned with national and cultural mythologies, while health services are characterised as dysfunctional and at crisis point. Ostensibly, the representations and identity formulations are aimed at redressing the health inequities in remote rural and Australia. They define and elaborate debates and contestations about needs and claims and how they should be addressed; a process that is crucial in the development of professional identity and power (Fraser; 1989). The research involves an analysis and critical reading of the entwined discourses of culture, power, and the politics of need. Following Wodak and others (1999), these dynamics are explored by examining documents that are part of the discursive constitution of the field. In particular, the research examines how prevailing cultural concepts are used to configure the Australian rural and remote medical practitioner in ways that reflect and advance socio-cultural hegemony. The conceptual tools used to explore these dynamics are drawn from critical and post-structural theory, and draw upon the work of Nancy Fraser (1989; 1997) and Ruth Wodak (1999). Both theorists developed approaches that enable investigation into the effects of language use in order to understand how the cultural framing of particular work can influence power relations in a professional field. The research follows a cultural studies approach, focussing on texts as objects of research and acknowledging the importance of discourse in the development of cultural meaning (Nightingale, 1993). The methodological approach employs Critical Discourse Analysis, specifically the Discourse Historical Method (Wodak, 1999). It is used to explore the linguistic hallmarks of social and cultural processes and structures, and to identify the ways in which political control and dominance are advanced through language-based strategies. An analytical tool developed by Ruth Wodak, Rudolf de Cillia, Martin Reisigl and Karin Leibhart (1999) was adapted and used to identify nationalistic identity formulations and related linguistic manoeuvres in the texts. The dissertation argues that the textual linguistic manoeuvres and identity formulations produce and privilege a particular identity for rural and remote medical practitioners, and that cultural myth is used to popularise, shore up and advance the goals of rural doctors during a period of crisis and change. Important in this process is the differentiation of rural and remote medicine from other disciplines in order to define and advance its political needs and claims (Fraser, 1989). This activity has unexpected legacies for the rural and remote health sector. In developing a strong identity for rural doctors, discursive rules have been established by the discipline regarding roles, personal and professional characteristics, and practice style; rules which hold confounding factors for the sustainability of remote and rural medical practice and health care generally. These factors include: the professional fragmentation of the discipline of primary medical care into general practice and rural medicine; and identity formulations that do not accommodate an ageing workforce characterised by cultural diversity, decreasing engagement in full time work, and a higher proportion of women participants. Both of these factors have repercussions for the recruitment and retention of rural and remote health professionals and the maintenance of a sustainable health workforce. The dissertation argues that the formulated identities of rural and remote medical practitioners in the texts maintain and reproduce relationships of cultural, political and social power. They have also influenced the ways in which rural and remote health services have been developed and funded. They selectively represent and value particular roles and approaches to health care. In doing so, they misrepresent the breadth and complexities of rural and remote health issues, and reinforce a reputational economy built on differential professional and cultural respect, and political and economic advantage. This disadvantages the community, professions and interest groups of lower value and esteem, and other groups whose voices are often not heard. Thus, regardless of their altruistic motivations, the politics of identity and differentiation employed in the formulated identities in the texts are based on an approach that undermines the redistributive goals of justice and equity (Fraser 1997), and works primarily to develop and advantage the discipline of rural medicine.

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11

Fitzpatrick, Lesley Maria Gerard. "Inventing cultural heroes : a critical exploration of the discursive role of culture, nationalism and hegemony in the Australian rural and remote health sector." Queensland University of Technology, 2006. http://eprints.qut.edu.au/16371/.

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Abstract:

Rural and remote areas of Australia remain the last bastion of health disadvantage in a developed nation with an enviable health score-card. During the last ten years, rural and remote health has emerged as a significant issue in the media and the political arena. This thesis examines print media, policy documents and interviews from selected informants to ascertain how they represent medical practitioners and health services in rural and remote areas of Australia, why they do so, and the consequences of such positions. In many of these representations, rural and remote medical practitioners are aligned with national and cultural mythologies, while health services are characterised as dysfunctional and at crisis point. Ostensibly, the representations and identity formulations are aimed at redressing the health inequities in remote rural and Australia. They define and elaborate debates and contestations about needs and claims and how they should be addressed; a process that is crucial in the development of professional identity and power (Fraser; 1989). The research involves an analysis and critical reading of the entwined discourses of culture, power, and the politics of need. Following Wodak and others (1999), these dynamics are explored by examining documents that are part of the discursive constitution of the field. In particular, the research examines how prevailing cultural concepts are used to configure the Australian rural and remote medical practitioner in ways that reflect and advance socio-cultural hegemony. The conceptual tools used to explore these dynamics are drawn from critical and post-structural theory, and draw upon the work of Nancy Fraser (1989; 1997) and Ruth Wodak (1999). Both theorists developed approaches that enable investigation into the effects of language use in order to understand how the cultural framing of particular work can influence power relations in a professional field. The research follows a cultural studies approach, focussing on texts as objects of research and acknowledging the importance of discourse in the development of cultural meaning (Nightingale, 1993). The methodological approach employs Critical Discourse Analysis, specifically the Discourse Historical Method (Wodak, 1999). It is used to explore the linguistic hallmarks of social and cultural processes and structures, and to identify the ways in which political control and dominance are advanced through language-based strategies. An analytical tool developed by Ruth Wodak, Rudolf de Cillia, Martin Reisigl and Karin Leibhart (1999) was adapted and used to identify nationalistic identity formulations and related linguistic manoeuvres in the texts. The dissertation argues that the textual linguistic manoeuvres and identity formulations produce and privilege a particular identity for rural and remote medical practitioners, and that cultural myth is used to popularise, shore up and advance the goals of rural doctors during a period of crisis and change. Important in this process is the differentiation of rural and remote medicine from other disciplines in order to define and advance its political needs and claims (Fraser, 1989). This activity has unexpected legacies for the rural and remote health sector. In developing a strong identity for rural doctors, discursive rules have been established by the discipline regarding roles, personal and professional characteristics, and practice style; rules which hold confounding factors for the sustainability of remote and rural medical practice and health care generally. These factors include: the professional fragmentation of the discipline of primary medical care into general practice and rural medicine; and identity formulations that do not accommodate an ageing workforce characterised by cultural diversity, decreasing engagement in full time work, and a higher proportion of women participants. Both of these factors have repercussions for the recruitment and retention of rural and remote health professionals and the maintenance of a sustainable health workforce. The dissertation argues that the formulated identities of rural and remote medical practitioners in the texts maintain and reproduce relationships of cultural, political and social power. They have also influenced the ways in which rural and remote health services have been developed and funded. They selectively represent and value particular roles and approaches to health care. In doing so, they misrepresent the breadth and complexities of rural and remote health issues, and reinforce a reputational economy built on differential professional and cultural respect, and political and economic advantage. This disadvantages the community, professions and interest groups of lower value and esteem, and other groups whose voices are often not heard. Thus, regardless of their altruistic motivations, the politics of identity and differentiation employed in the formulated identities in the texts are based on an approach that undermines the redistributive goals of justice and equity (Fraser 1997), and works primarily to develop and advantage the discipline of rural medicine.

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12

Filho, Rômulo Maciel. "Estratégias para distribuição e fixação de médicos em sistemas nacionais de saúde: o caso brasileiro." Universidade do Estado do Rio de Janeiro, 2007. http://www.bdtd.uerj.br/tde_busca/arquivo.php?codArquivo=7035.

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A distribuição geográfica de médicos é um problema com que se defrontam os sistemas nacionais de saúde e, no Brasil, tem se tornado um dos desafios para a consolidação do Sistema único de Saúde (SUS). A análise dos determinantes dessa distribuição está fundamentado em abordagens sobre o mercado de trabalho em saúde e no médico sua formação ou oferta inserido no contexto histórico, político, social e institucional em que são construídos. O referencial de análise proposto neste estudo tem como objetivo evidenciar os fatores e condicionantes que interferem na distribuição e fixação de médicos identificar possíveis estratégias de intervenção que podem ser aplicadas à realidade brasileira, no contexto das políticas públicas. O mote para essa discussão é a compreensão de que a forte concentração geográfica dos profissionais e dos serviços impede a concretização dos princípios que regem o Sistema Único de Saúde, particularmente no que se refere à universalização, à integralidade e à própria descentralização. As estratégias tentadas pelo governo brasileiro também são abordadas, mais especificamente, o Projeto Rondon, o Programa de Interiorização das Ações de Saúde e Saneamento (PIASS) e o Programa de Interiorização do SUS (PISUS). Essa análise é complementada com um estudo de caso sobre a experiência recente no campo da política pública em saúde destinada a minimizar a má distribuição de médicos no território nacional: o Programa de Interiorização do Trabalho em Saúde (PITS), implementado pelo Ministério da Saúde em 2001. Sua condição de estratégia inédita na política de recursos humanos em saúde em nosso país permitiu identificar aspectos relevantes para qualquer iniciativa que pretenda fortalecer a distribuição de profissionais de saúde, para além dos grandes centros urbanos. Por fim, o estudo oferece um referencial de análise para a distribuição e a fixação de médicos, construído a partir dos elementos contemplados na revisão da literatura, na discussão teórica, no aporte das experiências nacionais e internacionais e nos resultados obtidos no estudo de caso.
The medical geographical distribution is a matter that challenges the nationals systems of health and, Brazil, its becoming one of the main challenges to face to consolidate the SUS (Sitema Único de Saúde Unique System of Health). The analysis of the determinative ones of this distribution is based on approaches about the work market in health and the doctor his formation or offer inserted in the historical context, politician, economic, social and institutional where they are constructed. The referential of analysis considered in this study has as its objective to make evident the factors and conditioning matters that interfere with the distribution and retention of doctors and to identify possible strategies of intervention that they can be applied to the Brazilian reality, in the context of the public politics. The motto for this discussion is the understanding of that the strong geographic concentration of the professionals and of the services it obstructs the concretion of the principles that conduct the SUS (Unique System of Health), particularly as for the universalization, to the integrality and to the proper decentralization. The attempted strategies by the Brazilian government also are focused, emphasizing the Rondon Project, the PIASS (Program of Actions of health and Sanitation in the interior area of Brazil rural areas). This analysis is complemented with a case study on the recent experience in the field of the public health politics destined to minimize the bad distribution of doctors in the national territory: the PITS (a program to stimulate and increase work in the field of health in the interior area of Brazil), implemented by Ministry of Health in 2001. Its condition of unheard-of strategy in the politics of human resources in health in our country allowed identifying relevant aspects for any initiative that intends to fortify the distribution of health professionals towards out of the great urban centers. Finally, the study offers a referential of analysis for the distribution and retention of doctors, constructed from the elements contemplated in the bibliographic revision, in the theoretical discussion, in the related national and international experiences and in the results gotten in the case study.

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13

Chung, Kon Shing Kenneth. "Understanding Attitudes towards Performance in Knowledge-intensive Work: The Influence of Social Networks and ICT Use." University of Sydney, 2008. http://hdl.handle.net/2123/4018.

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Doctor of Philosophy (PhD)
Understanding factors that enhance or diminish performance levels of individuals is instrumental for achieving individual (low level) and organisational (high level) goals. In this study, the effect of social network structure, position, ties and information and communication technologies (ICT) use on performance attitudes of knowledge intensive workers in dispersed occupational communities is investigated. Based on social network theories of strength of weak ties and structural holes, and the social influence model of technology use, a theoretical framework is developed. In conjunction with qualitative interviews conducted with subject matter experts, the framework is used to further develop and refine a valid and reliable survey instrument. Secondly, network measures of degree centrality, density, structural holes (constraint and efficiency), tie strength and tie diversity are applied for exploring the association with ICT use and performance from a sample of 110 rural general practitioners. Empirical results suggest that network structure, position and ties of knowledge workers play a crucial role in individual performance and ICT use. In particular, degree centrality and task-level ICT use was found to be positively associated with performance while ego-network constraint was found to be negatively correlated with performance. In terms of ICT use, functional diversity and degree centrality were positively associated with task-level ICT use whereas ego-network efficiency was found to be negatively correlated with ICT use at the communication-structure level. Among the variables that showed significance, degree centrality best explained overall variance for performance, and functional diversity best explained overall variance for task-level ICT use, although professional accreditations remains a potent indicator also. The results from this study resonate with findings from past literature and extend traditional theory of social networks and performance within the micro level to include geographically dispersed individuals involved in knowledge intensive work. For individuals in such non-competitive settings, traditional network theories such as structural holes theory still apply. However, a key finding is that network structure is a much more potent predictor of performance although network position is important. The second key finding addresses a major gap in the literature concerning understanding social processes that influence ICT use. As the technology acceptance and the social influence models lack empirical evidence from a social networks perspective, this research shows that rather than the strength of ties which functions as a conduit of novel ideas and information, it is the functional tie diversity within individual professionals networks that increase ICT use at the task-level. Methodologically, the study contributes towards a triangulation approach that utilises both qualitative and quantitative methods for operationalising the study. The quantitative method includes a non-traditional “networks” method of data collection and analysis to serve as a fine complement to traditional research methods in behavioural studies. The outcome is a valid and reliable survey instrument that allows collection of both individual attribute and social network data. The instrument is theoretically driven, practically feasible to implement, time-efficient and easily replicable for other similar studies. At the domain level, key findings from this study contradict previous literature which suggests that professionals in occupational communities such as general practitioners decline in performance as they age. In fact, findings from this study suggest that age and experience do not affect for performance; rather, there is a negative relationship between experience and task-level ICT use, and that task-level ICT use is positively associated with performance in terms of attitudes to interpersonal care. Furthermore, degree centrality is also positively associated with professional accreditations, such as fellowship of the Royal Australian College of General Practitioners, which is conducive to performance in terms of attitudes to interpersonal and technical care. The contextual implication from the quantitative and qualitative evidence of this study is that while contemplating strategies for optimising ICT use or for improving attitudes to quality of care at the technical and interpersonal level, the importance of social structure, position and relations in the practitioner’s professional network needs to be considered carefully as part of the overall individual and organisation-level goals.

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Zhao, Nan, and 趙楠. "Village doctor as street-level bureaucrat and the impact on health care services in rural China." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2014. http://hdl.handle.net/10722/196453.

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The changes in the health care system have been remarkable over the past decades, along with the rapid economic development of China. The overall living standard of rural residents has generally improved; however, health expenses still make up a large part of their annual expenditure. During the new reform period, the importance of the village doctor has been emphasized by many scholars, and yet there are few studies conducted from the perspective of interactions between health administration, village doctor and rural resident to discover the invisible factors that influence the delivery of the health care service. Thus, this study aims to explore the street-level bureaucracy within the rural health care sector and its impact on rural residents. Guided by the Street-level Bureaucracy Theory and its application in public agency research, this study explores street-level bureaucracy in the grassroots health care sector in terms of health care regulation and provision before and after the recent series of health care reforms, and evaluates its impact on rural residents by analyzing health equity in terms of health care access, and the actual working and living conditions of the village doctor were identified. Apart from the official statistical data from document analysis and internet resources, the voices and advice of village doctors and rural residents in Jiangsu Province were also obtained from in-depth interviews, which provided the qualitative information for this study. There are four findings. First, as a typical street-level bureaucrat in the grassroots sector, the working condition of the village doctor has become more stable and their discretionary control has been enhanced greatly after the reforms, due to the implementation of specific rules and regulations and the changes in payment methods; Second, despite the fact that many regulations have been put into effect, compared to the supervision of the health administration, the payment method plays a significant role in the promotion of service equity; Third, village doctors regard their social reputation as important as their income, for they live in a small community network. Although the role of village doctor has been emphasized in the new reform, improvements in health equity are still not obvious and have had limited effect; Fourth, the function of the village doctor is not fully utilized, even though the coverage of current health insurance in rural areas has been tremendously expanded in the past decade. Accordingly, policy implications regarding the understanding of the work and social environment of village doctors in rural areas, especially on the future exploration of their function related to further reforms, are identified in the final chapter. Additionally, the theoretical and practical significances of this study have also been presented.
published_or_final_version
Social Work and Social Administration
Master
Master of Philosophy

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Taneka, D. "Estimating the performance of rural roads in remote areas." Thesis, Queensland University of Technology, 1996.

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Stewart, Donald J. "Rural students-urban schools: Rural students' experiences of computing in their urban post-compulsory education." Thesis, Queensland University of Technology, 2002. https://eprints.qut.edu.au/36676/1/36676_Digitised%20Thesis.pdf.

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This research focuses on the origins and nature of one cohort of students' computing experience as they progressed from their isolated rural junior setting to senior schooling in urban locations. The study investigated the influence of parents, teachers, peers and the wider rural community on their development as students in general. The data collection concentrated especially on how their rural upbringing influenced their educational outcomes, but serendipitously revealed the considerable effects of the religious beliefs held by many in their community. This further enhanced the capacity of the thesis to identify strategies needed to address the dilemmas that these students experienced. The study followed those members of a single cohort of students as they ended their compulsory education in a rural school and proceeded to post-compulsory, senior secondary, education in 'their nearest regional city. Some students entered the state schooling system while others opted for a senior education embedded within the religious boundaries of their Christian upbringing. The researcher maintained contact with these students socially, and also by meeting them weekly as they returned to their home town from their forays into the city. The research employed a phenomenographical approach in which regular meetings with the cohort were audio taped and later transcribed using a computer voice recognition package. The transcripts were then returned to the participants for validation and correction. These corrected transcripts were then analysed to reveal students' conceptions of their lived experiences of computing as part of their senior schooling, and these conceptions were then placed within an outcome space which illustrates the inter-relationships between them. The thesis reveals a complex relationship between rural families, how they live, how they interact with each other and how they perceive outsiders from the city. and illuminates the many quandaries they face in both their daily lives and their educational experiences. including communication problems between rural feeder schools and their urban counterparts; depth of curricula; and the impact that religious affiliations have on rural families. It concludes with a range of recommendations regarding the strategies that could be employed to help other teachers/educators who are placed in similar rural situations to understand the physical/developmental and cultural/spiritual inequalities that isolated rural families encounter.

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Duncan, Finley James. "Quality Control of Curriculum and Instruction in Rural North Florida High Schools." UNF Digital Commons, 1994. http://digitalcommons.unf.edu/etd/113.

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A model of managerial control and an instrument-The School Managerial Control Questionnaire was developed by Bogotch (1989). These were tested using a sample of elementary, middle, and high school teachers in the nation's fourth largest school district. A study by Williams (1990) used the same model and instrument with a sample of elementary school teachers from the same school district. This study used the same model and instrument to measure control processes exercised by principals in small, rural school districts in North Florida. The model reflects two managerial behavior styles: Discretionary and ministerial; four managerial control processes: Standards, information, assessment, and incentives; and four selected tasks of curriculum and instruction: Teacher evaluation, staff development, curriculum development, and selection of texts and instructional materials. In addition to the dependent variables studied, five independent variables related to the demographical responses from the high school teachers were measured along the managerial behaviors, control processes and the selected curriculum and instructional tasks. This study validated Bogotch's model and his instrument as they relate to rural high school principals.

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Hernandez-Martinez, Ana Celia. "Do You Speak "Doctor"? A Communication Skills Training Tool For Hispanic Patients." Diss., The University of Arizona, 2015. http://hdl.handle.net/10150/556442.

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Effective doctor-patient communication is critical to improving health outcomes. Good communication improves emotional health, symptom resolution, functional and physiologic status, and pain control. Conversely, ineffective communication leads to misdiagnosis, inappropriate treatment poor adherence, misuse of health services, and high patient stress. In the U.S., Hispanics are the fastest growing minority. Despite the high burden of illness among this population, Hispanics are less likely than other minorities to regularly see a health professional. This is explained in part because Hispanics navigate a health system designed for the majority, experience a mismatch between cultural values and health beliefs, and have limited English proficiency. These communication challenges contribute to health disparities among the Hispanic population living in the U.S. Despite the importance of doctor-patient communication, few communication interventions that focus on improving patient skills have been tested in this population. Therefore, the purpose of this study was to evaluate whether a patient communication intervention tailored for female Hispanic patients could be practically implemented in a practice setting. The first aim focused on adapting existing communication skills training tools for a Hispanic population. The second aim assessed the feasibility of implementing the training tool in a federally qualified health center in a US-Mexico border community. The third aim explored the extent to which trained patients were able to integrate the information provided. Results indicate that it is feasible to implement communication training when delivered by clinical staff. Patient follow-up revealed that patients valued training on how to communicate with their doctor the most. Moreover, it is feasible to sustain the intervention when it is aligned with the priorities of the clinical site. Patient communication training in medically underserved rural areas could improve barriers to improved health outcomes in communities with a high prevalence of Hispanic patients. Future funding is needed to further test, dissemination of communication training programs.

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Hemphill, Jean Croce, and Florence M. Weierbach. "Innovative, Intentional Doctoral Course Design: Theory, Epidemiology, and Social Determinants of Health with Rural, Vulnerable, and Underserved Populations." Digital Commons @ East Tennessee State University, 2019. https://dc.etsu.edu/etsu-works/7394.

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Hemphill, Jean Croce, and Florence Weierbach. "Innovative, Intentional Doctoral Course Design: Theory, Epidemiology, and Social Determinants of Health with Rural, Vulnerable, and Underserved Populations." Digital Commons @ East Tennessee State University, 2019. https://dc.etsu.edu/etsu-works/7575.

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Porter, Suzette Adela Tindal. "Dental effectiveness in rural and remote Queensland." Thesis, Queensland University of Technology, 2000. https://eprints.qut.edu.au/35843/1/35843_Digitised%20Thesis.pdf.

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This research was stimulated by the knowledge that dental services to rural and remote consumers in Australia are unpredictable and will remain so into the future. Rural and remote consumers are disadvantaged in their access to dental services due to distance, scarcity of dentists, lack of choice· and variable quality of treatment and facilities. Nonetheless, it is clear that some rural and remote consumers are able to achieve sound oral health. This study examined these dental consumers in order to identify characteristics which may contribute to their success. Providing appropriate and adequate dental services to rural and remote towns is predicted to become more difficult and require greater travel due to both a reduction in the number of dentists and a smaller population base. Encouraging rural residents to become more effective as dental consumers may result in improved preventive practices, more positive attitudes to oral health and better dental status. Dental effectiveness is improved when the dentist-patient relationship is sound and when there is a source of routine and continuing dental care, features which should form part of public health policies and training of rural dentists.

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Gaede, Bernhard Martin. "Civil servant and professional – understanding the challenges of being a public service doctor in a plural health care setting in rural South Africa." Thesis, University of Pretoria, 2014. http://hdl.handle.net/2263/45907.

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Using insider-ethnography the study is an exploration of the experiences of public sector doctors in a rural hospital in KwaZulu-Natal. In the context of a complex policy environment as well as a stressed public sector struggling to meet its constitutional obligations, the daily work of public sector doctors is at the civil service professional intersection. Engagement at this intersection is strongly influenced by the local context of the individuals and communities served. Interactions are also shaped by the local plural health care system where public sector doctors, private general practitioners and traditional healers form complex networks that are largely informal and dependent on personal relationships. The study uses Lipsky’s street-level bureaucracy as a theoretical framework to understand and explore the challenges of being a professional, a bureaucrat and a public official in the public health care sector. In interpreting the rules of their various roles they make many complex decisions that require considerable discretion. In this, their daily work as civil servant doctors remains largely regulated and managed locally by the doctors themselves. The convergence of the roles of professional and civil servant provides public sector doctors leverage to synergistically use discretion individually and collectively within their daily work. While discretion is abused at times, in the setting of a larger system struggling to deliver services, many of public sector doctors voluntarily align their activities and practices with the ideals of providing a high quality care to the population served. In this discretionary practice is vital for the service to function. While bureaucratic and professional standards of practices create distance and detachment from the people they serve, in their interaction with colleagues and the public care and caring is evident. Critically, caring is contingent on the space that discretion provides doctors to engage. These findings have considerable implications for how the work of public sector doctors is conceptualized, planned and managed.
Thesis (PhD)--University of Pretoria, 2014.
tm2015
Family Medicine
PhD
Unrestricted

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Poulsom, Katherine. "Dental health in rural Zambia : a report of observations made while serving as first dental officer to the Zambia Flying Doctor Service, 1967-68." Thesis, University of Edinburgh, 1985. http://hdl.handle.net/1842/24229.

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Shen, Fujun. "Tourism and the sustainable livelihoods approach : application within the Chinese context : a thesis submitted in partial fulfilment of the requirements for the degree of Doctor of Philosophy at Lincoln University /." Lincoln University, 2009. http://hdl.handle.net/10182/1403.

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Tourism has been increasingly used for, and directly linked with, rural poverty reduction in developing countries. In recent years, it has, however, been criticised by rural developers for its lack of concern for the rural poor and for being too increasingly focused on tourism specifically. Instead, it is argued that these inadequacies can be addressed by the Sustainable Livelihoods Approach (SLA), a widely used organising framework for facilitating poverty reduction. But the application, and to an extent the principles, of the SLA may not fully fit the tourism situation, and vice versa. Therefore, a comprehensive understanding about the relationship between the SLA and tourism needs to be explored. This thesis incorporates a review of the literature on rural and tourism development. Gaps between the SLA and tourism are identified. It is suggested that the SLA cannot fully address the issues when tourism is used as a rural livelihood strategy. New knowledge and thinking are needed. Based on the literature review, a Sustainable Livelihoods Framework for Tourism (SLFT) is proposed as a guiding tool in rural development when tourism is a livelihood strategy. For testing the applicability of the SLFT, a mixed methodology and case study research method was adopted. Three mountainous rural villages, respectively at involvement, development and rejuvenation Tourism Area Life Cycle (TALC) stages, in central China, were examined. Before implementation of the case study, SLFT indicators were firstly developed. Findings show that the SLFT provides an overall organising framework for the consideration of rural development using tourism as a livelihood strategy at all stages of TALC. Revisiting the SLFT, it is argued that an additional attraction capital should be added to the SLFT. Attraction capital includes natural, cultural, and other attractions, and is defined as all resources used to attract tourist arrivals from which local people benefit for better livelihood objectives. Based on the findings, the SLFT and its key elements are revised to offer a more complete insight and understanding of a tourism livelihood system for the purpose of tourism planning and management. Particular attention is drawn to the newly introduced concept of institutional capital, mainly evidenced in community participation practice. Appropriate institutional policies and practices can ensure local people share the benefits from tourism. The implication of a participatory approach is extended to access to tourist markets, benefit sharing, as well as participation in the decision-making. This research indicates that improvement of livelihood assets by tourism enhances local people’s resilience to vulnerability contexts. Institutional arrangements play an important role in mediating this process as well as the impact of vulnerability contexts through the planning portfolio (e.g., planning, policy-making, and legislation). Future research is suggested to evaluate and improve the SLFT’s applicability in multiple development contexts, and to explore ways of further developing SLFT indicators as a means for evaluating the usefulness of the SLFT.

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Patterson, Jean Ann. "A time of travelling hopefully : a mixed methods study of decision making by women and midwives about maternity transfers in rural Aotearoa, New Zealand : a thesis submitted to the Victoria University of Wellington in fulfilment of the requirements for the degree of Doctor of Philosophy in Midwifery /." ResearchArchive@Victoria e-thesis, 2009. http://hdl.handle.net/10063/1028.

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Hucker, Graham. "The rural home front : a New Zealand region and the Great War 1914-1926 : a thesis submitted in partial fulfilment of the requirements for the degree of Doctor of Philosophy in History at Massey University." Massey University, 2006. http://hdl.handle.net/10179/1103.

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New Zealand’s First World War studies have traditionally focused on the soldier and battlefield experiences. ‘The Rural Home Front’ breaks with that tradition and focuses on the lives of people and the local communities that the soldiers left behind in the predominantly rural region of Taranaki in New Zealand. ‘The Rural Home Front’ is essentially a study of the impact and effects of the First World War on rural society. By focusing on topics and themes such as ‘war enthusiasm’, the voluntary spirit of fund raising and recruiting, conscription, attempting to maintain normality during wartime, responses to war deaths, the influenza epidemic, the Armistice and the need to remember, this thesis argues that civilians experienced the Great War, too, albeit differently from that of the soldiers serving overseas.

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Pini, Barbara. "From the paddock to the boardroom: The gendered path to agricultural leadership in the Australian sugar industry." Thesis, Queensland University of Technology, 2001. https://eprints.qut.edu.au/36642/1/36642_Digitised%20Thesis.pdf.

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The most recurrent theme in the early literature on women and farming is of women's invisibility. By the end of the 1990s, however, an important shift had occurred with farm women's increased visibility. Two international conferences had been held on women and agriculture, numerous rural women's groups had been formed across the world and a substantial literature had emerged documenting women's role and work on farms. However, despite the increased prominence given to the private lives of women farmers, they are still largely unrepresented in the public sphere of agriculture. In the Australian cane industry, for example, women hold none of the 181 elected positions of leadership in their agri-political group, CANEGROWERS. This anomaly between what we now know about women's important role in farming and their absence from decision-making positions in the sector, has shifted the focus of academic work on women and agriculture from examining family farming to studies of organisational culture and leadership. This thesis contributes to this shift in academic focus by reporting on an in-depth study of a single agri-political organisation, the Australian sugar industry's, CANEGROWERS. Its significance is that it makes important and critical links between the gendered processes and practices on the farm and the gendered processes and practices of the agri-political group. In both metaphorical and real terms it makes links between the 'paddock' and the 'board room'. This research derives its feminist perspective from a commitment to five key principles. These are focusing on women, valuing women's experiences and knowledge, rejecting the split between subject and object, emphasising consciousness raising and emphasising political change and emancipation. The research design includes both qualitative and quantitative data collection methods. A case study of CANEGROWERS using in-depth interviews with fifteen elected members, participant observation and document analysis, provides contextual data on the organisation and its practices and processes. A survey of 234 women involved in the industry gives a quantitative perspective on the nature of women's farm work, the barriers to their participation in CANEGROWERS and possible strategies to facilitate greater participation. Two final case studies of the district locations of Mackay and the Herbert River are used to present a descriptive and localised understanding of the issues. Both case studies use a range of methods including focus groups with forty women, in-depth interviews with CANEGROWERS' staff members and women who have stood for election, participant observation and document analysis. The main finding that emerges from this thesis is that the path to leadership within the agri-political group CANEGROWERS is subjective, closed and distinctly gendered. This is in distinct contrast to the way it is represented by elected members and some CANEGROWERS' staff as a process which is objective, open and gender neutral. This gendered path to leadership begins with how the notion of farmer is constructed solely in terms of the on-farm physical work undertaken largely by men. Thus; importantly, women's work on sugar cane farms, what they do and what they do not do, is intricately connected with their level of participation in the organisation CANEGROWERS. The research provides evidence of the fact that women are actively involved on sugar cane farms performing a myriad of roles which contribute to the industry's sustainability. However, the roles they perform and the knowledge needed to conduct these roles are not valued. What work and knowledge is valued is that relating to on-farm physical labour. Despite the popular and mainstream rhetoric about the need for new types of farming and new types of farmers, there persists across the industry a view that the farmer is involved solely (or most importantly) in physical work and it is this which is given status. To be a farmer is to do physical work and to do physical work is to be a male. Furthermore, having legitimacy within the industry as an elected leader is equated with one's status as a farmer and the knowledge one has as a result of participation in on-farm physical work. Thus, while elected members cite the importance of having a diversity of knowledge to make up an effective agri-political board, the knowledge to which they refer is extremely narrow. The knowledge that women might have, for example, as a result of their high level of participation in financial management, is not afforded the same status and therefore does not entitle them to be a contender for industry leadership. Even on those few occasions in the sugar industry, where; because of their involvement in physical work, women have seen themselves as having a right to stand as an elected member, the gendered path to leadership continues to militate against their involvement. They are told to be visible in an industry where women are seldom seen, in an industry which rarely gives visibility to the work they do or the knowledge they have and in an industry where their contribution as partners in a farming enterprise does not necessarily entitle them to :franchise in the organisation. In addition, women do not have access to the same opportunities as men for demonstrating their visibility because the types of forums where visibility is judged (such as at industry meetings) are the very forums where women report their presence as being either denigrated or questioned. An understanding of rural culture provides further insight into the gendered nature of visibility and the way in which men's visibility is judged very differently from women's visibility. Within this culture, a woman who does demonstrate visibility may find herself censured by both women and men for operating against the status quo. The gendered path to leadership within CANEGROWERS culminates in both the definition and application of merit. While the term is purported by CANEGROWERS' elected members to be gender neutral an examination of the many extraneous factors which impact on the electoral process and the way in which they have differential meanings for women and men indicate that this is not the case. These factors include lack of options, longevity in office, grooming for office, the concept of tradition and family name, popularity, appointments outside of election, the conservatism of the constituency and protocol. Ultimately, within the organisation CANEGROWERS, merit has been equated with being a male. The research concludes that, while very few strategies have been initiated by CANEGROWERS to address the question of women's representation, there is some possibility for change in industry-based networks for women. These networks have the potential to challenge homogeneous and androcentric constructions of terms such as 'knowledge' and 'merit' and the potential to give women the confidence, space and opportunity to be 'visible'. Unfortunately, the findings indicate that there has been a high level of resistance to these networks. The resistance has characterised the involvement of women as a divisive force for families, communities and the broader industry. The potency of this discourse in terms of limiting women's involvement in networks is evident when one appreciates the way in which farm women so often subjugate their own needs to ensure that harmonious relationships are maintained. Overall, to be a successful force for positive change, sugar industry networks for women must be seen as legitimate forums for women to practice industry leadership, must be given unequivocal support from industry leaders and must be adequately resourced by the organisation. Most importantly, the formation of these networks must not be viewed as absolving the organisation from any need to make changes to its culture, processes and practices. The aim must be to make CANEGROWERS not just a 'men's organisation' as it was so often described in this research, with women's networks on the margins, but an organisation where both men and women can participate fully and equally. It would be unjust and inexcusable if CANEGROWERS' commitment to this research was used to suggest that impediments to women achieving leadership positions exist only in the sugar industry. The evidence that is available from the broader studies cited above is that this is not the case. What is different about CANEGROWERS is that they have commissioned research which has examined the nature of the culture and the construction of merit within the industry. That other agricultural industry groups have not cannot be used to suggest that CANEGROWERS or the sugar industry are particularly different from other agencies or industries. It is likely that very similar cultural constraints exist within their own agencies and industries. At the same time, knowing that women are likely to experience difficulties in participating in leadership in other agricultural agencies does not excuse or justify women's lack of inclusion in CANEGROWERS. This merely indicates that the entire agricultural sector needs to work harder to achieve greater diversity in representative decision-making positions.

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Laurence, Caroline Olivia Mary. "Overseas trained doctors in rural and remote Australia: do they practise differently from Australian trained doctors?" 2008. http://hdl.handle.net/2440/49903.

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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

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Laurence, Caroline Olivia Mary. "Overseas trained doctors in rural and remote Australia: do they practise differently from Australian trained doctors?" Thesis, 2008. http://hdl.handle.net/2440/49903.

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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

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30

Purevjav, Bolormaa, and Bolormaa Purevjav. "Factors Affecting Doctors' Retention In Rural Areas Of Mongolia." Thesis, 2012. http://ndltd.ncl.edu.tw/handle/26229090580046424351.

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碩士
亞洲大學
國際企業學系碩士班
100
Abstract Background: Rural health facilities of Mongolia are facing serious doctors’ shortage. Though there is implemented several policies to improve retention of doctors in rural areas, still today there have been found difficulties to accept physicians in rural posts. Therefore this study aimed to examine the personal, financial and non financial factors that mostly affect physicians’ retention in rural areas of Mongolia. Methodology: This study used mix method approaches. Data analysis were examined by the quantitative method Descriptive statistic, Pearson’s correlation and Multiple regressions with level of significance set at 0,05. Survey used for quantitative method. The research variables were personal, financial and non financial factors and doctors’ retention in rural areas. And for the qualitative method was used qualitative content analyses and self administered survey. Result: Results of this study ensured that there are significant correlations between age, marital status, education of physician, hometown, salary, bonus, remote area allowance, family support, housing, support on bank loan, pension benefit, constant training and career advancement of physicians and doctors’ retention in rural areas of Mongolia. The self administered survey result highlighted the financial incentives. Conclusion: In conclusion, younger higher educated physicians who have family and grew up in rural areas willing to stay in rural areas when support of health workers will become sufficient. And a major important factor was financial incentives. Furthermore constant training and career advancements were the important non financial factors in doctors’ preferences to remain in rural areas. On these accounts Mongolian MOH has to develop and promote implementation of incentive packages much better than today through Mongolian rural areas. Key words: doctors’ retention, human resource for health, factors affect, incentives, rural area

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Tolhurst, Helen. "'Landscape of fulfilment': a model for understanding rural medical recruitment and retention." Thesis, 2009. http://hdl.handle.net/1959.13/41207.

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Research Doctorate - Doctor of Philosophy (PhD)
Background Due to an ongoing shortage of rural medical professionals both in Australia and internationally, the recruitment and retention of rural doctors has been extensively researched. Mostly the research used quantitative methods to focus on factors associated with rural medical workforce recruitment and retention issues, and until now, limited work has investigated inter-relationships between these factors. Although a few qualitative studies have used thematic analysis to develop models to better understand these issues, none have specifically considered the attitudes of medical students, and female rural doctors. This Thesis responds to this need by using qualitative research methods to develop a model which incorporates feminisation of the medical workforce and generational change in the 21st century. Data were collected from Australian medical students and female rural general practitioners (GPs) as study participants. Aims The broad aims were to develop a model for understanding recruitment and retention of rural doctors in Australia, incorporating concepts of place, gender, and professional identity. Research Questions How are Australian medical students' and female general practitioners' perceptions of entering and remaining in a rural health career influenced by the constructs of place, gender and professional identity? Does this perception change as doctors progress through their careers from students to practising general practitioners? Methods A case series of three qualitative studies were used to develop a model for understanding rural GP recruitment and retention. Data, collected using focus groups and interviews, were analysed thematically by domains describing participants’ lives, and the interaction between the domains was explored to better understand influences on location choice. Results The 'Landscape of fulfilment' model which is integral to this research, incorporates the domains of self, place, work, significant others, recreation, and significant others’ work as the domains of life which influence location choice. Most participants sought balance within their lives, and maximum fulfilment in all domains, but at times they faced conflict between domains. Individuals’ gender, professional, and place identities were related to how they viewed the domains and how the domains interacted. Conclusion This model provides a way of understanding the complex interaction between aspects of life which affect a doctor’s location choice. There is important potential to use the model to inform the development of rural medical recruitment and retention strategies, and as a basis for further rural health workforce research. The model has already been used by General Practice Education and Training (GPET) in developing post graduate general practice training research, and also by the Sustainable Practice Working Group of the Rural Faculty of the Royal Australian College of General Practitioners (RACGP) in developing strategies for sustainable rural general practice.

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Tolhurst, Helen. "'Landscape of fulfilment': a model for understanding rural medical recruitment and retention." 2009. http://hdl.handle.net/1959.13/41207.

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Research Doctorate - Doctor of Philosophy (PhD)
Background Due to an ongoing shortage of rural medical professionals both in Australia and internationally, the recruitment and retention of rural doctors has been extensively researched. Mostly the research used quantitative methods to focus on factors associated with rural medical workforce recruitment and retention issues, and until now, limited work has investigated inter-relationships between these factors. Although a few qualitative studies have used thematic analysis to develop models to better understand these issues, none have specifically considered the attitudes of medical students, and female rural doctors. This Thesis responds to this need by using qualitative research methods to develop a model which incorporates feminisation of the medical workforce and generational change in the 21st century. Data were collected from Australian medical students and female rural general practitioners (GPs) as study participants. Aims The broad aims were to develop a model for understanding recruitment and retention of rural doctors in Australia, incorporating concepts of place, gender, and professional identity. Research Questions How are Australian medical students' and female general practitioners' perceptions of entering and remaining in a rural health career influenced by the constructs of place, gender and professional identity? Does this perception change as doctors progress through their careers from students to practising general practitioners? Methods A case series of three qualitative studies were used to develop a model for understanding rural GP recruitment and retention. Data, collected using focus groups and interviews, were analysed thematically by domains describing participants’ lives, and the interaction between the domains was explored to better understand influences on location choice. Results The ��Landscape of fulfilment�� model which is integral to this research, incorporates the domains of self, place, work, significant others, recreation, and significant others’ work as the domains of life which influence location choice. Most participants sought balance within their lives, and maximum fulfilment in all domains, but at times they faced conflict between domains. Individuals’ gender, professional, and place identities were related to how they viewed the domains and how the domains interacted. Conclusion This model provides a way of understanding the complex interaction between aspects of life which affect a doctor’s location choice. There is important potential to use the model to inform the development of rural medical recruitment and retention strategies, and as a basis for further rural health workforce research. The model has already been used by General Practice Education and Training (GPET) in developing post graduate general practice training research, and also by the Sustainable Practice Working Group of the Rural Faculty of the Royal Australian College of General Practitioners (RACGP) in developing strategies for sustainable rural general practice.

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Arviers, Peter. "The Training and Education Needs of Emergency Medicine Doctors working in Rural and Regional Australia." 2007. http://eprints.utas.edu.au/7761.

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For professional and lifestyle reasons, most specialist doctors (including emergency medicine specialists) choose to live and work in major metropolitan centres. In rural and regional hospitals, emergency presentations are generally dealt with by ‘non-specialist’ doctors, often with limited peer support and minimal specialist backup. Recruitment of suitably trained medical staff for rural and regional hospitals is increasingly difficult. The doctors working in the emergency departments of these smaller hospitals are a mix of junior medical staff, Career Medical Officers, short term locums, and part time General Practitioners - with a high reliance on overseas trained doctors from widely varying backgrounds. While undergraduate and general practice training in rural areas has been extensively studied, there has been relatively little attention given to postgraduate specialty training and few studies on adverse events and health outcomes in rural areas.

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Blue, Ian Alasdair. "The professional working relationship of rural nurses and doctors : four South Australian case studies / Ian Alasdair Blue." Thesis, 2002. http://hdl.handle.net/2440/21833.

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McFayden, Lisa. "An examination of the structural and political barriers preventing permanent resident overseas-trained doctors from working as general practitioners in rural New South Wales." Thesis, 2008. http://hdl.handle.net/1959.13/29762.

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Research Doctorate - Doctor of Philosophy
This thesis explores the barriers that are preventing large numbers of permanent resident overseas-trained doctors (PROTDs) from working as general practitioners (GPs) in rural New South Wales (NSW). It focuses specifically on doctors from non-English speaking backgrounds who are permanent residents of Australia or Australian citizens, and who migrated to Australia for reasons other than employment. This thesis explores the views and perceptions of PROTDs and does not specifically consider the views of other stakeholders. Archival, qualitative and quantitative research techniques have been used to determine the suitability of the policies and practices governing the appointment and registration of PROTDs in NSW, and to identify any policy changes required. This research demonstrates that the policies governing medical registration in NSW have frequently been driven by political factors, and have, at times, been used to control the size of the medical workforce. As a consequence of these policies, many PROTDs have been prevented from working as a doctor in NSW. Of particular concern is the lack of training or clinical experience available to PROTDs and their difficulties preparing for, and passing, the Australian Medical Council (AMC) examinations. The lack of accurate information regarding the requirements and opportunities for medical practice in NSW is also a major problem. PROTDs in NSW are unable to get the training and support they need to meet the requirements for medical registration in NSW and are rapidly losing their confidence, and their clinical skills. Not all PROTDs are going to have, or be able to acquire, the skills and knowledge required for general practice in rural NSW. However the need for additional doctors is sufficiently great to warrant a proactive approach from governments and relevant agencies. In the seven years it has taken to complete this research, most of the discriminatory aspects of the assessment and registration of PROTDs in NSW have been removed. However the legacy of previous policies and practices remains and a large number of PROTDs remain out of the medical workforce.

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McFayden, Lisa. "An examination of the structural and political barriers preventing permanent resident overseas-trained doctors from working as general practitioners in rural New South Wales." 2008. http://hdl.handle.net/1959.13/29762.

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Research Doctorate - Doctor of Philosophy
This thesis explores the barriers that are preventing large numbers of permanent resident overseas-trained doctors (PROTDs) from working as general practitioners (GPs) in rural New South Wales (NSW). It focuses specifically on doctors from non-English speaking backgrounds who are permanent residents of Australia or Australian citizens, and who migrated to Australia for reasons other than employment. This thesis explores the views and perceptions of PROTDs and does not specifically consider the views of other stakeholders. Archival, qualitative and quantitative research techniques have been used to determine the suitability of the policies and practices governing the appointment and registration of PROTDs in NSW, and to identify any policy changes required. This research demonstrates that the policies governing medical registration in NSW have frequently been driven by political factors, and have, at times, been used to control the size of the medical workforce. As a consequence of these policies, many PROTDs have been prevented from working as a doctor in NSW. Of particular concern is the lack of training or clinical experience available to PROTDs and their difficulties preparing for, and passing, the Australian Medical Council (AMC) examinations. The lack of accurate information regarding the requirements and opportunities for medical practice in NSW is also a major problem. PROTDs in NSW are unable to get the training and support they need to meet the requirements for medical registration in NSW and are rapidly losing their confidence, and their clinical skills. Not all PROTDs are going to have, or be able to acquire, the skills and knowledge required for general practice in rural NSW. However the need for additional doctors is sufficiently great to warrant a proactive approach from governments and relevant agencies. In the seven years it has taken to complete this research, most of the discriminatory aspects of the assessment and registration of PROTDs in NSW have been removed. However the legacy of previous policies and practices remains and a large number of PROTDs remain out of the medical workforce.

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Brua, Charles R. Schrauf Robert. "Health-care access in a rural area perspectives from Russian-speaking immigrants, English-speaking doctors, and volunteer interpreters /." 2009. http://etda.libraries.psu.edu/theses/approved/WorldWideIndex/ETD-4211/index.html.

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Everitt-Deering, Patricia. "The adoption of information and communication technologies by rural general practitioners: a socio technical analysis." Thesis, 2008. https://vuir.vu.edu.au/1412/.

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This thesis has been supported by an ARC Industry Linkage grant and sought to explain the process of adoption of information technologies by comparing two main theories that have been developed to explain adoption of innovations, that of innovation diffusion and that of actor network theory. In the process of analysis for this thesis I decided very early on that the better way of explaining the pattern of adoption was by using the framework of actor network theory supported by qualitative methodology. A major contribution of this thesis could be seen as an ANT analysis of IT/IM in general practice. It appears that the multi partner, multi discipline research approach was a success for it created the opportunity to draw on diverse backgrounds. More importantly this research indicates that the qualitative research methodology of Actor Network Analysis has delivered an insight that is richer in data than the quantitative research that is usually undertaken in this field. This process assisted with enlightening the barriers and enablers to the adoption of information technology/information management (IT/IM) in general practice in a particular study area and to explain why, in the study area the pattern is fragmented and unclear. This study found it is important to note the difference between the adoption of IT/IM by general practice and adoption and use by general practitioners. The adoption process has been complex and many stakeholders have grappled with issues such as the cost of computerization, the rapid changes in technology, the lack of agreed standards and the problems of introducing technology information solutions in to the daily work place of general practice. Through comparison via case studies, extended interviews and implementing several study phases to develop a longitudinal aspect for the research, the teasing out of such issues as decision making in general practice and general practice as small business was undertaken. Through review of models that seek to explain adoption I will finalise by formalizing which theory of adoption better suits explanation of adoption of innovation within this study area. This thesis reports that while there are generally pockets of high uptake and use of IT/IM, this is not the complete picture across the study area and this reflects the situation in Australia. There are differences in adoption from one practice to another and even within practices; there are differences in adoption in terms of acceptance of an idea versus doing; in the study area there is only one practice which can reasonably claim to be paperless. Throughout this thesis a series of vignettes will be developed which set out to provide a whole play. Each vignette presents an aspect in the total picture of computerization. This thesis does not set out to provide the whole picture as that is still a work in progress, as such this thesis has no definite border, and the vignettes will sometimes show only the head and shoulders of the story with the background fading off. Other vignettes are very clear but as with all vignettes there are questions about the shaded areas. It is in these areas that questions arise to demonstrate there is greater depth in the story of the adoption of IT/IM in general practice in the study area, and, that adoption of IT/IM in general practice is complex and a continuing developmental story.

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Garcia-Ditta, Alexa Nicole 1986. "Doctor without borders : he's a physician who covers huge stretches of rural Texas -- and whose work provides key lessons about the fate and future of rural health care in America." Thesis, 2011. http://hdl.handle.net/2152/26572.

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Dr. Jim Luecke, a rural family physician in Alpine, Texas, is one of six doctors responsible for thousands of patients across a sprawling 25,000 square foot remote region of the state. He is a community doctor that travels between three towns to treat patients with various illnesses, injuries and income levels. But his type of general medicine is a dying practice in Texas, especially in rural areas. Texas, with a primary care and family physician shortage likely to get worse over the next several years, faces continued obstacles in providing access to quality healthcare in some of its most isolated areas. Luecke, while he embodies some of the challenges that come with practicing rural medicine, is in some ways an exception to those challenges.
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Bensemann, Jo. "Copreneurship in rural tourism : exploring women's experiences : a thesis submitted in partial fulfilment of the requirements for the degree of Doctor of Philosophy in the University of Canterbury /." 2009. http://hdl.handle.net/10092/3395.

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Roskruge, Nick. "Hokia ki te whenua : a thesis presented in partial fulfilment of the requirements for the degree of Doctor of Philosophy in Soil Science at Massey University, Palmerston North, New Zealand." 2007. http://hdl.handle.net/10179/1725.

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This thesis aIms to produce a distinctive model for the sustainable horticultural development of Maori resources, primarily land. It is inclusive of tikanga Maori and indigenous production systems based on the unique body of knowledge aligned to Maori. The integration of this knowledge with western science is both argued and applied through the model itself. The hypothesis applied was that matauranga Maori relevant to horticulture and pedology can inform and add value to the future development of Maori land resources. The thesis is bui lt on a unique set of contributing knowledge bases aligned to soils and horticultural management supported by three case studies, identified through their common association i.e. whakapapa links. The format of the thesis intentionally follows science principles in structure and presentation and some assumptions are made regarding base knowledge surrounding Maori cultural factors and the science disciplines relative to soils and horticul ture. The indigenous element, including Maori knowledge, is incorporated into the model using a triadic kosmos/corpus/praxis approach. Where kosmos is applied as Te A o Miiori, corpus as miitauranga Miiori and praxis as tikanga Miiori, the relationship between each element is clear and the interpretation of the associated knowledge becomes more apparent and can be applied to cultural assessments of resources, i ncluding land. The crux of the cultural assessment model is the quality of information used to assess Maori resources, especially from the cultural perspective. The Maori cultural paradigm, traditional horticulture and pedology, and various decision systems are purposefully accessed to act as contributors to the assessment model and to highlight the diversity and quality of information land managers have at their disposal. The ability to apply a cultural layer drawn from a body of knowledge not previously included in decision models relative to land utility in New Zealand is the key point. of difference of the model. The model is discussed from the perspective of its beneficial role for future use by Maori and how it can be continuously refined to meet the needs of Maori land owners and thus contribute to the rangatiratanga of Maori.

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Fitri, Resfa. "Informal finance and poverty alleviation : a grassroots study of small farmers' credit in West Sumatra, Indonesia : a thesis presented in fulfilment of the requirements for the degree of Doctor of Philosophy in Development Studies at Massey University, Palmerston North, New Zealand." 2006. http://hdl.handle.net/10179/1490.

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The main objective of this study is to explore the credit and savings behaviour of small farmers in rural areas of Indonesia, with particular reference to informal systems of credit. It examines the relationship between credit and rural poverty and on identifying small farmers' credit and savings behaviour as well as problems they encounter in accessing credit programmes at the grassroots level. In this study, the extent of informal credit programmes in rural areas is identified and an assessment is made of how important these schemes are to rural people, especially small farmers, from economic, social and cultural points of view. The influence of local culture and values on informal rural credit systems is also examined. Fieldwork was conducted in three villages of Solok district, West Sumatra, Indonesia. This study reveals that credit programmes, whether from the formal or informal sectors, have not had a positive impact on poverty alleviation. The majority of formal credit programmes in the three case study villages failed to give service to the rural poor, especially small farmers. It is likely that the reason for the failure was the unmet demand between the formal financial institutions as the credit providers and the small farmers as the credit recipients. The informal credit programmes were also unsuccessful in helping the poor to increase their income because the loans were small in size and were mainly used for fulfilling basic and emergency needs. Credit from informal sources is used for survival rather than for development. However, informal credit schemes were favoured by the majority of the rural population due to their flexibility and adaptation to local cultures and values. This study finds that informal credit schemes in these three case study villages have potential to empower local people and to strengthen traditional rural credit systems in the era of decentralisation. Arisan Suku, Julo-julo and 'friendly moneylenders' are examples of these informal credit schemes, and they figured significantly in the credit and savings activities of the poor in the study area. Therefore, this study rejects the conventional assumptions that informal finance is exploitative, insignificant and unorganised. The positive impact of local culture and values on the informal credit systems in the study area mainly focuses on the influence of local culture of Minangkabau and the value of Islamic religion in shaping rural informal credit systems. In this case Minangkabau people have been practicing credit and savings activities for a long time, and this reinforces the informal credit system in the area. Regarding the influence of Islamic values, this is in line with the current growing attention paid to the Islamic finance system, both at national and international levels. The positive impacts of local culture and values are important for developing a more participatory rural financial system. This study recommends that the future rural financial systems can be developed by combining positive features of both formal and informal credit systems.

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Suttisa, Choopug. "Civil society in the Chi River, Northeast Thailand : a thesis presented in partial fulfilment of the requirements for the degree of Doctor of Philosophy in Social Policy and Social Work at Massey University, Auckland, New Zealand." 2005. http://hdl.handle.net/10179/1550.

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The thesis 'Civil Society in the Chi River, Northeast Thailand', aims to answer the questions of what civil society means in the Northeast Thai village context, which factors make civil society proactive and how civil society is activated. Participatory action research (PAR) was carried out in two communities in the Chi River Basin to answer the inquiries. The research discusses the contexts of the Northeast Region and the two communities in the Chi River Basin. The people in this area are of the Thai-Laos ethnic group and hold particular beliefs in an amalgam of Buddhism and animism which creates cultural rituals that are different from other regions. The society is based on kinship ties. The economic situation has transformed from an agrarian society to a commercial agriculture society. Through the research process the new term of 'grounded civil society' was created. It means 'the sphere of an autonomous group of local people who actively participate in collective action to deal with their struggles and promote their common interests by mobilizing cultural and social capitals in consort with other people to productively solve their problems. Grounded civil society may include traditional forms of mutual assistance, and formal or informal social associations. It seeks to have a significant influence on public policy at any level'. The research found that grounded civil society was activated by both outside and inside factors. The outside factors included the negative effect of government development projects and the intervention of the participatory action research, which stimulated local people to engage in civil society. The inside factors activating civil society were the poor economic conditions of the villagers and the social capital existing in the communities. The social capital was built up around kinship ties and cultural capital, which generated the social values and norms of the local people. The research concluded with an analysis of the causal links between social capital and civil society claiming that social capital facilitated the creation of civil society. Further research possibilities are suggested.

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King, Peter Stanton. "Land and lineage : the articulation of social and physical space in an atoll village : a thesis presented in partial fulfilment of the requirements for the degree of Doctor of Philosophy in Sociology at Massey University." 1996. http://hdl.handle.net/10179/1306.

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This thesis examines relationships between the social and physical environments of a village on Butaritari atoll in Kiribati. The system of ambilineal descent and land inheritance obtaining there results in complex networks of genealogical relationships which affect most aspects of social life, including land rights. While previous studies conducted in Kiribati have recognised the intimate connection between genealogy and land rights, none has investigated its ramifications for the distribution of land rights within a community. In contrast, this study engages that question as a central concern using a framework which integrates Bourdieu's concepts of social space, field and habitus with post-neo-Darwinian ideas about the relationship between organism and environment. The social space was found to be primarily structured by relationships based upon genealogy and secondarily by age and gender, each of which constituted a field within the wider social space. The genealogical field was defined by a network of positions, each representing a particular descent group. In accordance with the prevailing system of ambilineal descent, residents could belong to more than one descent group and it was upon the resulting networks of relationships between descent groups that the disposition of those groups within the genealogical field was defined. Because land-use rights were associated with genealogical connections the reconstruction of the genealogical field encompassing all of the village residents was a necessary precursor to discovering the distribution of those rights and the genealogical field was a central point of articulation between the social and physical spaces. The fields of age and gender relations provided further points of articulation between the social and physical spaces, the natures of which are examined through discussion of the material culture of the village and village and island politics. Despite a contemporary ideology of egalitarianism there were vestiges of a former hierarchy of social status groups. While the inter-group obligations, rights and responsibilities associated with this hierarchy were no longer practised, the association of contemporary residents with those social status groups bore a relationship to their position within the genealogical field and the amounts of land to which they shared rights.

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Bajracharya, Bijaya. "Institutional factors that influence access of the poor to forest benefits : case studies of community and leasehold forestry regimes in Nepal : a thesis submitted in partial fulfilment of the requirement for the degree of Doctor of Philosophy (PhD) in Rural Development, Massey University, Institute of Natural Resources, Palmerston North, New Zealand." 2008. http://hdl.handle.net/10179/715.

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The community and leasehold forestry regimes (CF and LF regimes) are high priority programmes that are designed by the Nepalese government to conserve forests and reduce poverty through the introduction of formal institutions in terms of legal property rights and governance structures and processes. However, little is known about the mechanisms through which informal and formal institutions influence resource access of the poor under these regimes. By employing a collective case study approach, this research provides some understanding of the mechanisms through which formal and informal institutional factors influence access of the poor to forest resources governed under the CF and LF regimes in Nepal. This study found that informal institutional factors significantly influence the impact of formal institutions irrespective of the regime that was imposed on the Nepalese hill communities. It was revealed that where more than one social group co-exist in a community, discriminatory sociocultural norms (for example patriarchal and caste-based norms), and customary property rights favour one social group over others. As a result, certain social groups have greater access to resources and benefits from the resources than do other social groups. Of particular significance, and not previously reported, the lack of prior experience in collective action of the low castes along with their weak social networks and poor leadership ability is highlighted as being directly linked to their relatively limited access to forest resources. When the Bista system, a specific type of a traditional bridging social network is eroded, the low castes end up with less access due to removal of support from the high castes. This study shows that a more inclusive regime (for example CF regime) is likely to lead to more effective outcomes for the livelihood of the poor as compared to a more exclusive regime (e.g. LF regime). When the powerful are included in the forest user group (FUG), along with the poor, there is less resistance to the shift in property rights and the improved access of the poor to forest benefits that the regimes are intended to achieve. However, it was found that active participation is more determinant of resource access than is a specified set of property rights granted by right of membership in a FUG. Although some FUG governance structures provide a forum where the disadvantaged members of the FUGs have the right to participate in decision making, their participation is constrained by discriminatory sociocultural norms. Further, this study revealed that the decision-making processes dominated by the elites tend to address the needs of the disadvantaged members to only a very limited extent. However, improving capacities has the potential to enhance participation of disadvantaged members in the processes. The research findings suggest that informal institutions must explicitly be considered in the design and implementation of CBNRM regimes in order for them to be successful in improving livelihoods of the poor. The implementing staff need support mechanisms for changing their own attitudes and behaviours to those that are more favourable to the social shift that the regimes are intended to bring about. CBNRM regimes have the potential to improve the livelihoods of the poor, but research must continue on how this can be achieved.

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Cahn, Miranda. "Sustainable rural livelihoods, micro-enterprise and culture in the Pacific Islands : case studies from Samoa : a thesis presented in partial fulfilment of the requirements for the degree of Doctor of Philosophy (Ph. D.) in Development Studies, Massey University, Palmerston North, New Zealand." 2006. http://hdl.handle.net/10179/1532.

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This thesis is about the relationships between sustainable livelihoods, micro-enterprise and culture in Samoa. The 'sustainable livelihoods approach' provides a basis for analysis. The research focuses on one livelihood strategy, micro-enterprise, in order to illustrate and explain issues that are important in supporting sustainable livelihoods in Samoa. Micro-enterprise is regarded as a livelihood strategy that, if successful and sustainable, can support livelihood outcomes for rural Samoan people, and reduce poverty. The sustainable livelihoods approach is reviewed and the thesis argues that culture is integral to sustainable livelihoods, but existing theory and frameworks do not incorporate cultural aspects in a way that provides a sound theoretical basis for this research, or any sustainable livelihoods analysis. The thesis argues that culture is interwoven into each of the components of the sustainable livelihoods framework, and in fact culture is a context in which livelihoods exist. Each of the components provides an entry point for analysis of the relationships between culture and livelihoods. This concept was used as a basis for an analysis of rural livelihoods in Samoa, where fa'aSamoa was found to be interwoven with almost every aspect of rural livelihoods in a complex and influential way. A revised definition of a sustainable livelihood, and a revised framework were then developed which were more appropriate for this research. A strength of sustainable livelihoods theory, and the related frameworks, is that the theory embraces flexibility, and could thus be adapted to incorporate cultural aspects in this way. The thesis reviewed business enterprise in Samoa, and described the relationships between fa'aSamoa and business enterprise. The research revealed both harmonies and tensions between fa'aSamoa and business which influenced the success and sustainability of business enterprise. Two 'types' of small and micro-enterprise were identified in Samoa (with a continuum between): private sector enterprises and traditional 'sphere ' enterprises. 'Traditional sphere' enterprises, in order to be sustainable, normally operate within the cultural context of fa'aSamoa, ensuring that relationships, trust and harmony within the family and community are maintained and social and cultural assets, which provide a sense of identity and security, are sustained. The field research described in the thesis focused on two separate groups of micro-entrepreneurs in Samoa, fine mat weavers and village-based coconut oil producers. The case studies described the outcomes the micro-entrepreneurs aspire to, the risk, adversity, and challenges they face, and the work of the non-government organisations (NGOs) that support them. The case studies illustrated and further developed concepts developed in previous chapters, and also demonstrated just how the relationships between fa'aSamoa and sustainable livelihoods were expressed in practice. In the fine mat weaving case study there was considerable harmony between fa'aSamoa and the livelihood strategy. However, in the village-based coconut oil case study there were some tensions between fa'aSamoa and the venture that were causing vulnerability. The thesis concluded that understanding the relationships between culture, and sustainable livelihoods is critical for ensuring that good judgements are made about development intervention and policy. The revised sustainable livelihoods framework, and the concept of using the components of the frameworks as multiple entry points for analysis, provided an appropriate and useful theoretical framework for understanding the relationships between fa'aSamoa, sustainable livelihoods and micro-enterprise in Samoa.

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Parker, Richard John. "Technological advances in the analysis of work in dangerous environments : tree felling and rural fire fighting : a thesis presented in partial fulfilment of the requirements for the degree of Doctor of Philosophy in Management and Ergonomics at Massey University, New Zealand." 2010. http://hdl.handle.net/10179/1709.

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Ergonomists have always been interested in studying work and especially the safety aspects of work. Studying work in dangerous situations is an area that presents particular challenges to the researcher and potentially to the worker. The objective of this study was to explore the use of new technologies in facilitating the field study of people engaged in dangerous work situations without disrupting the work or adding to the danger. This was achieved through the investigation of work activity in dangerous environments: tree felling and rural fire fighting. The two case studies formed the basis for an investigation into three aspects of work: first, to record, measure and understand the work (including physiological workload) of people engaged in dangerous occupations; second, to understand how hazards were identified and dealt with by individuals working in extreme conditions and third, to gain insight into hazardous work environments for the purpose of enhancing training for personnel working in dangerous conditions. An innovative suite of equipment was developed for the study, enabling data collection that did not disturb or inhibit the individual working in dangerous, and sometimes extreme, conditions. The results of the study have shown that, through triangulation of novel combinations of recording instrumentation and video-cued reflective interview, we can gain rich interpretative insights into the working world of the tree faller and rural fire fighter and understand how they manage the hazards they confront in their work. This in turn enables us to develop practices designed to minimise or avoid physical risk to the worker, Furthermore, the annotated video collected in the forests and at fires can be utilised as an authentic resource for training of both workers and trainers. My study has highlighted the value of, and need for, research that is situated in real work environments, and that captures the multidimensionality of workers’ activities without impeding or altering their behaviour.

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Islam, Md Mofakkarul. "Sustainability failure of donor-supported organisational reforms in agricultural extension : a Bangladesh case study : a thesis presented in partial fulfilment of the requirements for the degree of Doctor of Philosophy (PhD) in Agricultural Extension and Rural Development, Institute of Natural Resources, Massey University, Palmerston North, New Zealand." 2007. http://hdl.handle.net/10179/776.

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For several decades, international donor agencies have provided considerable support for organisational reforms within the agricultural extension system in Bangladesh. This support has been provided through a series of short-term projects that have experimented with a variety of novel extension systems. These have ranged from the centralised training and visit model to decentralised subdistrict based systems to an even more decentralised farmer-led extension system. They have also ranged from an extension system operated by a single government agency to systems run by a partnership between government and non-government organisations. The experimentation has also involved a country-wide or large-scale system to local or small-scale systems. Furthermore, the reforms have varied from a single organisation providing only advisory services to farmers to a constellation of organisations providing a combination of services. However, in virtually every case, when donor support was removed at the completion of a project, the extension reform was found to be unsustainable post-project. Despite the continued failure of donor sponsored extension reforms in Bangladesh, little is formally known as to why such reforms have been unsustainable. Such knowledge is critical if donor-assisted extension reforms in Bangladesh are to be effective and sustainable. Therefore, the overall aim of this study was to determine the reasons why a donor-supported extension reform becomes unsustainable in Bangladesh. From a review of literature, a conceptual framework was developed outlining the conditions/factors under which organisational systems or innovations supported through donor projects do, or do not, become sustainable. Using a qualitative single case study approach, a poorly sustained extension reform supported through a donor project was investigated in depth in Bangladesh. From this investigation, a model that explains the non-sustainability of a donor supported extension reform in Bangladesh was developed. Several theoretically important findings were identified in this study. The extension reform was poorly sustained because the principles underlying the reform lacked cultural legitimacy. This problem was compounded due to the presence of perverse institutional forces in the operational context, and because the extension agencies concerned lacked adequate human and financial resources. The sustainability of the extension reform was also compromised because of poor implementation performance, complex design, parallel modes of project implementation, a failure to develop recipient ownership, and poor capacity to learn and adapt the reform. The mechanisms by which these factors influenced the non-sustainability of the reform are described in detail. The results from this study suggest that the sustainability of donor-supported extension reforms cannot be achieved within the short time frame set out in most projects. Nor can such changes be sustainable unless they are aligned with the norms, values and traditions of extension agencies and rural people. In particular, sustainability will continue to be a serious challenge unless the perverse institutional incentives confronted by extension agencies and rural people are minimised. The donors concerned in Bangladesh should support a locally-owned and single reform idea rather than undertaking haphazard projects with varied ideas, improve inter-donor coordination and come up with a coordinated decision of not providing monetary incentives to extension agencies and rural people, support extension reforms according to the felt needs of recipients, and stop providing aid in the event of repeated failures.

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Mahat, Ishara. "Integrating gender into planning, management and implementation of rural energy technologies : the perspectives of women in Nepal : a thesis submitted in partial fulfillment of the requirements for the degree of Doctor of Philosophy in Development Studies, School of People Environment and Planning at Massey University, New Zealand." 2004. http://hdl.handle.net/10179/1744.

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Women in rural Nepal are heavily involved in management of energy resources particularly biomass, which constitute the main form of rural energy as is the case in most developing countries. Women's most time consuming activities in rural areas of Nepal are cooking, collecting firewood, and processing grain, all of which are directly associated with the rural energy system. Despite women's strategic interests in improved rural energy in Nepal, energy planners (normally male) rarely consider women's roles, needs, and priorities when planning any interventions on rural energy. This study targeted at rural women in the mid hill region of Nepal, has examined the socio-economic implications of alternative energy technologies (AETs) especially in terms of saving women's labor and time and increasing opportunities for them to participate in social and economic activities. The analysis indicates that there is a positive implication of AETs on women's workload especially with access to the micro hydro mills available in the villages. In general, women have been able to save their labor and time in collecting firewood, and milling activities, although this is not always apparent due to women using the saved time for other household chores. However, AETs were rarely used for promoting end use activities (such as, energy based small cottage industries) in order to enhance women's socio-economic status. In addition, AETs had rather limited coverage and were not able to fulfill the energy demands of all rural households. There were also limitations in the adoption of such technologies mainly due to financial, technical, and social problems. For instance, the solar photovoltaic system and biogas plants were still costly for the poorest households even with subsidies. Consequently, socio-economic gaps within small communities widened and became highly visible with access to such technologies. Women's participation was mainly in terms of their involvement in community organizations (COs) and representation in Village Energy Committees (VECs) rather than their active participation in planning and decision-making processes with regard to AETs. Nevertheless, women were actively involved in providing labor in construction work relating to AETs, and creating and mobilizing saving funds as a means to be involved in small income generating activities associated with AETs. This study ultimately suggests a framework for increasing women's participation in rural energy plans and programs at local and national level, and develops policy measures to enable integration of gender into energy planning and policies. This would help to address practical and strategic gender needs in terms of fulfilling basic energy needs managed by women, and providing them with opportunities to be involved in some social and economic activities, which lead towards the self-enhancement of women.

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Okorley, Ernest. "An operational framework for improving decentralised agricultural extension : a Ghanaian case study : a thesis submitted in partial fulfilment of the requirement for the degree of Doctor of Philosophy (Ph. D.) in Agricultural Extension, Massey University, Institute of Natural Resources, Agricultural/Horticultural Systems & Management." 2007. http://hdl.handle.net/10179/1404.

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The pressure on the public agricultural extension organisation in Ghana to improve its responsiveness to meet the needs of farmers has increased since the globalisation of trade in the early 1990s. To improve agricultural productivity and the livelihood security of farm households, the Ministry of Food and Agriculture in Ghana decentralised its extension service in 1997. Although this was a critical change in agricultural policy, the extension service has struggled to implement this policy effectively. Further improvement in the situation is hampered because there has been little research published in this area. To provide this understanding, a single-case study of a successful decentralised district level extension organisation in Ghana was used to identify the factors, processes and outcomes that contribute to its performance. The case organisation is an example of a district agricultural extension organisation that operates under a decentralisation system at the level of deconcentration, with a high farmer-to-extension agent ratio and limited and uncertain levels of Government funding. The results of the study emphasised the importance of the effects of both external and internal (or organisational) factors on the performance of the case organisation. The external factors included: (1) the political will to decentralise, (2) the level of decentralisation of other government departments, (3) the provision of a clear legal framework for decentralisation and (4) the existence of established institutions that are willing to support the decentralisation process. New external factors that were identified in this study were (1) the type and drivers of decentralisation, (2) stakeholders' willingness and commitment to support the decentralisation process and (3) the community characteristics in terms of land tenure arrangements and gender roles. The results confirmed the importance of the organisational factors prescribed in the literature: (1) stakeholder participation, (2) managerial and technical capacity, (3) operational funding and (4) accountability. However, the study also identified five other interrelated organisational factors that influenced the success of the case organisation that had not been previously reported in the literature. These included the needs to: (1) develop a needs-based extension programme, (2) expand the extension service focus and roles, (3) foster a cross-sector pluralistic extension approach (4) use needs-based groups for service delivery, and (5) extension staff attitudinal change. Multistakeholder (farmer and other organisations) participation was critical for the development of a needs-based extension programme. The case organisation had modified the traditional extension programme planning process to involve stakeholders at different levels of participation. Similarly, the case organisation involved stakeholders in its multilevel monitoring and evaluation processes. Stakeholder participation in planning and evaluation, although aimed ultimately at efficient and effective programme implementation and improvement, did enhance accountability. Because the case organisation had taken on a broader livelihood security focus to extension, the definition of farmer needs was extended to encompass on-farm and off-farm needs that have impact on the contribution agriculture makes to the livelihood security of farm households in the district. This broader livelihood security focus to extension required the case organisation to take on additional roles from those it traditionally held. In the study, a typology of such roles was developed and a role selection process used by the case organisation during its programme planning process was described. Similarly, because of this broader focus, the case organisation had to work both across sectors and with other extension providers from within the sector to meet the needs of farmers. Again, the multistakeholder programme planning process was central to fostering coordination and collaboration amongst the various extension providers in the district. Decentralisation has placed greater managerial responsibility on management staff of the case organisation. In addition, the livelihood security focus has required technical staff and attitudinal changes to develop and seek for a much broader range of skills and knowledge - meaning that the development of both managerial and technical capacity was important for the case organisation. Needs-based training, the development of a learning environment and the enhancement of staff motivation were critical for the development of staff capacity. As with other extension organisations in developing countries, the funding for the case organisation was limited and uncertain. To overcome these constraints, the case organisation had in place mechanisms to ensure its resources were used efficiently and that it could mobilise additional resources from outside the organisation. Resource efficiency was improved through an intensive monitoring system and the use of stable needs-based groups. Additional resources were mobilised by lobbying government and international donors for funds for projects that would meet the needs of farmers. Further resources were obtained through collaboration with other stakeholder organisations. Again, the multistakeholder planning process provided a platform for collaboration. Networking and special issue forums also provided mechanisms for enhancing collaboration within the district. Decentralisation was introduced into Ghana in 1997 with the aim of eventually developing a demand-driven extension system. Although viewed as successful, the case organisation has yet to achieve the level of farmer participation (i.e. self-mobilisation) that is required for a demand-driven extension system. Currently, after six years of decentralisation, the level of farmer participation can be classified as somewhere between consultation and collaboration. Therefore, the results of this study suggest that the transition from a top-down to a demand-driven extension system will take considerable time and resources.

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Dissertations / Theses on the topic 'Rural doctors'

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