Factors Influencing Patient Waiting Time in Public Health Facilities: A case study of Temeke Referral Hospital.

Waiting times for health care services is identified as an important indicator for patient satisfaction. Waitingtime is also associated with quality of health services. There is limited information about what influences long patient waiting in health facilities within Dar es Salaam region. Therefore, this study was conducted to examine the factors influencing patient waiting time at Temeke Referral Hospital. The study employed Queueing theory and the Grossman Model for Health.The study employed a case study design. The study enrolled 345 respondents. The study participants were selected by convenience and purposive sampling techniques. Data collection was by wayof questionnaire, interview and documentary review. Quantitative data was analysed by using SPSS and the findings gathered from the field revealed that majority (n=217, 71.2%) respondents were dissatisfied with the overall time that they spent while waiting for health care services which was associated with delays in several service points. These delays resulted from the shortage of health workers, inadequate facilities for service provision and logistics, few medical personnel per shift, lack of effective appointment system, types of services sought by patients and arrival time of patients. Also, results depicted from the study show that respondents were satisfied with the availability and quality of health services delivered at this facility despite waiting for long time. The study concludes that, there is a need to address limitations associated with human resources (availability), infrastructure, and internal hospital procedures. More efforts should be done to improve the capacities of health facilities in order to address the challenges of self-referral from lower-level facilities to the regional referral hospital. Keywords: Customer (patient), queue, Queue discipline, Service mechanism

Rebooting Empathy for the Digital Generation Lawyer

There is a growing preference in today’s technology-saturated society for online interaction via email, text messages, social networks, and instant messaging, rather than real-world interaction through face-to-face or telephonic conversations. For today’s young people—the Digital Generation—this is more than a mere preference; it is a way of life. Research indicates that the movement toward virtual communication comes with negative consequences, such as poor real-world communication skills and underdeveloped social skills. Most significantly, research suggests that the Digital Generation are less empathic than elder generations are. Some researchers speculate that the rising prominence of information and communication technologies (ICTs) in everyday life may have contributed to the Digital Generation’s decreased empathy.Today’s young ICT devotees are tomorrow’s future legal professionals. And when the Digital Generation enter legal practice they will find it entails far more than just reading cases and spotting issues. They will be called upon to counsel, to advocate, to persuade, and to adjudicate. To succeed in legal practice the Digital Generation will need strong empathic abilities. There are clear negative implications for the legal profession’s future if successful legal practice requires particular interpersonal skills but ICT usage is preventing the Digital Generation from developing these skills.This article analyzes social science literature regarding declining empathy, the Digital Generation, and technology. It establishes the importance of empathy in legal practice and examines prior suggestions for improving the legal profession’s historically fraught relationship with empathy. It then proposes new strategies to reverse this empathy decline so the Digital Generation may become successful legal practitioners despite—or perhaps even because of—their use of ICTs

A Feminist Political Economy Analysis of Medical Broker and Fertility Clinic Websites

This dissertation studies the ways in which market-based reproductive health services are advertised and virtually represented on a global scale. I detail the implicit values and assumptions found in the content of reproductive tourism websites. In doing so, I show how medical broker and fertility clinic websites reproduce dominant ideologies and how these websites portray reproductive tourists, egg providers and surrogates. Using a feminist political economy approach, I situate the practice of reproductive tourism within particular historical, economic and political contexts, including both domestic and global neoliberal healthcare reforms. The findings of this thesis reveal that the websites portray neoliberal policies that emphasize consumerism, individual responsibility for ones healthcare and that position reproductive tourists as empowered consumers capable of making informed choices in purchasing new reproductive technologies (NRTs). The marketing of reproductive tourism on these websites also ignore the physical and affective labour of women who are egg providers and surrogates and minimizes the unequal power relationships that exist between reproductive tourists and egg providers and surrogates. Their experiences are erased from view and their bodies objectified and fragmented for market consumption

Healthy snacks consumption and the Theory of Planned Behaviour. The role of anticipated regret

Two empirical studies explored the role of anticipated regret (AR) within the Theory of Planned Behavior (TPB) framework (Ajzen, 1991), applied to the case of healthy snacks consumption. AR captures affective reactions and it can be defined as an unpleasant emotion experienced when people realize or imagine that the present situation would be better if they had made a different decision. In this research AR refers to the expected negative feelings for not having consumed healthy snacks (i.e., inaction regret). The aims were: a) to test whether AR improves the TPB predictive power; b) to analyze whether it acts as moderator within the TPB model relationships. Two longitudinal studies were conducted. Target behaviors were: consumption of fruit and vegetables as snacks (Study 1); consumption of fruit as snacks (Study 2). At time 1, the questionnaire included measures of intention and its antecedents, according to the TPB. Both the affective and evaluative components of attitude were assessed. At time 2, self-reported consumption behaviors were surveyed. Two convenience samples of Italian adults were recruited. In hierarchical regressions, the TPB variables were added at the first step; AR was added at the second step, and the interactions at the last step. Results showed that AR significantly improved the TPB ability to predict both intentions and behaviours, also after controlling for intention. In both studies AR moderated the effect of affective attitude on intention: affective attitude was significant only for people low in AR

Integrating positive psychology constructs in psychotherapy: therapist perspectives on flourishing and virtue

The term "flourishing" means to grow or prosper and refers to a holistic, developmental sense of well being (VanderWeele et a l., 2019). There is growing interest in the principles of flourishing in psychotherapy. For instance, there are 20 studies of positive psychotherapy with results on par with other bona fide treatments and emphasize aspects of flourishing as factors in clie nt progress (e.g., AEDP, ACT; Fosha, 200; Rashid & Seligman, 2018). Still, the concept of flourishing remains largely segregated from mainstream mental healthcare practice. The disease model dominance within mental healthcare employs a view of the human pe rson as "clusters of symptoms" with the goal of treatment being the reduction of negative symptoms rather than increasing flourishing. Little is known about how mental health treatments improve clients' flourishing, as most studies have focused on symptom reduction. To address these limitations, the current study facilitated collaboration among four clinical research teams representing different clinical sites and training perspectives (e.g., CBT, Psychodynamic, Integrated). In doing so, we conducted eight focus groups utilizing a grounded theory qualitative approach to explore the processes through which flourishing is fostered in psychotherapy and the training of mental healthcare professionals.Published versio

Toward a Discourse Community for Telemedicine: A Domain Analytic View of Published Scholarship

In the past 20 years, the use of telemedicine has increased, with telemedicine programs increasingly being conducted through the Internet and ISDN technologies. The purpose of this dissertation is to examine the discourse community of telemedicine. This study examined the published literature on telemedicine as it pertains to quality of care, defined as correct diagnosis and treatment (Bynum and Irwin 2011). Content analysis and bibliometrics were conducted on the scholarly discourse, and the most prominent authors and journals were documented to paint and depict the epistemological map of the discourse community of telemedicine. A taxonomy based on grounded research of scholarly literature was developed and validated against other existing taxonomies. Telemedicine has been found to increase the quality and access of health care and decrease health care costs (Heinzelmann, Williams, Lugn and Kvedar 2005 and Wootton and Craig 1999). Patients in rural areas where there is no specialist or patients who find it difficult to get to a doctor’s office benefit from telemedicine. Little research thus far has examined scholarly journals in order to aggregate and analyze the prevalent issues in the discourse community of telemedicine. The purpose of this dissertation is to empiricallydocument the prominent topics and issues in telemedicine by examining the related published scholarly discourse of telemedicine during a snapshot in time. This study contributes to the field of telemedicine by offering a comprehensive taxonomy of the leading authors and journals in telemedicine, and informs clinicians, librarians and other stakeholders, including those who may want to implement telemedicine in their institution, about issues telemedicine

Innovative, Scalable and Affordable Interventions for the Treatment of Low Back Pain

The overall aim of the thesis was to investigate innovative, scalable and affordable interventions for the management of low back pain. Chapter Two shows an increasing online public interest in musculoskeletal conditions from 2008, with low back and neck pain being the ones with the highest annual increase (nearly 7%). Chapter Three reviews the use of text messages in the management of musculoskeletal pain. Text messages improved medication adherence compared to usual care and pain, function, quality of life and treatment adherence when added to comprehensive interventions and compared to control. Chapter Four describes the development process of the TEXT4myBACK intervention, which is a self-management text message intervention for people with low back pain. Chapter Five presents the protocol of the randomised controlled trial assessing the effect of the TEXT4myBACK intervention on function of people with low back pain compared to control. Chapter Six explores participants’ experience with the TEXT4myBACK intervention, including its acceptance, usefulness and behaviour-change ability. Chapter Seven proposes a methodology to aid the interpretation of the clinical significance of the TEXT4myBACK trial’s findings. It shows that people need to improve at least 9.4 points on a 0-30 function scale to consider self-management worthwhile. As pain management is complex and influenced by several factors including families, Chapter Eight reviews the effects of family-based interventions on health outcomes of people with musculoskeletal pain. It found that family-based interventions improve pain and disability compared to individual-focused interventions and pain compared to usual care. Chapter Nine explores the feasibility of a telephone health coaching intervention with or without an exercise buddy for people with low back pain compared to usual care and data collection approaches through a pilot and feasibility study. The thesis findings may be used to 1) guide the development of educational and text message interventions for musculoskeletal pain; 2) aid the interpretation of the clinical relevance of the TEXT4myBACK intervention’s effects through a responder analysis; 3) optimise the approaches of future randomised controlled trials including family members or exercise buddies for low back pain