We have examined aspects of the development of telemedicine and telecare in Japan. Despite Japan's reputation as an integrated and technocratic country, the diffusion of telemedicine has fallen below expectations,...
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We have examined aspects of the development of telemedicine and telecare in Japan. Despite Japan's reputation as an integrated and technocratic country, the diffusion of telemedicine has fallen below expectations, notwithstanding the urgent need to solve the problems of an ageing society. There has been a fragmentation of objectives and perspectives within the corporate (manufacturing) sector and within the policy sector of central and local government. There has also been a broader fragmentation between manufacturers, government and users (doctors and hospitals). As a result, the success or failure of individual projects appears to depend not on the quality of the technology, and often not on the evident importance of the social need, but on the overall coherence of a complex socio-technical system.
This paper describes planning, implementation, monitoring and evaluation activities carried out in support of a malaria control project that used permethrin-impregnated curtains in eight villages in rural Malawi. Find...
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This paper describes planning, implementation, monitoring and evaluation activities carried out in support of a malaria control project that used permethrin-impregnated curtains in eight villages in rural Malawi. Findings from formative evaluation and project monitoring aspects of the evaluation are presented. Permethrin-impregnated curtains were introduced to villagers who participated in household self-help projects. To implement the project, village health workers were trained and worked closely with existing project personnel as well as traditional headmen to assure village participation, facilitate health education and coordinate curtain-dipping (impregnation) meetings. A quasi-experimental evaluation design used surveys and observations to measure change in cognitive, behavioural and health outcome indicators. Village adoption rates averaged 50%, with variation between villages. Monitoring data showed a high degree of compliance with curtain re-impregnation initially and high perceived efficacy of curtains. Issues discussed include village readiness for change, trust, acceptability of the innovation, cost, sustainability and leadership.
The purpose of this study was to assess adoption, implementation and maintenance of a guided supermarket tour program of nutrition education by Dutch Public Health Services (PHSs), and the factors associated with prog...
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The purpose of this study was to assess adoption, implementation and maintenance of a guided supermarket tour program of nutrition education by Dutch Public Health Services (PHSs), and the factors associated with program dissemination. A first questionnaire was sent to all 60 PHSs, and measured program adoption, perceived program attributes, and characteristics of the adopting organization and person. A second questionnaire was only sent to adopting PHSs, and measured extent and success of implementation, intentions to continue the program, and characteristics of the main implementing person. Of the 59 PHSs who responded, 30 adopted the program and 17 implemented it sufficiently. Perceived program complexity, social influence within the PHS toward program participation and existence of a separate health education department were predictors of adoption. Perceived program complexity was also a predictor of extent of implementation, The number of health educators within each PHS was a predictor of sufficient implementation, It was concluded that adoption and implementation of the program was reasonable, considering the limited dissemination strategy. Dissemination might have been more successful if the program had been less complex and required less effort, if positive social influence had been generated, and if specific attention had been given to PHSs without a separate health education department.
Mental health care reform in the public sector remains a local proposition. Oregon has thus far been able to avoid major failures and has modest successes to report. Although the road to achieving all that was envisio...
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Mental health care reform in the public sector remains a local proposition. Oregon has thus far been able to avoid major failures and has modest successes to report. Although the road to achieving all that was envisioned at the outset remains long, the inclusive process followed gives reason for hope.
This paper presents initial findings of the Canadian Heart Health Initiative, Ontario Project (CHHIOP). CHHIOP has two primary objectives. The programmatic objective is to coordinate and refine a system for supporting...
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This paper presents initial findings of the Canadian Heart Health Initiative, Ontario Project (CHHIOP). CHHIOP has two primary objectives. The programmatic objective is to coordinate and refine a system for supporting effective, sustained community-based heart health activities. This paper addresses the scientific objective: to develop knowledge of factors that influence the development of predisposition and capacity to undertake community-based heart health activities in public health departments. A systems theory framework for an ecological approach to health promotion informs the conceptualization of the key constructs, measured using a two-stage longitudinal design which combines quantitative and qualitative methods. This paper reports the results of the first round of quantitative survey data collected from all health departments in Ontario (N = 42) and individuals within each health department involved in heart health promotion (n = 262). Results indicate low levels of implementation of heart health activities, both overall and for particular risk factors and settings. Levels of capacity are also generally low yet predisposition to undertake heart health promotion activities is reportedly high. Analyses show that implementation is positively related to capacity but not predisposition, while predisposition and capacity are positively related, Overall, results suggest predisposition is a necessary but not sufficient condition for implementation to occur;capacity-related factors appear to be the primary constraint, These findings are used to inform strategies to address CHHIOP's programmatic objective.
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