Rozprawy doktorskie: „Rural health – Western Australia”

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Speldewinde, Peter Christiaan. "Ecosystem health : the relationship between dryland salinity and human health". University of Western Australia. School of Population Health, 2008. http://theses.library.uwa.edu.au/adt-WU2008.0127.

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Australia is experiencing widespread ecosystem degradation, including dryland salinity, erosion and vegetation loss. Approximately 1 million hectares (5.5%) of the south-west agricultural zone of Western Australia is affected by dryland salinity and is predicted to rise to 5.4 million hectares by 2050. Such degradation is associated with many environmental outcomes that may impact on human health, including a decrease in primary productivity, an increase in the number of invasive species, a decrease in the number of large trees, overall decrease in biodiversity, and an increase in dust production. The resulting degradation affects not only farm production but also farm values. This study examines the effects of such severe and widespread environmental degradation on the physical and mental health of residents. Western Australia has an extensive medical record database which links individual health records for all hospital admissions, cancer cases, births and deaths. For the 15 diseases examined in this project, the study area of the south west of Western Australia (excluding the capital city of Perth) contained 1,570,985 morbidity records and 27,627 mortality records for the 15 diseases examined in a population of approximately 460,000. Environmental data were obtained from the Western Australian Department of Agriculture?s soil and landscape mapping database. A spatial Bayesian framework was used to examine associations between these disease and environmental variables. The Bayesian model detected the confounding variables of socio-economic status and proportion of the population identified as Aboriginal or Torres Strait Islander. With the inclusion of these confounders in the model, associations were found between environmental degradation (including dryland salinity) and several diseases with known environmentally-mediated triggers, including asthma, ischaemic heart disease, suicide and depression. However, once records of individuals who had been diagnosed with coexistent depression were removed from the analysis, the effect of dryland salinity was no longer statistically detectable for asthma, ischaemic heart disease or suicide, although the effects of socio-economic status and size of the Aboriginal population remained. The spatial component of this study showed an association between land degradation and human health. These results indicated that such processes are driving the degree of psychological ill-health in these populations, although it remains uncertain whether this 4 is secondary to overall coexisting rural poverty or some other environmental mechanism. To further investigate this complex issue an instrument designed to measure mental health problems in rural communities was developed. Components of the survey included possible triggers for mental health, including environmental factors. The interview was administered in a pilot study through a telephone survey of a small number of farmers in South-Western Australia. Using logistic regression a significant association between the mental health of male farmers and dryland salinity was detected. However, the sample size of the survey was too small to detect any statistically significant associations between dryland salinity and the mental health of women. The results of this study indicate that dryland salinity, as with other examples of ecosystem degradation, is associated with an increased burden of human disease.

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Loh, Poh Kooi. "Innovations in health for older people in Western Australia". University of Western Australia. School of Medicine and Pharmacology, 2009. http://theses.library.uwa.edu.au/adt-WU2010.0051.

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Australia and many other developed communities are ageing rapidly, placing a strain on the delivery of health services. This thesis examines the use of innovative health services management coupled with information and communication technology (ICT) to more efficiently deliver services to disabled older people in the hospital, community and residential care. The hypothesis explored is that ICT can provide clinical services to older people in poorly serviced communities and groups, thus extending the influence and capabilities of specialist health care professionals. The relevance of these studies is predominantly for those people who live outside the metropolitan regions, particularly in remote and rural communities, and also for those frail older people, who because of disability, are unable to travel to specialist health services. There are a series of studies presented in this thesis which have all been published. They have demonstrated that in a community and rural setting, ICT use in the assessment and management of geriatric syndromes such as dementia is valid and practical. This included the validation of commonly used assessment tools via Telehealth. A Telehealth protocol for assessment of Alzheimer's Dementia (AD) was developed and published. The use of ICT to link health services clinical and administrative data for determining stroke outcomes and disability has been evaluated and a resource utilization prediction model developed. Finally, in residential care a survey and a qualitative study of poor uptake of ICT services in hostels and nursing homes revealed insights into ICT perception by the older people in care facilities and their professional staff. The implications and future development of these studies have been discussed, especially barriers to increased uptake of ICT, cost comparisons and the potential of future technologies such as video conferencing mobile phones.

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Lewis, Janice A. "The clinician manager in rural Western Australia: a sensemaking perspective of the role". Curtin University of Technology, Graduate School of Business, 2001. http://espace.library.curtin.edu.au:80/R/?func=dbin-jump-full&object_id=13059.

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Economic, political and social forces are driving the implementation of reforms in health service systems worldwide. As the health industry concentrates on ways to improve operations and to achieve overall cost effectiveness, health service organisations are developing and implementing structural changes to address issues of cost containment, utilisation and resource allocation. One approach has been to devolve resource allocation and utilisation decisions to the program or unit level. Clinical practitioners have been required to assume general management responsibilities in addition to their clinical role. A new type of clinician, the clinician manager has emerged to take on this task. Despite the trend towards the clinician manager role in many sections of health care world wide, there is little research in the area and a poor understanding of the experience of the role.The aim of this research was to explore clinician managers' perceptions of their experiences in their adaptation to and their enactment of the new role. The study was based in the symbolic interactionist paradigm. Sensemaking, the process by which individuals ascribe meaning to the events in their environment, provided a theoretical context that directed the inquiry. Grounded theory was the methodological approach. The research sample was made up of Directors of Nursing/Health Service Managers, a clinician manager role that had emerged from the restructuring of rural health services in Western Australia. Data was gathered from in-depth interviews.Findings suggested that sensemaking was influenced by structural and personal elements. Structural elements were created by the stakeholders, individuals and groups who relied on the clinician manager for the achievement of their goals but upon whom, in turn, the clinician manager relied upon for their support and cooperation. The sensemaking process of the ++
clinician manager was mediated by the interaction with the stakeholders - the most influential factors being the clinician manager's perceptions of the trustworthiness of the stakeholders, the political behaviour that characterised the interactions with the stakeholder and role stress. In particular, role conflict, role ambiguity and role overload emerged. Personal elements were the personal characteristics of the clinician manager - the most salient being the experience of role strain, self-efficacy (i.e. their belief in their ability to do the job) and their commitment to the sensemaking process.Circumstances in the environment constrained their reliance on others for validation of their explanations of events and the actions they took. Most made decisions based on intuition and "gut feeling" - validating these decisions with subjective evaluations of outcomes and retrospective explanations. These processes were further mediated by the characteristics of the individual, particularly perceptions of self-efficacy. The ways in which the clinician managers adapted to and interpreted their role was diverse, which made the role more an expression of individual preferences than a coherent part of a larger organisational structure. Findings indicated that the clinician managers relied on their sensemaking processes in order to explain the ambiguous nature of their practice environment and to plan actions within the context of a role that was poorly defined by the organisation.

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Mostafanejad, Karola. "Young adults' experience of living with a mental illness in rural Western Australia : a grounded theory approach /". Curtin University of Technology, School of Nursing and Midwifery, 2005. http://espace.library.curtin.edu.au:80/R/?func=dbin-jump-full&object_id=16160.

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It is estimated that one in five Australians are affected by a mental disorder, and the associated burden of living with a mental illness will become one of the greatest health care issues during the next 20 years. Since the 1960s, the care of people with mental disorders has been transferred to community settings including to rural areas of Australia through the process of deinstitutionalisation. However, research on young adults living with a mental illness in rural communities is limited, and the multidimensional experience of this group of young adults has not been previously explored. This study, guided by grounded theory methodology, explored young adults' experience of living with a mental illness in rural Western Australia. This thesis presents the findings of interviews with nine participants aged between 18 and 30 and places the findings within the context of relevant scientific literature. The constant comparative method used in grounded theory analysis identified that the basic social psychological problem experienced by all participants was "being shut out". The problem of being shut out consisted of two aspects: "being excluded" and "withdrawing from society". In order to manage the problem of being shut out, participants engaged in the basic social psychological process of "seeking normality". In seeking normality participants moved from a state of being shut out to one whereby they sought to take part in ordinary social activities taken for granted by other members of society. The process of seeking normality consisted of three phases: "floundering", "taking charge", and "moving forward. Phase one of the process occurred primarily in the period prior to experiencing a turning point, which changed the participants' willingness to take control of their life and to take effective steps in reducing their isolation.
Participants' experience of being shut out was not related to the duration of their illness but to their experience of seeking normality and the three conditions identified as influencing that experience. The findings, while supporting existing scientific literature, also present a new insight into young adults' experience of living with a mental illness in rural Western Australia. The findings of this study highlight the importance of health professionals' understanding young adults' experience of being shut out and to incorporate the increased knowledge and understanding into their clinical practice. Finally, the findings have implications on public education, healthcare services and healthcare policy in relation to young adults living with a mental illness.

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au, martinia@westnet com, i Angelita Martini. "Community participation in government and private sector planning: a case study of health and telecommunications planning for rural and remote Western Australia". Murdoch University, 2006. http://wwwlib.murdoch.edu.au/adt/browse/view/adt-MU20081002.100047.

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This study was conducted in the context of health service planning in an environment of changing government strategies for regional, rural and remote area health care and telecommunications infrastructure planning in Western Australia. The study provides an account of the State Government of Western Australias planning for the implementation of a telecommunications network infrastructure, and specifically the Telehealth Project, conducted between 1998 and 2002. The purpose of this study was to examine influences on community participation in planning within the dynamic political, economic and social forces that impact on the development of regional, rural and remote area health services. Specifically, the study outlines the issues and barriers in providing for significant local participation in projects that are centrally initiated and controlled. It examines the influences in planning for projects that incorporate local community based beliefs and needs, the requirements of collaborating with multiple state and national government departments, and the private sector. This study was situated within the interpretive paradigm, and is conceptualised within Donabedians (1969) framework for assessing and assuring quality in health care. The methodological approach is bound within a case study and consists of a participatory action research approach. The research method uses the single case to undertake in-depth interviews, observations and a survey to collect data from community, government and industry members as a basis for reflection and action. The findings of the study clearly indicated that there was consensus between all rural, remote and metropolitan area participants that telecommunications did offer the opportunity to provide increased, improved or alternative health services. However, there were a number of obstacles to the success of the planning process, including a lack of local community inclusion in planning committees, poor communication within central government agencies, overuse of external consultants, a bias toward the medical view, a limited scope of invitation to contribute, and local information being overlooked in the final implementation plan. Analysis of planning for the Telehealth Project reveals the implications of organisational and political stakeholders making final decisions about outcomes; and provides a reminder of the importance of engaging communities authentically when planning for health and telecommunications services which involve the public and private sectors. The originality and significance of this study stems from understanding how technology can advance community health; through measures such as the use of community participation strategies, through authentic community based leadership, truly representative participants, decentralised decision making, a focus on community based health needs and change management strategies that include all of these. Consequently, the study advances knowledge of community participation in planning, and the evidence suggests implications for practice, education and further research.

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Martini, Angelita. "Community participation in government and private sector planning: a case study of health and telecommunications planning for rural and remote Western Australia". Martini, Angelita (2006) Community participation in government and private sector planning: a case study of health and telecommunications planning for rural and remote Western Australia. PhD thesis, Murdoch University, 2006. http://researchrepository.murdoch.edu.au/184/.

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This study was conducted in the context of health service planning in an environment of changing government strategies for regional, rural and remote area health care and telecommunications infrastructure planning in Western Australia. The study provides an account of the State Government of Western Australia's planning for the implementation of a telecommunications network infrastructure, and specifically the Telehealth Project, conducted between 1998 and 2002. The purpose of this study was to examine influences on community participation in planning within the dynamic political, economic and social forces that impact on the development of regional, rural and remote area health services. Specifically, the study outlines the issues and barriers in providing for significant local participation in projects that are centrally initiated and controlled. It examines the influences in planning for projects that incorporate local community based beliefs and needs, the requirements of collaborating with multiple state and national government departments, and the private sector. This study was situated within the interpretive paradigm, and is conceptualised within Donabedian's (1969) framework for assessing and assuring quality in health care. The methodological approach is bound within a case study and consists of a participatory action research approach. The research method uses the single case to undertake in-depth interviews, observations and a survey to collect data from community, government and industry members as a basis for reflection and action. The findings of the study clearly indicated that there was consensus between all rural, remote and metropolitan area participants that telecommunications did offer the opportunity to provide increased, improved or alternative health services. However, there were a number of obstacles to the success of the planning process, including a lack of local community inclusion in planning committees, poor communication within central government agencies, overuse of external consultants, a bias toward the medical view, a limited scope of invitation to contribute, and local information being overlooked in the final implementation plan. Analysis of planning for the Telehealth Project reveals the implications of organisational and political stakeholders making final decisions about outcomes; and provides a reminder of the importance of engaging communities authentically when planning for health and telecommunications services which involve the public and private sectors. The originality and significance of this study stems from understanding how technology can advance community health; through measures such as the use of community participation strategies, through authentic community based leadership, truly representative participants, decentralised decision making, a focus on community based health needs and change management strategies that include all of these. Consequently, the study advances knowledge of community participation in planning and the evidence suggests implications for practice, education and further research.

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au, jmaxwell@katel net, i John Alexander Loftus Maxwell. "Rural veterinary practice in Western Australia 1964 to 2007". Murdoch University, 2008. http://wwwlib.murdoch.edu.au/adt/browse/view/adt-MU20081113.142241.

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Concern for the plight of rural veterinary practice in Australia existed throughout the 20th century. During the 1970s, the profession highlighted the problems faced by rural practitioners and in 2003, the Frawley Review examined current rural veterinary services. However, neither influenced the course of rural practice in Australia. The present thesis examined the status of rural practice in Western Australia from the 1960s to the present day. It did this by investigating the historical changes in agriculture during this period and their effect on rural practice. The practice at Katanning, in rural Western Australia, was used as a case study a study of the changes and adaptions made by that practice to remain viable. In 2006, surveys of both rural practitioners and government veterinary officers were conducted to obtain information of the veterinary services being provided to rural Western Australia. In addition, oral history interviews with a number of respondents to the surveys were carried out. Rapid expansion of Western Australian agriculture took place during the 1960s and was matched by growth in rural veterinary services. A government subsidy scheme recruited a number of veterinarians to the state. A Preventive Medicine/Animal Production service with sheep was established at Katanning in 1967. The reasons for developing such a service, its promotion, the results achieved and its subsequent failure are documented in the thesis. The 1970s was a troubled decade for agriculture and for those servicing it. The collapse of the beef-cattle boom was accompanied by a 20% reduction in veterinary staff in rural practice Australia-wide and a number of changes were implemented at Katanning to meet these circumstances. The 1980s saw a reduction in the economic significance of agriculture in Western Australia. At the same time, students from the Veterinary School at Murdoch University began graduating and, for the first time in the professions history, an overproduction of veterinarians existed. The 1990s was a period of relative stability, but was accompanied by major changes for the profession and rural practice. Many practices adopted merchandising and the sale of pet foods to supplement dwindling income. Previously, a male dominated profession, during this decade, it rapidly changed to one dominated by female graduates. Accompanying this gender change there was an increase in the demand for part-time work, whereas previously the profession had been predominantly a full-time vocation. The present decade opened with a questioning of the direction being taken by the profession and its undergraduate education. The current study revealed that the government veterinary services in Western Australia have contracted in size and scope, whilst at the same time, most rural practitioners attend companion animals at the expense of economic livestock. As a result, veterinary services to economic livestock have reduced and are likely to continue to do so and suggestions are made to counter this trend.

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Maxwell, John Alexander Loftus. "Rural veterinary practice in Western Australia 1964 to 2007". Access via Murdoch University Digital Theses Project, 2008. http://wwwlib.murdoch.edu.au/adt/browse/view/adt-MU20081113.142241.

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Tonts, Matthew A. "Rural restructuring, policy change and uneven development in the central wheatbelt of Western Australia". Curtin University of Technology, School of Social Sciences and Asian Languages, 1998. http://espace.library.curtin.edu.au:80/R/?func=dbin-jump-full&object_id=9689.

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This thesis examines economic restructuring and changing governmental regulation in the Central Wheatbelt of Western Australia. It argues that, for much of this century, Australian governments were committed to the development and maintenance of export orientated agriculture and stable rural communities. While the agricultural industry, and the rural society that it supported, were periodically affected by economic downturns, wars, and technological changes, the full socio-economic impacts were often tempered by interventionist agricultural, social and regional development government policies. Since the early 1970s, however, the Central Wheatbelt, and rural Australia more generally, have experienced profound economic, social and political changes. During this period, the rapid transformation of the global economy has contributed to a series of problems in the Australian economy, such as low levels of economic growth, rising interest rates, and increasing unemployment. In the case of agriculture, the upheaval in the global economy contributed to world surpluses of agricultural commodities, declining returns for food and fibre production, and the rising cost of farm inputs.Since the early 1980s, the response of Federal and State governments to the turmoil in the Australian economy has been to argue that the only workable solution to globalisation was the adoption of policies based on the principles of economic rationalism. However, this thesis argues that, in the Central Wheatbelt, the combination of global restructuring and policies based on economic rationalism have contributed to: the declining viability of family farming; farm amalgamation; labour force adjustments; the contraction of local economies; depopulation; public service rationalisation and withdrawal; and uneven economic and social development. It is contended that policies based on the principles of ++
economic rationalism have increased levels of uncertainty and socio-economic disadvantage in a region already adversely affected by the economic pressures associated with restructuring. The thesis concludes by arguing that a more integrated policy framework, based to a greater extent on the principles of social equity, is critical to ensuring the social and economic welfare of rural people.

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Wilson, Sally B. "Family Centred Care: A Descriptive Study of the Situation in Rural Western Australia". Curtin University of Technology, School of Nursing and Midwifery, 2004. http://espace.library.curtin.edu.au:80/R/?func=dbin-jump-full&object_id=15170.

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Family centred care is a concept espoused to be fundamental to achieving excellence in paediatric nursing. Although it is recognised that family centred care includes the child's rights to self determination the focus of this study is parental participation in the decision making and care of their hospitalised child at a partnership level. This is based on negotiation and requires frequent, effective communication between parents and nurses and for each to respect the other's knowledge and appreciate the other has something to offer in the relationship which will benefit the child. The purpose of this study was to identify whether family centred care was occurring in paediatric settings in rural Western Australia and explored parents' and nurses' perceptions of the concept. A questionnaire was designed based on the literature and common themes identified from focus groups. Convenience sampling was used and 15 rural hospitals facilitated participation of 243 parents who had a child under ten years of age hospitalised and 108 nurses who cared for children. Exploratory factor analysis identified four subscales from the parents' questionnaire and three subscales from the nurses' questionnaire which measured separate concepts of family centred care. Descriptive statistics were generated for each subscale, and independent t-tests, ANOVA and correlations were examined between independent variables and subscales of family centred care. There was a statistically significant difference in scores for parents' perceptions of `child friendly environment' between regional and district hospitals. Those parents who did not have social support scored a statistically significantly lower mean score for `respect as parent'. Nurses in district hospitals generated statistically significantly higher mean scores for `family focussed hospital' than those who worked in regional hospitals.
Parents and nurses both perceived that parents wanted to continue parenting their hospitalised child, however parents wanted to provide more nursing care than was perceived by nurses. Nurses' perceptions of delivering family centred care were greater than the perceptions of parents receiving it, however they were consistent in items that were scored low. Nurses did ask parents about the amount of participation they wanted in their child's care on admission however, it was not done on a regular basis. Parents perceived that nurses were unaware of other things that parents needed to attend to while their child was hospitalised and therefore did not enable parents to attend to these needs. More frequent negotiation of roles between parents and nurses by communicating each shift, or at least daily, could narrow the gap between differing perceptions in care provision and also enable parents to attend to their other roles thereby reducing their levels of physical and emotional stress.

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Sharplin, Elaine Denise. "Quality of worklife for rural and remote teachers : perspectives of novice, interstate and overseas-qualified teachers". University of Western Australia. Graduate School of Education, 2008. http://theses.library.uwa.edu.au/adt-WU2008.0211.

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[Truncated abstract] It is essential to attract, recruit and retain quality teachers in rural and remote schools for provision of quality education to rural and remote students. A robust body of research confirms that teacher quality contributes to quality of education (Darling-Hammond, 2000; Hay McBer, 2000; Kaplan & Owings, 2002; OECD, 2002; Ramsay, 2000). Staffing histories of rural and remote schools identify persistent difficulties in recruiting and retaining teachers, but previous research has failed to address the experiences and perspectives of rural and remote teachers from the earliest phases of appointment, tracking their experiences over time. In times and places of persistent teacher shortages, teacher quality of worklife issues are paramount. Factors impacting on teacher quality of worklife may impact on teacher retention, staffing levels and ultimately the quality of education for children. For these reasons, this study aimed to develop substantive theory about the experiences of teachers commencing appointments in rural and remote schools by investigating the perspectives of novice, interstate and overseas-qualified teachers. The study sought to develop understandings of rural and remote teachers quality of worklife. In order to achieve this aime, the experiences of 29 teachers were examined, in four categories of teachers likely to be appointed to rural and remote locations: young novices; mature-aged novices; interstate; and overseas-qualified teachers in a qualitative collective case study. ... Awareness of the variety of factors in multiple environments, and the complex interplay between them, helps to account for the diversity of perspectives and quality of worklife outcomes for rural and remote teachers. Two theories were generated from ten propositions. The first theory, Quality of Worklife for Rural and Remote Teachers: Person-Environment Fit to Multiple Environments, identified protective and risk factors associated with workrole, workplace, organisation, geographic and socio-cultural community environments. The theory recognises spillover between work and non-work life experiences, impacting on quality of teacher worklife; however, factors directly associated with worklife impacted most significantly on quality of worklife. The second theory, Processes of Adaptation to Multiple Rural and Remote Environments, identified processes (teacher expectations, evaluations of environments, responses to environments) and coping strategies (direct-action, palliative and avoidant) as leading to one of four outcomes: integration; resilient integration; disequilibrium; and withdrawal. The case study findings offer original understandings of experiences of teachers newly appointed to rural and remote schools, through the development of theory about multiple environments teachers encounter and processes of adaptation associated with their relocation to rural and remote areas. The findings have implications for theory, policy and practice, and contribute new dimensions to the general quality of worklife literature.

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McCarron, Robyn Janelle. "Performing arts and regional communities : the case of Bunbury, Western Australia /". Access via Murdoch University Digital Theses Project, 2004. http://wwwlib.murdoch.edu.au/adt/browse/view/adt-MU20050501.153348.

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au, Editech@iinet net, i Pamela-Anne Shanks. "A critical policy analysis of the Crossroads Review: Implications for higher education in regional Western Australia". Murdoch University, 2006. http://wwwlib.murdoch.edu.au/adt/browse/view/adt-MU20061019.134304.

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This work is a critical policy analysis of the Crossroads Review, especially those aspects of it that are most likely to have a significant impact on higher education in regional Western Australia. It aims to understand the place of higher education in regional Western Australia historically with a view to critiquing current policy directions and the potential consequences of Crossroads. The thesis argues that the ideologies of marketisation and corporatisation are driving current higher education policy and this may significantly damage the long-term viability of regional campuses and learning centres as well as public and private funding allocations. The implications for the dismantling of the social contract (or social democratic settlement) in the knowledge economy is an important issue for regional populations for their continued growth, health, education and welfare. The issues examined here are relevant to regional higher education in this State. The purpose of this thesis is to examine the potential policy effects with regard to accessibility of higher education in regional Western Australia. The thesis analyses the advantages and disadvantages of studying in regional WA in the current policy environment where there has been a dramatic shift in ideology from the welfare state to economic rationalism. Factors that impact on higher education in regional Western Australia include the provision of telecommunications services for access to and participation in the knowledge economy. The thesis considers the evolution of higher education in Australia in general and more particularly in Western Australia, as it has evolved since its foundations in the mid-nineteenth century to the beginning of the twenty-first century. In this time there have been radical changes in higher education in Australia in line with changes to our society and its place in an increasingly globalised environment. The thesis concludes by considering some possible options for the future such as the development of learning communities and branch campuses. In discussing such possible alternative forms of delivery of higher education to regional Western Australia, this thesis seeks to raise awareness in relevant government bodies and in rural and remote communities of their particular higher education needs. It is hoped also to encourage regional communities to become more confident and pro-active in their own endeavours to gain greater access and equity in higher education.

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Wood, Lisa Jane. "Social capital, neighbourhood environments and health : development of measurement tools and exploration of links through qualitative and quantitative research". University of Western Australia. School of Population Health, 2006. http://theses.library.uwa.edu.au/adt-WU2006.0111.

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[Truncated abstract] BACKGROUND This thesis explored the relationship between social capital, sense of community and mental health and wellbeing; and factors that may influence these within the environments in which people live. Area variations in health are well documented and are mirrored in emerging evidence of geographic and neighbourhood variations in social capital. Little is known, however, about the specific facets of the impact of local physical environment on social capital; or about the mechanisms by which these are linked with each other, and with health determinants and outcomes. Despite the recent proliferation of social capital literature and growing research interest within the public health realm, its relationship to mental health and protective factors for mental health have also been relatively unexplored. AIMS The overall aim of this thesis was to explore the potential associations between social capital, health and mental health, and neighbourhood environments. In particular, the thesis considered whether the physical attributes and street network design of neighbourhoods are associated with social capital or particular dimensions of the social capital construct. It also examined the relationship between social capital and demographic and residency factors and pet ownership ... CONCLUSION The combined use of qualitative and quantitative research is a distinguishing feature of this study, and the triangulation of these data has a unique contribution to make to the social capital literature. Studies concerned with the measurement of social capital to date have tended to focus on dimensions pertaining to people’s involvement, perceptions and relationship with others and their community. While these constructs provide insight into what comprises social capital, it is clear that each is in turn influenced by a range of other factors. Elucidating what fosters trust and neighbourly interactions in one community and not in another, and by what mechanisms, is one of many research questions unanswered in the published literature to date. The consideration of measures of social capital that relate to the physical environment is therefore of relevance to the growing research and public policy interest in identifying what might build or restore social capital in communities.

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De, Vos Johanna B. M. "Respiratory health effects of occupational exposure to bushfire smoke in Western Australia". University of Western Australia. School of Population Health, 2008. http://theses.library.uwa.edu.au/adt-WU2009.0001.

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Bushfires are an integral part of the Australian environment, and consequently Australian fire fighters are regularly confronted with the challenge of bushfire fighting activities. Bushfires can be extensive and long-lasting, and as a result fire fighters can be exposed to bushfire smoke for long periods without respite. Anecdotal evidence suggests that bushfire smoke exposure can lead to respiratory symptoms such as coughing, wheezing, and shortness of breath. In an optimal environment, fire fighters are equipped with respirators and protective filters to prevent the inhalation of the air toxics in bushfire smoke. Yet, reports from the fire ground indicate that the protective filters are not effective in preventing the inhalation of bushfire smoke. As a result, fire fighters have increasingly expressed concern about the ineffective equipment and the resultant respiratory symptoms during and after bushfire fighting. This research aims to establish a scientific data base to support the anecdotal evidence. The objectives of the research were: (1) to identify and quantify the air toxics in Western Australian bushfire smoke; (2) to profile the acute respiratory health effects associated with bushfire smoke exposure; (3) to assess the effectiveness of three different types of filters under controlled conditions in a smoke chamber, and in the field during fuel reduction burn-off; (4) to formulate recommendations for reducing fire fighters' exposure to bushfire smoke; and (5) to inform policy decision makers about the most effective form of respiratory protective equipment for bushfire fighting. Exposure trials were conducted in an experimental setting utilising bushfire smoke conditions in a smoke chamber and during prescribed burn-offs. Repeated measurements of respiratory symptoms, pulmonary function and oximetry were undertaken before and after bushfire smoke exposure. In addition, personal air sampling inside the respirators was undertaken to quantify and compare the levels of filtered air toxics. The analysis of the collected data demonstrated that, of those compared, the particulate/organic vapour formaldehyde filter was most effective in protecting fire fighters' respiratory health during the smoke exposure period of maximally 120 minutes. Further research would be useful to determine the v effectiveness of the filters under more realistic conditions during bushfire fighting activities. The findings of this research have resulted in a policy review in Western Australia. In 2006, the Fire and Emergency Services Authority of Western Australia (FESA) reviewed its Bush Fire Smoke Exposure Standard Operational Procedures 51, and now issues the recommended particulate/organic vapour/formaldehyde filters to the 1,000 FESA career fire fighters. The use of protective equipment for bushfire fighters is inadequately regulated worldwide and the recommendation implemented by FESA can be seen as proactive and in advance of national and international best practice. In conclusion, this project was instrumental in the translation of public health research into best practice that protects occupational health, without the need for the lengthy process of legislative reform. Fire fighter organisations in other countries with high frequencies of bushfires could learn from this example, and move to review their policies and introduce adequate personal protection for fire fighters.

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Norrie, Philip Anthony. "Wine and health through the ages with special reference to Australia /". View thesis, 2005. http://library.uws.edu.au/adt-NUWS/public/adt-NUWS20060420.102152/index.html.

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Thesis (PhD.)-- University of Western Sydney, School of Social Ecology and Lifelong Learning, 2005.
"A thesis submitted in fulfillment of the requirements for the degree of Doctor of Philosophy, School of Social Ecology and Lifelong Learning, University of Western Sydney." Includes bibliographical references and index.

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Gardos, Amy. "The historical archaeology of the Old Farm on Strawberry Hill : a rural estate 1827-1889, Albany, Western Australia". University of Western Australia. Archaeology Discipline Group, 2004. http://theses.library.uwa.edu.au/adt-WU2005.0032.

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This thesis presents the results of historical archaeological research at the Old Farm on Strawberry Hill in Albany, Western Australia. The site is an important colonial farm in Western Australia’s history; the location for the first farm in Western Australia (1827) and linked to many important individuals in the state’s colonial past. The site is owned and managed by the National Trust of Australia (W.A.) and is registered on both the West Australian, Heritage Council Register of Historical Places and the Australian Heritage Commission’s National Estate. Past historical and cultural biases had created an incomplete interpretation of this site that did not represent all social groups, including indentured servants, convict and Aboriginal labourers and women. The research has provided a holistic site interpretation that identified all social groups living and working on this site in the 1800s by analysing historical documents and archaeological excavated materials. The historical documentary record included both personal and official correspondence, diaries and drawings, as well as two valuable farm log books that documented the day to day events on the farm in the early to mid 1800s. The archaeological excavation was restricted to small area excavations in habitation areas still present on the site or in areas identified from 19th century surveyor maps. Both of these data sources were analysed to identify social and economic relationships, such as gender, status, class and ethnicity so that a comparison could be made between historical and archaeological data and a complementary interpretation created. The research was divided into three main periods of site occupation, firstly by convict gardeners during the government farm period from 1827 to 1832. The Spencer family period from 1833 to 1889, which is further defined by two phases, the six years from their arrival until Richard Spencer’s death in 1839 and the dispersal of the family and the property decline until it was sold in 1889. The third period of occupation by the Bird family was not discussed due to the discontinuation of a farming subsistence that distinguished it from a rural rather than an urban property. This study provides the current heritage managers with an updated interpretation of the site’s past and changing social and economic relationships on site and with the early town of Albany. It is hoped that this interpretation will be used to improve the site’s current representation and becomes the basis for a heritage conservation plan which not only recognises the importance of existing site structures, but also sub surface remains. This thesis also identifies a number of avenues for future research that will further enhance the site’s interpretation.

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Clifford, Susan Amanda. "The effects of fly-in/fly-out commute arrangements and extended working hours on the stress, lifestyle, relationships and health characteristics of Western Australian mining employees and their partners". University of Western Australia. School of Anatomy and Human Biology, 2010. http://theses.library.uwa.edu.au/adt-WU2010.0018.

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The Western Australian (WA) mining industry directly employs approximately 56,000 people. Almost half work Fly-in/Fly-out commute arrangements (FIFO, e.g. employees living in a city are flown to a remote worksite where they live and work during their work roster) and approximately half work more than 50 hours per week, on average. There are many anecdotal claims that FIFO has negative impacts on WA mining employees, leading to an elevated risk of high stress levels, depression, binge drinking, recreational drug use and relationship break-ups. Previous studies found FIFO can be stressful, and have negative impacts on WA employees 'and partners' lifestyles and relationships. This project investigated the long-term (Study One) and short-term (Study Two) impacts of FIFO and extended working hours on a representative sample of WA FIFO mining employees and partners. In Study One, a total of 222 FIFO and Daily Commute (DC) mining employees and partners completed an anonymous questionnaire investigating long-term impacts on work satisfaction, lifestyle, relationships and health. A subgroup of 32 Study One FIFO employees and partners also participated in Study Two; a detailed study of the short-term impacts of FIFO and extended working hours and how these impacts fluctuate in intensity during the mining roster. Study Two participants completed a diary and provided saliva samples each day throughout a complete mining roster. The main findings of the study were that FIFO and extended working hours had negative impacts on employees work satisfaction and FIFO was frequently reported to be disruptive to employees 'and partners' lifestyle, in the long-term. However, FIFO and extended working hours did not lead to poor quality relationships, high stress levels or poor health, on average in the long-term; there were generally no significant differences in these characteristics between FIFO and DC employees, or between the FIFO sample and the wider community. There were minor differences between FIFO and DC employees in long-term health characteristics, and Study One employees had similar, or in some cases poorer health outcomes than other community samples.

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Koo, Fung Kuen. "Disharmony between Chinese and Western views about preventative health : a qualitative investigation of the health beliefs and behaviour of older Hong Kong Chinese people in Australia". University of Sydney, 2005. http://hdl.handle.net/2123/1610.

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Doctor of Philosophy
This study explores the health beliefs and preventive health behaviours of older Hong Kong Chinese people resident in Australia. Participation in physical activity was used as the case study. There were two frameworks used to shape the research. Because of their perceived influence on the health beliefs and practices of Hong Kong Chinese people, the traditional Chinese philosophies of Confucianism, Taoism, and Buddhism provided the philosophical framework. The Theory of Planned Behaviour provided a theoretical framework for understanding the target group's preventive health behaviour. Data was collected by means of in-depth interviews, participant observation and case study. Twenty-two informants were interviewed, their transcripts analysed, summarised and typologised, identifying six states of physical activity participation. Findings demonstrated that this target group possessed a holistic view of health, with food taking a special role in preventive care and self-treatment at times of illness. The Cantonese terms used to denote “physical activity” caused confusion among the target group. Most interpreted it as meaning deliberate planned body movement, strength-enhancing activities or exercise, although some did see it as including mundane daily activities and chores. Lack of time, no interest and laziness were reported as the main reasons for low participation in deliberate planned physical activity. Cultural, social and environmental determinants were the intrinsic and extrinsic factors influencing attitudes toward physical activity, as well as perceived social supports and perceived control over physical activity participation barriers. To a large extent, these interactive determinants of health were rooted in the three traditional Chinese philosophies mentioned above. The thesis concludes by arguing that rather than simply advocating activities designed for other populations, health promotion strategies and education need to create links to the traditions of this target group and also clarify their conception of physical activity.

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au, A. Eades@murdoch edu, i Anne-Marie Eades. "Factors that influence participation in self-management of wound care in three Indigenous communities in Western Australia: Clients' perspectives". Murdoch University, 2008. http://wwwlib.murdoch.edu.au/adt/browse/view/adt-MU20090702.111437.

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The purpose of this study was to identify any barriers or enablers as influences on wound care self-management by Indigenous people. A qualitative, interpretive study sought to investigate how participants perceived their wounds and their general health, and to identify the influences on them accessing wound care services. There is a dearth of information on culturally appropriate practice in wound management for Indigenous Australians. This research project was therefore significant in attempting to bridge the gap in nursing knowledge of Indigenous clients' perceptions of barriers and enablers for seeking wound care services,especially in relation to lower leg ulcers. The lack of culturally sensitive wound management practices potentially impacts on Indigenous clients' behaviours in seeking treatment from their health service providers. Participant observations and semi-structured interviews with the research participants investigated the management of their wounds, and the ways in which their culture influences wound management. The main aim was to understand participants' comprehension of the importance of wound care through reflection. Understanding the enhancing or obstructive influences on wound management practices was expected to provide a foundation for teaching self care of wounds in Indigenous populations and inform health professionals' approach to health education. The data were analysed using thematic analysis, which generated common themes related to the research questions. These themes are: visibility, of the problem,4 perceived versus actual level of knowledge, acceptance of co-morbid health conditions and pre-determined path of ill health. These findings indicated that in one region, participants' perception of poor health was related to visibility of the problem. Participants chose to have their visible wounds managed by Silver Chain Nursing Association, whereas Diabetes and Hypertension and any other non-visible disorders were seen as appropriate to the Aboriginal Medical Service (AMS). Further to this finding, most participants displayed a sense of helplessness and hopelessness when sharing information about their diagnosis of diabetes, believing this was the norm. Many also believed that having a strong family history of a particular disease resulted in the participants also inheriting the disease. During post interview educational sessions many of the Indigenous participants were surprised by the evidence based-research reported to them by the researcher that diabetes is a manageable disease with life style changes. Another issue highlighted was the perceived level of knowledge the participants had about wound care. Reassurance was given by the participants that their level of knowledge about how to manage their wounds was adequate. However, none of the participants were concerned about the length of time that their wound/s had or were being managed, between 3 months and 5 years. This acceptance that although a wound is not getting any worse and not getting any better was the norm is cause for concern, and indicates a low level of health literacy. This theme was 'perceiving an imbalance in perceptions of wound care knowledge with actual knowledge'. The most important recommendation from the study findings is the need to consider health literacy more carefully in the development of health promotion and health education for Indigenous clients with wounds.

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Jardine, Andrew. "The impact of dryland salinity on Ross River virus in south-western Australia : an ecosystem health perspective". University of Western Australia. School of Population Health, 2007. http://theses.library.uwa.edu.au/adt-WU2007.0182.

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[Truncated abstract] A functional ecosystem is increasingly being recognised as a requirement for health and well being of resident human populations. Clearing of native vegetation for agriculture has left 1.047 million hectares of south-west Western Australia affected by a severe form of environmental degradation, dryland salinity, characterised by secondary soil salinisation and waterlogging. This area may expand by a further 1.7-3.4 million hectares if current trends continue. Ecosystems in saline affected regions display many of the classic characteristics of Ecosystem Distress Syndrome (EDS). One outcome of EDS that has not yet been investigated in relation to dryland salinity is adverse human health implications. This thesis focuses on one such potential adverse health outcome: increased incidence of Ross River virus (RRV), the most common mosquito-borne disease in Australia. Spatial analysis of RRV notifications did not reveal a significant association with dryland salinity. To overcome inherent limitations with notification data, serological RRV antibody prevalence was also investigated, and again no significant association with dryland salinity was detected. However, the spatial scale imposed limited the sensitivity of both studies. ... This thesis represents the first attempt to prospectively investigate the influence of secondary soil salinity on mosquito-borne disease by combining entomological, environmental and epidemiological data. The evidence collected indicates that RRV disease incidence is not currently a significant population health priority in areas affected by dryland salinity despite the dominant presence of Ae. camptorhynchus. Potential limiting factors include; local climatic impact on the seasonal mosquito population dynamics; vertebrate host distribution and feeding behaviour of Ae. camptorhynchus; and the scarce and uneven human population distribution across the region. However, the potential for increased disease risk in dryland salinity affected areas to become apparent in the future cannot be discounted, particularly in light of the increasing extent predicted to develop over coming decades before any benefits of amelioration strategies are observed. Finally, it is important to note that both dryland salinity and salinity induced by irrigation are important forms of environmental degradation in arid and semi-arid worldwide, with a total population of over 400 million people. Potential health risks will of course vary widely across different regions depending on a range of factors specific to the local region and the complex interactions between them. It is therefore not possible to make broad generalisations. The need is highlighted for similar research in other regions and it is contended that an ecosystem health framework provides the necessary basis for such investigations.

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Peer, Nazia. "Factors associated with Contraceptive Use in a rural area in the Western Cape, South Africa". Master's thesis, University of Cape Town, 2012. http://hdl.handle.net/11427/14235.

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BACKGROUND: Safe and effective contraceptive use can improve women's reproductive health. Although the contraceptive prevalence rate in South Africa is comparable to rates globally, the distribution is inequitable and marginalises poor and rural women. This study aimed at identifying factors associated with contraceptive uses in a rural area in South Africa. METHO D: Cross-sectional survey data based on face-to-face interviews with female participants between 18 to 44 years were collected for a primary FAS prevention study in rural and urban South Africa. This study examined data for rural women only. The outcome variable was Effective Contraceptive use (ECC) which included use of oral contraceptives, condoms or injectables, or having been sterilised. Independent variables included socio-demographic factors, substance use, psychosocial factors, community factors, childbearing characteristics and partner characteristics RESULTS: Women were more likely to use ECC if they reported high self-esteem (compared to low or moderate self-esteem PRR=1.53; 95% CI: 0.99-2.39 ); if they strongly or moderately agreed that their culture entitled men to children compared to those who disagreed (PRR=1.55; 95% CI: 0.95-2.52); and if they had one child or more compared to no children (PRR=2.51; 95% CI: 1.64-3.84). CONCLUSION: To promote contraceptive use in in similar rural populations, family planning programmes could focus on increasing men's approval of contraception, improving partner communication around family planning and bolstering women's confidence in their reproductive decision-making, particularly their self-esteem. There should be greater focus on nulliparous women and women between 18 and 24 years old who have th e lowest Contraceptive prevalence rate (CPR).

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Davies, Marcella. "Women's Perceptions of Malaria in the Western Rural Areas of Sierra Leone". ScholarWorks, 2018. https://scholarworks.waldenu.edu/dissertations/5618.

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Malaria is one of the leading causes of death for children and women in Sierra Leone. The purpose of this qualitative study was to explore and understand the lived experiences of women from the rural areas of Sierra Leone regarding malaria. A purposive sample of Krio women from the western rural area, aged 21-55 years, spoke English, and had taken care of someone with malaria described their perceptions and lived experiences with the disease in face-to-face interviews. The research questions were based on the health belief model and focused on knowledge, beliefs, and perceptions about malaria prevention and treatment. Interpretative phenomenological analysis was used to identify themes through coding. The findings indicated that (a) lack of doctors, medicines, and medical supplies at government clinics discourages malaria victims from visiting those clinics; (b) the use of traditional herbs is prevalent because of their effectiveness, affordability, easy access, and lack of side effects; (c) women were not aware of recommended comprehensive malaria control measures, which include the continuous use of durable insecticide nets, residual spraying, case management, and artemisinin-based therapy. The results also show that (a) pregnant women should not take prescribed medications to prevent or treat malaria because they harm the fetus, and (b) traditional herbs may be taken with Western medicines to treat severe malaria. Recommendations include: that the government evaluate the efficiency and effectiveness of its current malaria programs in local clinics, and that future studies be undertaken to identify antimalarial properties in commonly accepted local herbs. Changes in policies and practices relating to the prevention and treatment of malaria will serve as building blocks for positive social change to reduce the malaria incidence rate in Sierra Leone.

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Owen, Julie. "Development of a culturally sensitive program delivering cardiovascular health education to indigenous Australians, in South-West towns of Western Australia with lay educators as community role models". University of Western Australia. School of Population Health, 2006. http://theses.library.uwa.edu.au/adt-WU2006.0061.

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[Truncated abstract] Indigenous Australians suffer cardiovascular disease (CVD) at a rate six times greater than the general population in Australia and while the incidence of CVD has been reduced dramatically amongst the majority of non-indigenous Australians and amongst Indigenous populations in other countries in the last 30 years, there has been little change in the figures for Aboriginal Australians, showing that heart health campaigns have little impact, for this group of people. Aims : The principal aims of this study were firstly, to determine and record the barriers to the development and delivery of CVD prevention programs amongst Indigenous Australians and secondly, to develop an alternative, effective and culturally sensitive method of delivering heart health messages. Methods and results : The study was qualitative research undertaken in three South-West towns of Western Australia where the incidence of CVD was high amongst the Aboriginal community members. The use of semi-formal interviews, informal individual consultation, observation, and focus groups were methods implemented to obtain information. The first phase of the research was to identify the barriers which affected the Aboriginal Health Workers’ ability to deliver specialist educational programs. Questionnaires and interviews with the Aboriginal Health Workers and other health professionals in the towns, and community focus groups were undertaken in this phase of the study. The second phase of the research was aimed at developing an alternative strategy for delivering heart health messages. The focus changed to adopt more traditional ways of passing on information in Indigenous communities. The idea of small gatherings of friends or family with a trusted community member presenting the health message was developed. The third phase of the research was to implement this new approach. Lay educators who had been identified within focus groups and by Aboriginal Health Workers were trained in each of the towns and a protocol involving discussions of health issues, viewing a video on CVD, produced by the National Heart Foundation, sharing in a ‘heart healthy’ lunch and partaking in a ‘heart health’ knowledge game which was developed specifically for the gatherings. Several of these gatherings were held in each of the towns and they became known as ‘HeartAware parties’.

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English, René Glynnis. "Reproductive health effects due to pesticide exposure amongst boys in the rural Western Cape, South Africa". Master's thesis, University of Cape Town, 2011. http://hdl.handle.net/11427/12797.

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Includes bibliographical references.
Contemporary agricultural pesticides have been shown to possess hormonally-active properties, and have been associated with declining male reproductive health. These chemicals act by disrupting the normal functioning of the male endocrine system, through their actions on the hypothalamic-pituitary-gonadal axis. Reported male reproductive abnormalities are reproductive organ defects, cancers and declining fertility. Cryptorchidism, hypospadias, testicular cancer and poor sperm quality (testicular dysgenesis syndrome) have also been reported to be associated with these endocrine-disrupting chemicals. This study therefore aims to investigate the adverse reproductive health effects of environmental pesticide exposure in male children and adolescents, based on their lifetime residential history (namely, having lived on a farm or not).

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Joyce, Sarah Julia. "Demographic, clinical and environmental risk factors for prelabour rupture of membranes in Western Australia". University of Western Australia. School of Population Health, 2009. http://theses.library.uwa.edu.au/adt-WU2009.0126.

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[Truncated abstract] This thesis explores the risk factors and perinatal outcomes associated with prelabour rupture of membranes, with a particular focus on the environmental context. Prelabour rupture of membranes is defined as the rupture of fetal membranes before the onset of labour. It is a relatively common obstetric endpoint, occurring in approximately 8-10% of pregnant women at term (PROM) and in up to 40% of all preterm deliveries (pPROM). Despite the high prevalence of the condition, the biological mechanisms and risk factors, and in particular the role of environmental predictors, behind the development of PROM and pPROM remain largely unclear. A record-based prevalence design was used to analyse a population of 16,229 nulliparous, Caucasian women residing in Perth, Western Australia who gave birth to a single newborn during 2002-2004. Maternal age, socioeconomic status and threatened preterm labour during pregnancy were identified as risk factors for prelabour rupture of membranes. Term PROM was significantly associated with fetal distress (OR 1.19; 95%CI 1.00-1.43) and post-partum haemorrhage (OR 1.99; 95%CI 1.60-2.48). A number of perinatal complications were observed to be associated with the presentation of preterm PROM, including prolapsed cord (OR 13.95; 95%CI 4.57-42.61), ante-partum haemorrhage (OR 3.29; 95%CI 2.20-4.91), post-partum haemorrhage (OR 2.12; 95%CI 1.54-2.91), low birth weight (OR 17.79; 95%CI 13.87-22.82), very low birth weight (OR 20.01; 95%CI 14.12-28.35) and stillbirth (OR 5.42; 95%CI 2.87-10.21). However, the outcomes were similar between pPROM patients and other preterm deliveries, indicating that the complications arose due to the timing of the delivery. In contrast though, the risk factors between the two outcomes varied which may suggest that a different aetiological pathway exists between preterm PROM and other preterm deliveries. The frequency of complications decreased with increasing gestational age at delivery until the pregnancy reached full-term, whereupon an increase in gestational age at delivery resulted in an increased risk of fetal distress and post-partum haemorrhage. This finding is novel and may have important implications for the management of prelabour rupture of membranes, specifically with regard to the relative risks and benefits of expectant management (that is, the patient is admitted to an obstetric facility or hospital and closely monitored) versus planned delivery. ... This study represents the first attempt to investigate the potential associations between environmental risk factors and prelabour rupture of membranes. The results of the thesis provide a substantial contribution to our knowledge on prelabour rupture of membranes, including findings of direct relevance to clinical practice as well as a potentially contributing environmental exposure pathway. These original findings suggest a possible preventative approach to reducing the occurrence and associated morbidity of prelabour rupture of membranes may be feasible, and should be pursued if future research confirms the preliminary findings of this thesis.

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Nakao, Jolene H. "Acceptance and access : home-based HIV counselling and testing and barriers to care in rural Western Kenya". Master's thesis, University of Cape Town, 2009. http://hdl.handle.net/11427/12137.

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Includes abstract.
Includes bibliographical references (leaves 83-94).
Home-based HIV counselling and testing (HBCT) is a wayt to provide confidential HIV testing in a person's home. As home-based testing has not yet been evaluated on a wide scale in Kenya among adult individuals [over age 15], this project is designed to assess in rural Kenya 1) overall acceptance rates and variables that predict differential acceptance rates of home-based HIV testing, 2) reasons for refusal of home-based testing, and 3) barriers to seeking treatment for people who are HIV positive.

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Hawley, Georgina. "A phenomenological study of the health-care related spiritual needs of multicultural Western Australians". Curtin University of Technology, Science and Mathematics Education Centre, 2002. http://espace.library.curtin.edu.au:80/R/?func=dbin-jump-full&object_id=13369.

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This study was designed to identify the spiritual needs of multicultural Australians with a health problem, in order to understand the educational implications for health care professionals. The rationale for the research was supported by the Australian Council for Health Service (1997) requirement that health care professionals meet the spiritual needs of their patients and clients'. At the commencement of this study, no research had been published on what these spiritual needs might be. To discover what health care professionals needed to be taught in order to meet the spiritual needs of their patients, I required a suitable group of patients. Then, after identify their spiritual needs, I wanted to explore ways in which these needs could be met. For this to occur, I also needed to identify factors that would fulfill patients' spiritual needs or prevent them from being met. This research proceeded in two stages. The first involved collecting data from all spiritual groups in Western Australia. The second involved the recruitment and interviewing a small number of ex-patients to gain their perspective of health care related spirituality and needs. To gain data about the various spiritual groups in Western Australia, I wrote to all organisations and associations, asking for information and reference material. This data was analysed using HyperResearch (1995), and themes common to all spiritual groups were developed. The inter-relationship between these themes provided the framework for an emergent model of spirituality.
For the second part of the research which involved a case study of health care patients, a qualitative methodology was used. This approach enabled me to explore the phenomenon of spirituality from the perspective of eight participants, which involved identifying their spiritual needs, the care they desired, and the rite of passage they underwent when receiving health care. The qualitative methodology enabled me to explore the subject from a sensitive holistic perspective, and to protect the integrity of the participants. I wanted to know what patients understood about their spirituality and how spiritual care could be implemented not only in clinical practice but also into health care education programs. The participants' detailed subjective experience was especially important, because I wanted to know how they identified their spiritual needs, how they had requested their needs be met by health care professionals, and the extent to which health care professionals had reacted to those cues. I formulated an 'interpretive phenomenology research' design based on the philosophical writings of Heidegger and Bakhtin. Heidegger argued that people gain knowledge of a subject from their own subjective experience, and of the person being in their world (simultaneous past, present and future thoughts). Bakhtin stated that to bring about social change, the researcher needed to understand the social context of the people's language including their culture, politics, government-provided amenities (such as education and health care), employment and social interaction, both within and outside their communities in which they live. The eight participants were interviewed a number of times in order to explore the phenomenon of spirituality beyond the notions already published in the literature (i.e. from multicultural Australian's perspective).
They told of hospital or health care experiences that included: health care for childbirth, mental and psychiatric illnesses (depression, manic-depression, and anxiety), immunology (lymphoma), stroke, detoxification of alcohol, arthritis, coronary occlusion, hypertension, and peritonitis; surgical procedured/s such as repair of hernia, bowel obstruction, eye surgery, orchiopexy (removal of testes from inguinal canal into the scrotal sac), caesarian birth, appendectomy, and oophorectomy (removal of ovaries); treatments such as radiotherapy, chemotherapy, and physiotherapy; and hospital experiences in both large and small public and private acute hospitals, private and public mental health/psychiatric hospitals, intensive care and coronary care units. These situations demonstrate the diversity of contexts which people want their spiritual needs met. The study revealed that it is not only dying patients who have spiritual need; spiritual needs exist in widespread ordinary conditions and across a wide range of health care services. The eight participants - Ann, Athika, Garry, Red, Rosie, Scarlet, Sophie, and Tom (pseudonyms) - were drawn from many of the multicultural groups resident in Western Australia including Aboriginal, Chinese, English, European, Indian, and Irish peoples. Their spiritualities encompassed Judeo-Christian, Buddhist, Hindu, Pagan Romany, Society of Friends (Quaker), Humanist, Socialist, and Communist values and beliefs. The results of the research give insight into the eight participants' perspectives on being a person, their understanding of spirituality, perceived spiritual needs, their desired levels of spiritual care, and the rite of passage they experienced when undergoing health care treatment in hospital.
The participants' spiritual needs comprised of four categories: 'mutual trust', 'hope', 'peace' and 'love'. The levels of spiritual care spoke of desiring were: 'acknowledgement', 'empathy', and 'valuing'. Recommendations are given for health care professionals to provide spiritual care for the eight participants, and implications are considered for the spiritual education of future health care professionals in order to sensitise them to the wide range of healthcare related spiritual needs they might encounter in local multicultural communities. It is recognised that the scope of the implications is contingent on further research establishing the incidence of health-care related spiritual needs among the broader population of multi-cultural Western Australians. The richness and depth of the data and the very sensitive nature of the material that came from the eight people who shared their experiences with me has rendered this thesis an important document. The nature of the various incidents and situations they shared with me, I believe, demonstrated their preparedness to tell their story so that health care can be improved. On many occasions, I felt honoured that they had sufficient trust in me to enable them to report such deep and personal suffering. For example, Rosie told me of her mental torment and of not knowing if she was alive or dead; of how she burnt her legs to try to feel pain in order to see if she was alive. It was stories such as this that gave me the passion to write this thesis well in order to do justice to all people who want spirituality included in health care treatment.

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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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Katzenellenbogen, Judith Masha. "Use of data linkage to enhance burden of disease estimates in Western Australia : the example of stroke". University of Western Australia. School of Population Health, 2009. http://theses.library.uwa.edu.au/adt-WU2009.0117.

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[Truncated abstract] The Disability-Adjusted Life Year index, developed by the Global Burden of Disease Study, is used extensively to compare disease burden between locations and over time. While calculation of the fatal component of this measure, Years of Life Lost, is relatively straight-forward, the non-fatal component, Years Lived with Disability, is based on parameters that are challenging to estimate. This thesis pioneers the use of the Western Australian Data Linkage System to enhance epidemiological parameters underpinning Years Lived with Disability, providing, by way of illustration, a robust quantitative profile of burden of stroke in the state of Western Australia at the turn of the 21st century. The principal methodological objective was to utilise data linkage analytic methods for the specific requirements of burden of disease estimation. The principal stroke-related objectives were: 1. To estimate the parameters underpinning the non-fatal burden of stroke (Years Lived with Disability) in Western Australia in 2000. 2. To estimate the total burden of stroke (Disability-Adjusted Life Years) in Western Australia in 2000. 3. To investigate differentials in stroke burden between different sub-populations in Western Australia. 4. To calculate projections of stroke burden for Western Australia in 2016. Years Lived with Disability from stroke were calculated for Western Australia from nonfatal stroke incidence, expected duration and disability (severity) weights. Non-fatal incidence was estimated using linked hospital and death records of first-ever hospitalised stroke 28-day survivors in 2000. This was then adjusted for out-of-hospital cases determined from the population-based Perth Community Stroke Study. iv Analysis of mortality in hospitalised 28-day survivors using linked data revealed that the excess mortality in prevalent, rather than incident cases was the main disease-specific parameter required for modelling stroke duration using DisMod II specialised software. ... Access to data linkage and population-based stroke studies in Western Australia allowed more accurate estimation of non-fatal stroke burden, with previous reports most likely underestimating disability as a contributor to total burden. Although predominantly affecting the growing aged population, stroke also affects a sizable number under the age of 65 years, the age group where differentials in stroke burden are the greatest. The findings highlight the continued need for primary prevention efforts for all ages, targeting especially younger people in disadvantaged groups. The shift to greater disability burden in the future and the needs of disadvantaged groups must be considered when planning stroke services. The multiple studies undertaken for this thesis contribute to ongoing improvement of data quality and methodological refinements underpinning estimates of Years Lived with Disability, specifically for stroke, but applicable also to other diseases. Similar linked data approaches can be used in other Australian states in the future once infrastructure is developed, thereby improving estimates of disease burden for health policy and planning in the future.

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Wildschutt, Phillip Jacobus. "The effect of accumulative physical activity on the fitness and health status of rural school children". Thesis, University of the Western Cape, 2005. http://etd.uwc.ac.za/index.php?module=etd&amp.

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Numerous studies focusing on cardiovascular disease risk factors such as obesity, hypertension, smoking, diabetes mellitus, elevated serum lipids, inactivity and lack of physical fitness prevalent in children highlight the importance of the early diagnosis and prevention of conditions that are associated in adulthood with cardiovascular disease. The purpose of this study was to assess the impact of accumulative physical activity on the fitness profile, blood pressure and body composition in 14-16 year old school children in the Western Cape of South Africa.

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Wilks, Kathryn. "Canine zoonoses in Aboriginal communities : the effects of a canine breeding program in the Kimberley Region, Western Australia". Murdoch University, 1999. http://wwwlib.murdoch.edu.au/adt/browse/view/adt-MU20060829.145909.

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The hypothesis central to this study is that the implementation of a canine breeding and parasite control program in Aboriginal communities results in a reduction in the reservoir of zoonotic parasites within communities. The effect of the parasite and breeding control program on the health status of dogs as well as the population characteristics of dogs in communities was also investigated. The study was conducted in 17 Aboriginal communities of the Kimberley region of Western Australia, divided into three regions according to cultural and geographical attributes. All dogs from each community were permanently identified using a microchip system. Owners of dogs were asked the usual location of their animals, the origins of their dogs and the whereabouts of any missing animals at subsequent visits. Every three months dogs were treated with 200ygikg iverrnectin (a potent endo- and ecto-parasiticide) subcutaneously and adult female dogs were treated with an injectable contraceptive (10-30mgkg proligestone) at the request of their owners. At the time of treatment, dogs were assessed for ecto-parasites and photographs taken for later comparison and diagnosis of alopecic skin conditions. Faecal and blood samples were collected every three to six months and skin scrapings were collected from dogs that were refractory to treatment. The samples were used to determine internal parasite prevalence (using formal ethyl acetate sedimentation), blood parameters (for anaemia status) and evidence of scabies or Demodex infestation. A pilot study at one group of communities, involving weekly assessment of dogs after one iverrnectin treatment, showed that the treatment was effective in reducing the prevalence of scabies (as determined by clinical evaluation), hookworm and ticks. The treatment resulted in improvement in animal health as evidenced by a reduction in the number of dogs with anaemia. The long-term use of the ivermectin treatments at the other communities showed that over a period of three years, the prevalence of scabies and hookworm had reduced at most areas. The initial scabies prevalence varied from 17 to 52% and reduced to below 10% for all communities. The hookworm infection rates were affected by seasonal factors, as was evidenced by a seasonal variance in prevalence. Animals that were treated with ivermectin, though, had lower prevalences of hookworm than those that were not. There was a reasonable compliance rate for contraceptive treatments for female dogs (greater than 60% at each visit) and fewer puppies were born within communities when compared with rates before and after the establishment of the treatment program. High rates of acquisition of puppies from other communities continued to maintain the dog population numbers despite the reduction in breeding within communities. The dog population was young, biased towards male dogs, and very unstable (almost 50% of dogs died or went missing in a one year period). The rate of dog ownership across the Kimberley varied according to the region investigated and always remained higher or equal to ownership rates at the town centres of the Kimberley Region (as determined by a survey conducted during the study). Overall the canine parasite and breeding control program resulted in a reduction in scabies and hookworm prevalence in dogs (and hence a reduction in the potential zoonotic transmission), a reduction in dog breeding within communities, an improvement in dog health, and an understanding in the dynamics and health status of dogs within communities.

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33

Kendall, Garth Edward. "Children in families in communities : a modified conceptual framework and an analytic strategy for identifying patterns of factors associated with developmental health outcomes in childhood". University of Western Australia. School of Paediatrics and Child Health, 2003. http://theses.library.uwa.edu.au/adt-WU2004.0006.

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Mental health reflects an array of causal influences that span biological, psychological, and social circumstances, with resultant underlying causal pathways to poor mental health outcomes in childhood that are complex. Key features of this complexity are reciprocal interactions between person and environment that take place over time. The core of this thesis seeks to attend to the complexity of development to move the field of developmental health forward toward greater explanation, and more successful prediction and prevention. The focal point of the thesis is the psychosocial determinants of childhood mental health, the resource domain of the developing child, and the interplay between characteristics of the individual child, the family, and the community. The eventual goal is to better understand why and how socioeconomic circumstances impact on developmental health. One component of this thesis focuses on the expansion of extant developmental theory. The other component focuses on the development of an analytic strategy that more appropriately reflects the intricacies of this theoretical expansion. In the process, data are analysed, principally as a heuristic strategy, to illustrate the analytical approach needed to support the theoretical framework. The specification of a bioecological conceptual framework suitable to guide research and policy in developmental health is the first principal objective of the thesis. A critical examination of the resource framework proposed by Brooks-Gunn, Brown, Duncan, and Anderson Moore (1995) reveals it to be centred on family and community resources, but otherwise silent with respect to the physical and psychological resources of the child. The quintessential point of this thesis is that theory in developmental health must be able to account for the contribution individuals make to their own development. A modified resource framework is proposed that acknowledges financial, physical, human, and social capital, within the domains of the individual child, the family, and the community. The second principal objective of the thesis, the development of analytical methods that focus on the individual child and the complexity of data generated by this theoretical approach, is then introduced. Theory and method are thus integrated when comprehensive measures of characteristics in multiple domains across developmental periods are modeled using longitudinal data from the Western Australian Pregnancy Cohort (Raine) Study (Newnham, Evans, Michael, Stanley, & Landau, 1993). The mothers of 2,860 children were enrolled at 18 weeks in pregnancy and the children have been followed at birth, one, two, three, five, and eight years of age. Eighty-nine per cent (2,537 /2,860) of families were available for follow-up at eight and 74 per cent (2,126/2,860) of families responded. Extensive demographic, psychological, and developmental data were available for the children and their families and a limited amount of data were available for the communities in which they reside. A measure of mental health morbidity, the Child Behaviour Checklist (Achenbach, 1991), was available for the children at two, five, and eight years of age. In the first instance, dichotomous summary variables are derived for the demographic, psychological, and developmental variables of interest. Variables are then selected for inclusion in one of several explanatory models. To create a mathematical representation of resource characteristics, the information for each child is concatenated as a series of binary strings. Frequency tabulation is then used to aggregate the data and odds ratios are calculated to determine the degree of risk associated with each string of code, or pattern of factors relative to a nominated mental health outcome. The results provided a scaffold from which this theoretical and analytical approach is compared and contrasted with the reviewed literature. Two principal themes of investigation are pursued. The first theme to be examined is the interplay between characteristics of the child, family, and community and the contribution children make to their own development. The specific approach models the interaction between selected characteristics of the child, family and community in each of four developmentally significant time periods. The theoretical position adopted in the present study suggests that the effect of any personal or contextual factor on later development, if a relationship does truly exist, is most likely to be differential. That is, it is a combination of influences that determines developmental outcomes for children, not any single factor acting independently. The modelling process demonstrates that, for the children involved, personal and contextual factors impact mental health differentially depending on various other individual, family and/or community characteristics. The modelling process identifies patterns of factors that impact relatively small, but significant, numbers of children because the models focus on the effect for individual children rather than the effect for the group. For example, one model suggests that the effect of intra-uterine growth restriction for the group as a whole may be minimal, but the impact for some children could be critical depending on the combination of family and community influences, such as the mothers level of education, the family’s experience of significant life stress, and residence in a relatively disadvantaged community. The second theme to be examined is the possibility that the accumulation of resource deficits or risk characteristics, over time, amplifies the likelihood of mental health problems in childhood. The approach models selected characteristics of the child in each of the four periods of development collectively, and it also models selected characteristics spanning each of the four time periods discretely. The results suggest that latency, pathway, and recency effects may operate simultaneously, and that timing and accumulated burden may both be important determinants of risk. For example, with regard to children whose family experienced life stress, these three effects operated in a systematic way to increase the degree of risk of a mental health problem. In summary, the aggregation of data at the individual level is a productive approach in seeking to explain population level social phenomena. While seemingly paradoxical, the identification of the joint, interactive effects between individual, family, and community characteristics, better allows for the quantification of family and community characteristics operating through multiple causal pathways.

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Beyers, Belinda. "Experiences of community service practitioners who are deployed at a rural health facility in the Western Cape". Thesis, University of Western Cape, 2013. http://hdl.handle.net/11394/3321.

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Magister Curationis - MCur
South Africa has a general shortage of most categories of health professionals, which include nurses, doctors, dentists and pharmacists. However, the problem is exacerbated by the fact that most of these professionals either work in the private health sector or have migrated to more affluent countries. Shortages of nurses in the rural setting continue to pose a problem for the Department of Health. The community service policy is stated in Section 40 of the Nursing Act, of 2005, and in the Regulations relating to Performance of Community Service published in the Government Notice No. 765 of 24 August 2005. In 2008, the first professional nurses started with their community service. Community service for health professionals is a policy proposal of the Department of Health that reacts to the lack of meeting the health requirements in poor communities, particularly in rural areas. It offers graduating health professionals with the prospect of gaining first-hand working experience in conditions of poverty and underdevelopment. South Africa is implementing community service for health professionals as a plan to manage the difficulties of human resources in the health sector. The transition period for community service practitioners in a rural setting is different, which implies that most support may need to be strengthened due to the remoteness of the rural setting. The purpose of this study was to describe the experiences of community service practitioners during their community service at a rural health facility. From the findings, guidelines were described for the operational managers who are responsible for supporting the community service practitioners at a health facility in a rural area. A qualitative, exploratory, and descriptive design was applied, using individual unstructured interviews and field notes. Each interview took around 30-45 minutes to complete. The purposively selected sample consisted of community service practitioners (n = 10) who were practicing at rural health facilities. The process of inductive coding of Thomas (2003:5) was used to analyse the data. The results of this study indicate that a process is needed for community service practitioners fresh from university and an urban environment to adapt to a remote rural health facility. Some of the participants did receive an orientation programme at the beginning of their community service year. However, most of the community service practitioners that took part in the study learned from their experience during the year of their placements. For some, the learning opportunities were more available in the rural setting than when they had worked as students at the urban hospital during their training.

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Macfarlane, Chelsea Elizabeth. "A comparison of the predictors of hepatitis B vaccination acceptance amongst health care and public safety workers in Australia /". View thesis, 2001. http://library.uws.edu.au/adt-NUWS/public/adt-NUWS20031222.150943/index.html.

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Thesis (Ph.D.) -- University of Western Sydney, 2001.
"A thesis submitted in partial fulfillment of the requirements for the degree of Doctor of Philosophy, University of Western Sydney" Bibliography : leaves 193-208.

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McLoughlin, Jo-Ann. "Papsak consumption and problem drinking amongst farm workers in the rural Western Cape : prevalence and risk factors". Master's thesis, University of Cape Town, 2007. http://hdl.handle.net/11427/9331.

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Includes bibliographical references (leaves 79-84).
[Motivation] A high prevalence of alcohol consumption and the negative impact of alcohol on rural communities in the Western Cape have been linked to coercive labour practices and the ease of availability of cheap, low quality white wine, typically packaged in foil bags (papsakke). A process is underway to regulate papsakke out of the market. However, limited research has been conducted on the use and impact of papsakke. [Aims and objectives] This study aims to determine the prevalence of, and risk factors for papsak consumption and problem amongst farm workers in the rural Western Cape. It also explores the attitudes of drinkers with respect to their choice of alcohol type and the practices of papsak drinkers, in order to identify target groups for community level interventions and to inform the consent and monitoring of developmental and/or restrictive interventions. [Study design] A cross sectional analytical study performed as a post hoc analysis of data obtained from a larger study on papsakke which included a farm worker survey. [Subjects] 461 female and male farm workers resident on predominantly wine grape producing farms in Stellenbosch, Franschoek and Vredendal in the rural Western Cape Province from February to May of 2004.

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Dahari, Zainurin. "The effect of price and health information in shifting young children [sic] preference towards healthier food". UWA Business School, 2007. http://theses.library.uwa.edu.au/adt-WU2008.0011.

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Young children have becoming an important target by marketers. Marketers have used many strategies to influence their food choices including advertising and free gifts. According to literature, young children, are cognitively vulnerable and may make unhealthy decisions about their food choices that could lead to serious problems associated with being overweight and obese. This thesis examines whether price and health claim information can shift young childrens' choices towards healthier foods. Most of the previous published research literature has focused on adults. Those findings, using surveys and experiments, suggest that adults' food preferences and choices can be influenced by setting price and by providing health information. These findings suggest that these strategies may have a potential effect in young children decision making. The literature on Children Socialization and Information Processing Theory in consumer behaviour suggests that most young children under 8 are not cognitively skilled to use price and health claim information for their decision making. Nonetheless, most 5 to 8 year olds are making purchases of food at their school canteen several times a week. In order to test for the effects of price and nutrition information, several experiments that used discrete choice modelling were conducted to determine their choices, the reliability of their choices and the between their experimental choice behaviour and their choice in the market place. More than one hundred young children, aged from five to eight years old, completed the discrete choice experiments conducted in two primary schools in the suburbs of Perth. The choice experiments on subjects that had previous experience with the food items, but did not know their relative nutritional value, showed a strong positive effect of price. In other words, higher priced options were often in more demand. Although this may appear a poor response to price by an observer, children have little knowledge of food costs, so they may use price as a surrogate for quality. Price level was also a main effect in reducing the share of unhealthy choices. The results of the analyses also show that young children can provide reliable choice decisions within 5 months of experiment. However, their experimental choices were not associated with their later choices in the canteen. These findings provide evidence of the effectiveness of price and health claim information in changing young childrens' preference toward healthy choices, and the potential usefulness of using discrete choice techniques to shift children to more healthy food options.

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Rukundo, Emmanuel Nshakira [Verfasser]. "Effects of community-based health insurance on child health outcomes and utilisation of preventive health services : Evidence from rural south-western Uganda / Emmanuel Nshakira Rukundo". Bonn : Universitäts- und Landesbibliothek Bonn, 2018. http://d-nb.info/1173898611/34.

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Hanna, Elizabeth Gayle (Liz), i lizhanna@netc net au. "Environmental health and primary health care: towards a new workforce model". La Trobe University. School of Public Health, 2005. http://www.lib.latrobe.edu.au./thesis/public/adt-LTU20061110.152550.

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Public health was once synonymous with environmental health. However, as living conditions improved the two fields diverged. Environmental factors are again re-emerging as hazards human health. Increasing global reliance on agricultural and veterinary chemicals (AgVets) over recent decades has is now a serious public health concern. Evidence of their toxicity has prompted international efforts to minimize, monitor and manage exposure risks. Direct involvement of the primary health care workforce is seen as critical to this process, yet little data exists on the health burden on Australian rural communities imposed by these chemicals. The study presented here attempts to explore the impact of these chemicals on two rural communities in Victoria, and ascertain the how the existing primary heath care system responds to AgVet exposure issues. Health determinants are complex, and inter-related, and the client �provider interface is not an entity acting in isolation from other frameworks. The provider-client service relationship has evolved against a background of legislation and provider training. Many external factors also impinge, such as the structure and focus of the health sector, and Australia�s systematic approach to environmental and chemical management. Examination of this underlying infrastructure in Australia provided the background against which the issue of exposure to agricultural and veterinary chemicals was explored. A brief summary of international developments in this area served to provide insight as to what interventions may be introduced to address the issue of chemical exposure. A CATI (Computer Assisted Telephone Interview) survey of 1050 households sought the perspectives from two Victorian agricultural communities to gather self-reported AgVet exposure patterns and health data, and whether respondents perceived their health problems were linked to exposure. Respondents were also asked to comment on the primary health care service experiences from local providers, and which services they preferred to seek for health advice. Perspectives were then sought from all primary health care providers servicing these communities. Information was sought on their level of expertise in diagnosing, and managing exposure related illness, via face-to-face interviews, focus groups and paper surveys. The study revealed rural communities have a long history of hazardous exposure to toxic AgVets. Awareness of toxicity risks is growing, yet further scope exists to improve safe handling of chemicals. High levels of illnesses known be associated with AgVet exposure exist among rural populations. Many believe their own ill-health is linked to exposure, and express strong dissatisfaction with the apparent lack of environmental health expertise especially among their GPs. Health providers demonstrated limited understanding of the health impacts of AgVet exposure. The lack of environmental health expertise among the existing primary health care workforce means that health conditions associated with exposure to AgVets are not being identified, and the absence of health intelligence hampers health planning. In Australia, the health, environment and primary industries sectors function in effect, as distinct silos, with little cross-fertilisation. The United States has combined its agricultural chemical legislative authority to develop a focus on human health, establish direct links, and biomonitoring programs to protect human heath. The U.S. has also developed environmental health expertise at the primary health care level to address community needs as they arise. Strategies are required in Australia to connect the environment, chemical management and health portfolios, with respect to the emerging environmental issues of chemical exposure. There is a need also in Australia to inject environmental health capacity into the primary health care practice.

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Griffin, Sandra Lenore. "Interactions between zooplankton grazers and phytoplankton as part of the energy and nutrient dynamics in the Swan River Estuary, Western Australia". Curtin University of Technology, School of Chemical and Biological Sciences, 2003. http://espace.library.curtin.edu.au:80/R/?func=dbin-jump-full&object_id=14320.

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Most Australian studies on estuarine plankton have examined distribution and abundance in relation to hydrological changes, primary productivity and associated nutrient dynamics. Relatively few have examined the complex interactions between zooplankton grazers and the type and quality of food available, or the role of zooplankton grazers in structuring phytoplankton communities, or their contribution to the nutrient pool. The ecological role of zooplankton grazers in the Swan River estuary, Perth, Western Australia, was examined as part of a collaborative research project directed by the Western Australian Estuarine Research Foundation, which was established in response to concern about increasing intensity and persistence of algal blooms. The present study focussed on one component of the zooplankton, the Copepoda, as model zooplankton grazers. A regular zooplankton monitoring programme, undertaken over a two year period, provided data on seasonal patterns of abundance and distribution of zooplankton over a broad spectrum of physical conditions. Relationships were identified between habitat variables, such as algal biomass, dissolved oxygen, salinity and suspended solids and zooplankton distribution, relative abundance and species composition. Prior to the inception of this study, it was assumed that copepod species composition, abundance and richness in the Swan River estuary may have changed over time, in response to long-term declines in water quality. Comparison of historical copepod monitoring data with current data did not detect any such change and it was concluded that there was greater variation in copepod species composition, abundance and richness within years than between years and that no significant change had occurred between 1966 and 1997.
However, an absence or reduction in abundance of copepods in areas of very high algal biomass (>80 pg chlorophyll a.L-1) suggests that local loss of water quality may have an impact on copepods over a small spatial scale within the estuary. Different aspects of the interactions between zooplankton grazers and phytoplankton were studied. Zooplankton grazing rates were measured in situ during algal blooms and in the laboratory under controlled conditions to determine the potential for zooplankton grazers to reduce algal biomass. Field and laboratory experiments supported the hypothesis that copepods and other zooplankton can exert 'top-down control' over phytoplankton biomass, but that the type and biomass of phytoplankton present affected their ability to exert this control. The results of the field and laboratory grazing experiments, along with literature data, were used to provide input data for a model of zooplankton and phytoplankton dynamics during a dinoflagellate bloom in the Swan River estuary. The model was tested against biomass measurements of zooplankton and phytoplankton to determine how well it predicted actual changes in the plankton community. The simulated output closely followed the measured Page x field data and fitted regression curves and provided information about diurnal patterns of phytoplankton production, respiration and migration and hydrodynamic transport, which was not available from field data. It was shown that zooplankton grazing, particularly grazing by microzooplankton, was the process contributing most to the observed decline in dinoflagellate biomass. Nutrient availability is one of several factors determining productivity of phytoplankton. Nutrients within copepod faecal pellets are relocated by faecal deposition to sediments, where microbial activity leads to the remineralisation of these nutrients.
Quantification of metabolic excretion of nutrients by copepods and the rate at which pellets are produced by copepod grazers, the concentration of nutrients within faecal pellets and the rate at which these nutrients are released indicated that copepods may play an important role in nutrient regeneration during summer and autumn when allochthonous nutrients are unavailable. At other times of the year, it is unlikely that copepods play an important role in nutrient regeneration. The research has provided a more detailed level of understanding of the interactions between zooplankton, phytoplankton and their environment. The data is ideally suited for use in a computer model to predict the effects of management actions on the Swan River estuary. This would allow pre-emptive management strategies to be developed and lessen the focus on reactive management.

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Hurter, Theunis. "The culture of data use in the management structures of a rural health district in the Western Cape Province". Master's thesis, University of Cape Town, 2015. http://hdl.handle.net/11427/15545.

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Background: Health information system (HIS) performance has been defined as â€œdata quality and the continuous use of information â€ . The quality of data, as well as the culture of data use in an organisation has been shown to shape the way data is used. In order to fully understand data use practices with the aim of strengthening the HIS, one needs to first understand whether the context and â€œcultureâ€ in the organisation is conducive to data use. Are the policies, structures, processes and people within the organisation aiding data use? In what ways do managers view and use data? Aim: In this study, we sought to explore the culture of health information use on a district and sub district management level. The aim was to contribute to the wider knowledge on information use by exploring the data use practices and factors that shape its use among these managers. What is the culture of data use in the district management structures? When, why and in what way does data get brought into the management discussion? Do managers feel that the information produced are useful in aiding their decision making, and what do they recommend be changed? What are the key factors that affect data use practices? Methods: This thesis comprises a literature review of published articles, conducted in order to provide context for the study of the culture of data use, whilst defining the problem to be investigated. The full thesis comprises the literature review, the original study protocol, a full manuscript in the format of a publishable article and a set of appendices. The study was granted ethical approval and permission from the provincial department of health. Given the exploratory purpose of the study, we conducted a mini ethnographic case study using qualitative research methods in a rural health district of the Western Cape Province of South Africa. The researcher employed ethnographic methods that included participant observation, in depth key informant interviews, document reviews as well as informal conversations to collect data. We used the PRISM framework as a guide for analysing our findings. Findings: Our findings suggest that there is a strong focus in this district on reporting requirements and technical aspects of producing good quality data. The drive to achieve excellence in production of quality data may be in tension with another important organisational value, which is the need of managers, for ease of access to relevant data, to facilitate decision-making and improvement of health service delivery. Managersâ€™ overall experience is of not receiving the health information support they require. Instead, they experienced an organisational culture of using health information to narrowly measure targets and performance, which left them feeling unsupported and frustrated. Managers were resilient in managing these challenges and created alternative ways of accessing the data they needed for decision-making. Conclusion: We conclude that in our setting where the technical component of producing good data was well performed, this was not sufficient to guarantee effective use of data for quality improvements. Behavioural and organisational factors were found to play an important role as both obstacles and facilitators in shaping the culture of data use, information that is useful to inform design of interventions for health information strengthening.

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Rörich, Eben Eugéne. "An economic evaluation of the winelands health worker programme". Thesis, Stellenbosch : Stellenbosch University, 2002. http://hdl.handle.net/10019.1/52664.

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Thesis (MComm)--Stellenbosch University, 2002.
ENGLISH ABSTRACT: Historically health care in South Africa has been an area of great inequity. Health care was inequitable, inadequate and racially based. In order to redress the gap in the delivery of health care services, created by the previous dispensation of separate development, the National Department of Health has adopted a Primary Health Care (PHC) approach as the guiding principle for the reconstruction of the health system in South Africa. One of the pillars of this approach is the empowerment of communities to participate, thus moving from facility based- to community based health care. The aim of the National Health System (NRS) is to promote health and health knowledge, to provide an equitable, accessible, and appropriate health service, and to empower people to take greater responsibility for their own health. It is constructed around the belief that health for all cannot be achieved simply by improving the formal health system, but that a holistic and multi-sectoral approach is required. This thesis explores the community health worker (CRW) as a possible cost-effective and efficient supplementary service, to the current formal health system, to bridge the gap in the formal health system through the provision of PHC services in a rural setting. This was done through the economic evaluation of a CHW programme operating in the Winelands are of the Western Cape. The aim of this study was to evaluate and analyse the nature, performance, and costs of the programme and place it in context by comparison to other similar programmes. This comparison focused on physical characteristics, goals, and cost structures. It also aims to measure the direct and indirect impact of this type of intervention on the agribusiness sector as well as the local health authorities. The evaluation proceeded from the premise that the CHW programme, if implemented correctly with proper and appropriate training, and adequate post training support, will be a cost-effective and efficient model for the provision ofPHC services in this rural/farming area. The economic evaluation of this CHW programme required it to be viewed from two perspectives. The first component viewed the implementation of the programme from the perspective of the agribusiness sector. This aspect of the study included both a qualitative as well as a quantitative VIew of the costs, benefits (perceived or otherwise), and perceptions of the CHW intervention. The second component assessed the CHW programme within the context of a resource constrained public sector health budget. Since the implementation of this programme implies certain expenditures on the part of the local health authorities, these cost had to be identified and quantified to gauge the effectiveness of that expenditure.
AFRIKAANSE OPSOMMING: Geskikte en doeltreffende gesondheidsdienste in Suid-Afrika se onlangse geskiedenis was nog gereserveer vir 'n uitgesoekte groep mense. Die gesondheidstelsel was ontoereikend, onvoldoende en gebaseer op ras. Daar het 'n gaping ontstaan tussen die dienste wat gelewer is en die werklike behoeftes van die mense wat dit moes gebruik. Ten einde hierdie gaping aan te spreek het die Nasionale Departement van Gesondheid besluit om 'n Primêre Gesondheidsorg (PRe) benadering te volg wat klem plaas op die bemagtiging van plaaslike gemeenskappe deur deelname. Dit was 'n duidelike skuifvanaffasiliteit- na gemeenskap gebaseerde gesondheidsdienste. Die oorkoepelende doel van hierdie verskuiwing in fokus was om voorheen benadeelde gemeenskappe voldoende toegang te gee tot gesondheidsdienste en ook om hierdie dienste aan te pas by die behoeftes van sodanige gemeenskappe. Hierdie tesis ondersoek die Wynland distriksraad se Gemeenskap Gesondheidswerker Program as 'n moontlike koste-effektiewe stelsel vir die lewering van toepaslike primêre gesondheidsdienste in landelike areas. Die doel van die studie was die sistematiese ontleding van die werking en omvang van, en die kostes verbonde aan die implementering en onderhoud van hierdie program. Die studie poog om die impak van hierdie program op die formele landbou sektor asook die plaaslike gesondheidsowerhede te identifiseer en, waar moontlik en prakties wenslik, te kwantifiseer. Die ondersoek sluit in die stelselmatige ontleding van kostes en voordele vir die formele landbou sektor sowel as die plaaslike gesondheidsowerhede. Die kostes asook die kliniese uitkomste geassosieer met die implementasie van die Gesondheidswerker program sal dan in konteks geplaas word deur dit te vergelyk met ander soortgelyke programme wat in die verlede aangepak is. Die vergelyking sal fokus op die fisiese eienskappe, koste struktuur, bronne van ondersteuning en die primêre doel van die intervensie.

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Van, Zyl Marjorie Alice. "Factors influencing community integrated management to childhood illness in rural areas". Thesis, Stellenbosch : Stellenbosch University, 2013. http://hdl.handle.net/10019.1/80383.

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Thesis (MCurr)--Stellenbosch University, 2013.
ENGLISH ABSTRACT: Child mortality is a worldwide problem and, according to the World Health Organization (WHO), 8,1 million children under the age of five years die each year. The Millennium Development Goals focus on the worldwide reduction in child mortality by two-thirds between 2000 and 2015. Several studies show that worldwide Community Integrated Management of Childhood Illness (CIMCI) interventions by community care workers (CCWs) have a positive effect on child health. The goal of this study was to determine the factors influencing CIMCI in the rural areas of the West Coast District in the Western Cape of South Africa. The objectives for this study were to determine the factors influencing CIMCI carried out in rural areas by the CCWs, which were identified as: • having working hours that are adequate for such a comprehensive service package; • being adequately trained; • having adequate knowledge of the “16 Key Family Practices” of CIMCI; • having equipment that is adequate for the execution of their daily duties; • being able to cope with the challenges of working in rural and remote areas; and • receiving adequate supervision and support related to CIMCI. A descriptive, non-experimental exploratory research design with a quantitative approach was applied. The target population (N = 270) consisted of CCWs who are funded by the Provincial Government of the Western Cape (PGWC) in the West Coast District. For this study a response rate of 257 (95,18%) was obtained. Data was collected personally by the researcher with a self-administered questionnaire. The data was analysed with the assistance of a statistician and are presented in histograms and frequency tables. The participants were tested on their knowledge of CIMCI, and more than half of them achieved an average score that was not satisfactory. Statistically significant correlations were found between the participants’ total score achieved and highest school grade passed (p < 0. 01); their level of Expanded Public Works Programme (EPWP) training (p < 0.01); their attendance of the CIMCI five-day course (p < 0.00); and if they had done a refresher course on CIMCI (p < 0.00). The total score was also shown by the Mann-Whitney U test (p < 0.01) to have a direct relationship with whether they had received any health-related training after school. The conclusion that can be drawn is that the higher the level of education of the CCWs, the better their knowledge of CIMCI. This could also improve their work performance. The recommendations arising from this study include that CIMCI training should be standardised to ensure that the CCWs have adequate knowledge. The current policy on community-based services (CBS) of the Provincial Government Western Cape Department of Health should also be standardised to ensure adequate working hours, training, equipment and supervision, and to take into consideration the challenges of working in rural areas. In conclusion, should these recommendations be implemented, CIMCI will have a huge, positive impact on child morbidity and mortality. CCWs will be ensured adequate working hours in relation to their workload, and will receive adequate training, equipment and supervision. This will reduce the challenges CCWs face and strengthen their services in rural areas.
AFRIKAANSE OPSOMMING: Kindersterftes is wêreldwyd ’n probleem en volgens die Wêreldgesondheidsorganisasie sterf 8,1 miljoen kinders onder die ouderdom van vyf jaar elke jaar. Die Millenniumontwikkelings-doelwitte fokus daarop om kindersterftes tussen 2000 en 2015 met twee-derdes te verminder. Verskeie studies toon dat intervensies deur middel van Gemeenskapsgeïntegreerde Bestuur van Kindersiektes deur gemeenskapsorgwerkers die wêreld oor ’n positiewe effek op kindergesondheid het. Die doel van hierdie studie was om die faktore te bepaal wat Gemeenskapsgeïntegreerde Bestuur van Kindersiektes in die landelike gebiede van die Weskusdistrik in die Wes-Kaap van Suid-Afrika beïnvloed. Die doelwitte vir hierdie studie was om die faktore te bepaal wat beïnvloed hoe Gemeenskapsgeïntegreerde Bestuur van Kindersiektes in die landelike gebiede deur gemeenskapsorgwerkers uitgevoer word, wat soos volg uiteengesit is: • werksure wat voldoende is vir die omvattende pakket dienste wat aangebied word; • dat hulle voldoende opgelei is; • dat hulle voldoende kennis het van die “16 Sleutel Familiepraktyke” van Gemeenskapsgeïntegreerde Bestuur van Kindersiektes; • dat hulle die nodige toerusting besit wat voldoende is vir die uitvoer van hulle daaglikse pligte; • dat hulle raad weet met die uitdagings van werk in landelike en afgeleë gebiede; en • dat hulle voldoende toesig en ondersteuning met betrekking tot Gemeenskapsgeïntegreerde Bestuur van Kindersiektes ontvang. ’n Beskrywende, nie-eksperimentele verkennende navorsingsontwerp met ’n kwantitatiewe benadering is gebruik. Die teikenbevolking (N = 270) het bestaan uit gemeenskapsorgwerkers wat deur die Provinsiale Regering van die Wes-Kaap in die Weskusdistrik befonds word. Vir hierdie studie is ’n responstempo van 257 (95,18%) verkry. Die data is persoonlik deur die navorser deur middel van ’n selftoepastoets ingesamel. Die data is met behulp van ’n statistikus geanaliseer en word deur middel van histogramme en frekwensietabelle voorgestel. Die deelnemers is getoets op grond van hulle kennis van Gemeenskapsgeïntegreerde Bestuur van Kindersiektes, en meer as die helfte het ’n gemiddelde telling behaal wat nie bevredigend is nie. Statisties beduidende korrelasies is verkry tussen die deelnemers se totale telling en die hoogste skoolgraad behaal (p < 0.01); hulle vlak van Expanded Public Works Programme (EPWP) opleiding (p < 0.01); hulle bywoning van die vyfdaagse Gemeenskapsgeïntegreerde Bestuur van Kindersiektes kursus (p < 0.00); en of hulle ’n opknappingskursus oor Gemeenskapsgeïntegreerde Bestuur van Kindersiektes gedoen het (p < 0.00). Die totale telling is deur die Mann-Whitney U-toets (p < 0.01) gewys om ’n direkte verwantskap te hê met of hulle enige gesondheidsverwante opleiding ná skool ondergaan het. Die gevolgtrekking is dat hoe hoër die gemeenskapsorgwerkers se vlak van opvoeding, hoe beter hulle kennis van Gemeenskapsgeïntegreerde Bestuur van Kindersiektes. Dit sou ook hulle werkverrigting kon verbeter. Die aanbevelings wat uit hierdie studie spruit, sluit in dat Gemeenskapsgeïntegreerde Bestuur van Kindersiektes-opleiding gestandaardiseer moet word om te verseker dat gemeenskapsorgwerkrs voldoende kennis het. Die huidige beleid van die Provinsiale Regering van die Wes-Kaap oor gemeenskapsgebaseerde dienste moet ook gestandaardiseer word om te verseker dat hulle toereikende werksure, opleiding, toerusting en toesig het, en om die uitdagings van werk in landelike gebiede in ag te neem. Ter afsluiting: sou hierdie aanbevelings geïmplementeer word, sal Gemeenskapsgeïntegreerde Bestuur van Kindersiektes ‘n groot, positiewe impak op kindermorbiditeit en kindersterftes hê. Gemeenskapsorgwerkers sal van voldoende werksure met betrekking tot hulle werklas verseker wees, en sal voldoende opleiding, toerusting en toesig ontvang. Dit sal die uitdagings verminder waarvoor hulle te staan kom en hulle dienste in landelike gebiede versterk.

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44

Smith, Kathryn Elizabeth. "Assessment and prevalence of dementia in indigenous Australians". University of Western Australia. School of Primary, Aboriginal and Rural Health Care, 2009. http://theses.library.uwa.edu.au/adt-WU2009.0062.

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Until recently, there was no dementia screening tool for Indigenous Australians and a paucity of information on the extent of dementia in Indigenous Australians. This thesis describes the development and validation of a tool to assess cognitive impairment in remote Indigenous Australians with the primary purpose of determining the prevalence of dementia and other associated conditions in this population. The tool was reevaluated with the larger prevalence sample and a short version of the tool was developed and evaluated. The Kimberley Indigenous Cognitive Assessment (KICA) tool was validated with Indigenous Australians aged over 45 years from the Kimberley region of Western Australia (n=70). The results were later confirmed in a larger sample from the remote Kimberley (n=363), and an additional sample in rural and remote areas of the Northern Territory (n=47). The KICA results were compared to independent consensus diagnoses using DSM-IV and ICD-10. Interpreters were used whenever participants were not proficient in English. These data led to the determination of a cut-off score of 33/34 out of a possible total score of 39 for the cognitive component of the KICA (KICA-Cog), with a sensitivity of 0.93 and specificity of 0.95 and AUC of 0.98. The tool is now widely used within remote areas of Australia. A short version of the KICACog (sKICA-Cog) was developed and found to be a valid brief screening tool for dementia in the Kimberley population, and had a cut-off score of 20/21 out of a possible 25, with a sensitivity of 0.89, specificity of 0.95 and AUC of 0.98. The sKICA-Cog should be used in combination with the KICA cognitive informant questionnaire (KICA-IQ). The KICA-IQ cut-off score of 2/3 out of a possible 16 was determined, with a sensitivity of 0.76 and specificity of 0.84 and AUC of 0.91. Using the validated KICA, the prevalence of dementia and cognitive impairment not dementia (CIND) was determined in a semi-purposive sample consisting of 363 Indigenous Australians aged over 45 years from 6 Aboriginal communities and one town in the Kimberley region. Participants were screened with the full KICA and 165 participants had an independent specialist review with consensus diagnoses. The prevalence of dementia was 12.4%, 5.2 times greater than the Australian prevalence of 2.4%, after age adjustment. The prevalence of CIND was 8.0%. Characteristics associated with dementia included older age, male gender (OR 3.1, 95% CI 1.4, 6.8), no formal education (OR 2.7, 95% CI 1.1, 6.7), smoking (OR 4.5, 95% CI 1.1, 18.6), previous stroke (OR 17.9, 95% CI 5.9, 49.7), epilepsy (OR 33.5, 95% CI 4.8, 232.3) and head injury (OR 4.0, 95% CI 1.7, 9.4). Other factors associated with dementia included incontinence, falls and poor mobility. The KICA is a valid assessment tool for rural and remote Indigenous Australians. The prevalence of dementia amongst Indigenous Australians is substantially higher than generally found in non - Indigenous Australians and other populations in the developed and developing world.

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Mannan, Haider Rashid. "Development and use of a Monte Carlo-Markov cycle tree model for coronary heart disease incidence-mortality and health service usage with explicit recognition of coronary artery revascularization procedures (CARPs)". University of Western Australia. School of Population Health, 2008. http://theses.library.uwa.edu.au/adt-WU2008.0101.

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[Truncated abstract] The main objective of this study was to develop and validate a demographic/epidemiologic Markov model for population modelling/forecasting of CARPs as well as CHD deaths and incidence in Western Australia using population, linked hospital morbidity and mortality data for WA over the period 1980 to 2000. A key feature of the model was the ability to count events as individuals moved from one state to another and an important aspect of model development and implementation was the method for estimation of model transition probabilities from available population data. The model was validated through comparison of model predictions with actual event numbers and through demonstration of its use in producing forecasts under standard extrapolation methods for transition probabilities as well as improving the forecasts by taking into account various possible changes to the management of CHD via surgical treatment changes. The final major objective was to demonstrate the use of model for performing sensitivity analysis of some scenarios. In particular, to explore the possible impact on future numbers of CARPs due to improvements in surgical procedures, particularly the introduction of drug eluting stents, and to explore the possible impact of change in trend of CHD incidence as might be caused by the obesity epidemic. ... When the effectiveness of PCI due to introduction of DES was increased by reducing Pr(CABG given PCI) and Pr(a repeat PCI), there was a small decline in the requirements for PCIs and the effect seemed to have a lag. Finally, in addition to these changes when other changes were incorporated which captured that a PCI was used more than a CABG due to a change in health policy after the introduction of DES, there was a small increase in the requirements for PCIs with a lag in the effect. Four incidence scenarios were developed for assessing the effect of change in secular trends of CHD incidence as might be caused by the obesity epidemic in such a way that they gradually represented an increasing effect of obesity epidemic (assuming that other risk factors changed favourably) on CHD incidence. The strategy adopted for developing the scenarios was that based on past trends the most dominant component of CHD incidence was first gradually altered and finally the remaining components were altered. iv The results showed that if the most dominant component of CHD incidence, eg, Pr(CHD - no history of CHD) levelled off and the trends in all other transition probabilities continued into future, then the projected numbers of CABGs and PCIs for 2001-2005 were insensitive to these changes. Even increasing this probability by as much as 20 percent did not alter the results much. These results implied that the short-term effect on projected numbers of CARPs caused by an increase in the most dominant component of CHD incidence, possibly due to an ?obesity epidemic, is small. In the final incidence scenario, two of the remaining CHD incidence components-Pr(CABG - no history of CHD) and Pr(CHD death - no CHD and no history of CHD) were projected to level off over 2001-2005 because these probabilities were declining over the baseline period of 1998-2000. The projected numbers of CABGs were more sensitive (compared to the previous scenarios) to these changes but PCIs were not.

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46

Leighton, Kim. "Improving enhanced surveillance of notifiable enteric illnesses". University of Western Australia. School of Population Health, 2005. http://theses.library.uwa.edu.au/adt-WU2005.0074.

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[Truncated abstract] Gastroenteritis is frequently associated with a food or water borne source and the investigation of such cases is undertaken to identify potential sources of infection. Where contaminated food or water are identified as the source of infection/intoxication, action may be taken to limit or prevent further people being affected, and in so doing limit costs to the health care system. This study was undertaken to determine if there is a more effective and efficient way to collect information from patients with certain enteric illnesses. This was based on a trial process of posting self-administered questionnaires with a reply-paid return envelope to the patient and compared with the existing process where local government Environmental Health Officers interview the patient and provide a report to the Department of Health. A limiting factor in the existing process is the time lapse between the onset of illness and follow-up by Environmental Health Officers (EHOs), which results in difficulties in contacting the patient and obtaining a dietary history. Furthermore, the existing system is resource intense, requiring officers to individually interview patients either in person or by telephone. The study was of those patients living in the Perth metropolitan area whose doctor notified the Department of Health that the patient had contracted any of three notifiable enteric illnesses (campylobacterosis, giardiasis or salmonellosis), and the patient was not part of a known outbreak and was assessed as not requiring urgent follow-up. The trial process was used for patients living in five local government areas and the return rate, timeliness of return and completeness of questionnaires in the trial process was compared with the reports returned under the existing process of investigation and reporting by EHOs from 24 metropolitan local government areas that were not part of the trial process. An estimate of the potential costs to local government and the Department of Health was undertaken for both the existing and trial processes of collecting information from patients. A survey of local government EHOs in the metropolitan area was also undertaken to assess the perception of EHOs about roles and responsibilities in the follow-up investigation, the use of the Enteric Disease Investigation Report (EDIR) and the limitations that they identified in the current investigation process.

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Mills, David. "The role of goal setting in the diabetes case management of aboriginal and non-aboriginal populations in rural South Australia /". Title page, table of contents and abstract only, 2005. http://web4.library.adelaide.edu.au/theses/09MD/09mdm6571.pdf.

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

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Schoevers, J. F. "Factors influencing specialist outreach and support services to rural populations in the Eden and Central Karoo districts of the Western Cape : a Delphi study". Thesis, Stellenbosch : Stellenbosch University, 2012. http://hdl.handle.net/10019.1/80461.

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Thesis (MFamMed)--Stellenbosch University, 2012.
INTRODUCTION: Access to health care, like childhood survival, often depends on where one lives. The infant mortality rate in rural South Africa (SA) is 52.6 per 1000 births, compared to 32.6 per 1000 births in urban areas. Furthermore, three of the four districts in SA with the highest HIV prevalence are rural. These being two commonly used health indicators, it is clear that rural populations have significantly poorer health outcomes than their urban counterparts. About half the world’s population live outside major urban centres, where health services and specialist medical services are concentrated. Rural SA are home to 43.6% of the population, but are served by only 12% of doctors and 19% of nurses. Of the 1200 medical students graduating in the country annually, only about 35 work in rural areas in the long term. There are 30 generalists and 30 specialists/100 000 people in urban areas, compared to an average of 13 generalists and two specialists/100 000 people in rural areas. The question arises whether the poorer access to particularly specialist services is a contributing factor towards poorer outcomes. Specialist outreach to rural communities is one way of improving access to care. In the Eden and Central-Karoo districts of the Western Cape of SA there are one level 2 (regional) hospital and ten level 1 (district) hospitals. All clinical disciplines reach out, with varying frequencies. On average, the four main district hospitals receive 17 specialist outreach visits per month; while the smaller district hospitals receive three specialist visits per month (Appendix 1). A typical outreach visit includes a problem ward round, outpatient session, theatre list for some surgical disciplines and formal/informal educational sessions. In principle, stakeholders agree that specialist outreach and support (O&S) to rural populations is necessary, as it improves access to specialized health care services. In practise however, there are factors that influence whether or not O&S reaches its goals. This in turn affects the sustainability of O&S projects. Understanding these factors would aid recommendations for a suitable model for O&S.

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Loots, Reginald. "Factors associated with malnutrition amongst children six months to five years of age in a semi-rural area of the Western Cape". Thesis, Cape Peninsula University of Technology, 2019. http://hdl.handle.net/20.500.11838/3079.

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Thesis (MTech (Health and Science))--Cape Peninsula University of Technology, 2019
Malnutrition is a global concern and particularly in children. It impacts negatively on mortality, morbidity, educability and productivity, and it affects millions of children in South Africa. As part of our Millennium Development Goals set by the Department of Health and WHO, it is vital to combat malnutrition by eradicating extreme poverty and hunger. Malnutrition is regarded as a change in nutritional status that carries the penalty of illness, dysfunction or death. Child malnutrition poses one of the biggest challenges in South Africa according to the WHO and has been well documented over the past 20 years. A lack of knowledge from parents or caregivers on the nutritional needs of children and the levels of poverty contribute to childhood malnutrition; the extent of hunger has also been associated with low energy intake, low micronutrient intake and poor income levels. This affects growth patterns negatively. Thus, this study aims to examine the key factors that are causing malnutrition in children in a semi-rural community in the Western Cape. A combination of both qualitative and quantitative research approaches were used. Qualitative data were collected through group interviews and quantitative data were collected through a self-administered questionnaire from 105 parents and caregivers. Thematic content analysis was used for qualitative data analysis and SPSS was used to analyse the quantitative data. The results revealed that the associated factors to malnutrition amongst children six months to five years of age included obesity, underweight, stunting, severe acute malnutrition and moderate acute malnutrition. The results further indicated that the majority of households were single mothers with low income and a poor educational background. This study recommended that health education and health promotion should be done at all heath facilities with regular intervals as well as within the community. Authorities should provide a platform for all clinicians to go for regular updates and to participate in continuous development programmes to combat malnutrition. The findings of this study could contribute to the existing body of knowledge with regard to the factors that contribute to malnutrition. The results could improve health care practices in the communities of the Western Cape and the South African context at large.

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Ochieng, Anne Achieng. "The relationship between environmental exposures to pesticides measured by means of environmental exposure indices and the anthropomentric outcomes of boys living on farms in the rural Western Cape". Master's thesis, University of Cape Town, 2011. http://hdl.handle.net/11427/12169.

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Includes abstract.
Includes bibliographical references.
Few epidemiological studies have investigated the effect of pesticides on growth of boys and results are conflicting. Pesticide environmental exposure indices have not previously been developed. To investigate the effect of pesticide exposure using environmental exposure indices on pubertal growth of boys...

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