The Role of Gay Spaces for a Gay Destination : Gay Tourism in Gran Canaria

This thesis has the aim to evaluate the role of gay spaces in Gran Canaria as a gay tourists destination with particular reference to gay exclusive resorts. The validation of the gay identity is a key motivation for homosexuals to travel, in order to connect with other homosexuals and experience the gay life that they might not be able to experience at home. Gay spaces have been defined both as liberated areas as well as ghettos, where the homosexuals are, in a way, restrained. The method chosen, a small number of semi- structured interviews with managers of gay exclusive resorts in Maspalomas, the hub of gay life in Gran Canaria, where major LGBT events are held, there is a gay friendly environment, a thriving gay scene and many gay exclusive resorts. In the case of Gran Canaria the gay-specific offer is complementary to the ‘regular’ tourism offer, as they coexist, complement and at times overlap. Nevertheless the gay centric holiday is still predominant amongst gay men, and it is likely to continue to be according to the informants. This is because gay tourists seek freedom and a sense of inclusion that they would not be able to find in mixed environments.

Health system context and implementation of evidence-based practices-development and validation of the Context Assessment for Community Health (COACH) tool for low- and middle-income settings

Background: The gap between what is known and what is practiced results in health service users not benefitting from advances in healthcare, and in unnecessary costs. A supportive context is considered a key element for successful implementation of evidence-based practices (EBP). There were no tools available for the systematic mapping of aspects of organizational context influencing the implementation of EBPs in low- and middle-income countries (LMICs). Thus, this project aimed to develop and psychometrically validate a tool for this purpose. Methods: The development of the Context Assessment for Community Health (COACH) tool was premised on the context dimension in the Promoting Action on Research Implementation in Health Services framework, and is a derivative product of the Alberta Context Tool. Its development was undertaken in Bangladesh, Vietnam, Uganda, South Africa and Nicaragua in six phases: (1) defining dimensions and draft tool development, (2) content validity amongst in-country expert panels, (3) content validity amongst international experts, (4) response process validity, (5) translation and (6) evaluation of psychometric properties amongst 690 health workers in the five countries. Results: The tool was validated for use amongst physicians, nurse/midwives and community health workers. The six phases of development resulted in a good fit between the theoretical dimensions of the COACH tool and its psychometric properties. The tool has 49 items measuring eight aspects of context: Resources, Community engagement, Commitment to work, Informal payment, Leadership, Work culture, Monitoring services for action and Sources of knowledge. Conclusions: Aspects of organizational context that were identified as influencing the implementation of EBPs in high-income settings were also found to be relevant in LMICs. However, there were additional aspects of context of relevance in LMICs specifically Resources, Community engagement, Commitment to work and Informal payment. Use of the COACH tool will allow for systematic description of the local healthcare context prior implementing healthcare interventions to allow for tailoring implementation strategies or as part of the evaluation of implementing healthcare interventions and thus allow for deeper insights into the process of implementing EBPs in LMICs.