I got pregnant, I was so like ... crying inside...: experiences of women of Pakistani ancestry seeking contraception in the UK

South Asian women in Britain are less likely to use contraception than women in other ethnic groups. Previous studies have identified a lack of knowledge combined with low levels of English language and/or literacy as barriers to using contraception, but have not examined in detail women's experiences of accessing services. This qualitative study focused on the experiences of 19 Muslim women of Pakistani ancestry and the views of six health and community workers. The findings detail considerable institutional barriers to accessing contraceptive services, such as a lack of information and the paternalistic attitudes of some health professionals. The study suggests that, although all the women were motivated to access and use contraception, their ability to make informed choices was often limited. It was only when the women encountered advocates, who might be professionals or from their social networks, that they could begin to take control of their fertility. This study is consistent with earlier research and shows that lack of access to contraceptive services can have high personal and social costs for South Asian women.

A study of outcomes measures in forensic mental health

Outcomes measures, which is the measurement of effectiveness of interventions and services has been propelled onto the health service agenda since the introduction of the internal market in the 1990s. It arose as a result of the escalating cost of inpatient care, the need to identify what interventions work and in what situations, and the desire for effective information by service users enabled by the consumerist agenda introduced by Working for Patients white paper. The research reported in this thesis is an assessment of the readiness of the forensic mental health service to measure outcomes of interventions. The research examines the type, prevalence and scope of use of outcomes measures, and further seeks a consensus of views of key stakeholders on the priority areas for future development. It discusses the theoretical basis for defining health and advocates the argument that the present focus on measuring effectiveness of care is misdirected without the input of users, particularly patients in their care, drawing together the views of the many stakeholders who have an interest in the provision of care in the service. The research further draws on the theory of structuration to demonstrate the degree to which a duality of action, which is necessary for the development, and use of outcomes measures is in place within the service. Consequently, it highlights some of the hurdles that need to be surmounted before effective measurement of health gain can be developed in the field of study. It concludes by advancing the view that outcomes research can enable practitioners to better understand the relationship between the illness of the patient and the efficacy of treatment. This understanding it is argued would contribute to improving dialogue between the health care practitioner and the patient, and further providing the information necessary for moving away from untested assumptions, which are numerous in the field about the superiority of one treatment approach over another.

Acquirer and owner perceptions of technology integration:the South African case

Developing countries are subject to the same global pressures as their developed counterparts but have additional domestic challenges that may place them at a significant, and perhaps insurmountable, disadvantage. However, technology still offers them the opportunity to participate in the international economy. Difficult conditions in their countries do not absolve managers from formulating and implementing technology policies that can make their firms globally competitive. At a macro-economic level, a number of broad developmental issues impact on the use of technology in developing countries. The subject of this paper is to examine the challenge for South African firms in their efforts to master technology, despite internal and external difficulties. Owners of technology need to consider the local context when supplying their technology to developing markets. The paper aims to investigate the views of technology recipients by examining the perceptions of South African managers regarding technology integration in a manufacturing environment. A number of technology suppliers were also interviewed in order to obtain their opinions on the issues raised by the technology acquirers. The importance of different factors in integrating technology is studied in relation to managers ’ abilities to control these variables. An importance-control grid framework is used to identify critical parameters and to assess how they can be managed in a complex environment.

Personal uses and perceived social and economic effects of advertising in Bulgaria and Romania

Purpose - The objective of this paper is to uncover the underlying dimensions of, and examine the similarities and differences in, personal uses of advertising, perceived socio-economic effects of advertising, and consumer beliefs and attitudes toward advertising in Bulgaria and Romania. Moreover, it aims to identify the relative importance of the predictors of attitudes toward advertising in the two countries. Design/methodology/approach - The paper draws upon findings of previous research and theoretical developments by Bauer and Greyser, Sandage and Leckenby, and Pollay and Mittal. The study uses a stratified random sample of 947 face-to-face interviews with adult respondents from major urban areas in Bulgaria (507) and Romania (440). Variables are measured on multi-item scales as a typical application of the reflective indicator model. Findings - Results show that there are significant differences between Romanian and Bulgarian respondents in terms of their attitudes toward advertising. Romanians are more positive about advertising as an institution than the instruments of advertising. Romanians seem to accept the role of advertising in a free market economy, but have less confidence in advertising claims and techniques. Bulgarian respondents seem more sceptical toward advertising in general and are less enthusiastic about embracing the role of advertising as an institution. Moreover, Bulgarians are highly negative towards the instruments advertising uses to convey its messages to consumers. Research limitations/implications - The research findings reflect the views of urban dwellers and may not be generalisable to the wider population of the two countries. Interviewer bias was reduced by eliminating verbal or non-verbal cues to the respondents, and by the use of stratified random sampling. Practical implications - The paper suggests that the regulatory role of codes of advertising practice and industry regulating bodies should be enhanced, and their ability to protect consumers enforced. Marketing campaigns should be more inclusive to involve diverse social groups and reflect generally-accepted social norms. Originality/value - This study reveals that, while general attitudes toward advertising may be similar, attitudes toward the institution and instruments of advertising may differ even in countries with geographic proximity and low cultural distance. © Emerald Group Publishing Limited.

The past, present and future of observational research in marketing

Purpose - To introduce the contents of the special issue, and provide an integrative overview of the development of observational methodologies in marketing research, as well as some directions for the future. Design/methodology/approach - A historical review of the development of observational methods, beginning with philosophical foundations, is provided. Key philosophical debates are summarized, and trends in observational methods are described and analyzed, with particular reference to the impact of technology. Following this, the contributions to the special issue are summarized and brought together. Findings - Observational research in marketing is more than the well-known method of "participant-observation." In fact, technology has the potential to revolutionize observational research, and move it beyond a solely "qualitative" method. The internet, video, scanner-tracking, and neuroimaging methods are all likely to have a big impact on the development of traditional and innovative observation methods in the future. The articles in the special issue provide a good overview of these developments. Research limitations/implications - The views of the authors may differ from those of others. Practical implications - Observation is a far more wide-ranging strategy than many perceive. There is a need for more expertise in all types of observational methodologies within marketing research schools and departments, in order to take account of the vast opportunities which are currently emerging. Originality/value - Provides an original perspective on observational methods, and serves as a useful overview of trends and developments in the field.

Self monitoring of blood glucose in type 2 diabetes:Longitudinal qualitative study of patients' perspectives

Objective: To explore views of patients with type 2 diabetes about self monitoring of blood glucose over time. Design: Longitudinal, qualitative study. Setting: Primary and secondary care settings across Lothian, Scotland. Participants: 18 patients with type 2 diabetes. Main outcome measures: Results from repeat in-depth interviews with patients over four years after clinical diagnosis. Results: Analysis revealed three main themes - the role of health professionals, interpreting readings and managing high values, and the ongoing role of blood glucose self monitoring. Self monitoring decreased over time, and health professionals' behaviour seemed crucial in this: participants interpreted doctors' focus on levels of haemoglobin A1c, and lack of perceived interest in meter readings, as indicating that self monitoring was not worth continuing. Some participants saw readings as a proxy measure of good and bad behaviour - with women especially, chastising themselves when readings were high. Some participants continued to find readings difficult to interpret, with uncertainty about how to respond to high readings. Reassurance and habit were key reasons for continuing. There was little indication that participants were using self monitoring to effect and maintain behaviour change. Conclusions: Clinical uncertainty about the efficacy and role of blood glucose self monitoring in patients with type 2 diabetes is mirrored in patients' own accounts. Patients tended not to act on their self monitoring results, in part because of a lack of education about the appropriate response to readings. Health professionals should be explicit about whether and when such patients should self monitor and how they should interpret and act upon the results, especially high readings.

Development and validation of the Attitudes Towards the Homeless questionnaire

CONTEXT: The homeless are a significant group within society, which is increasing in size. They have demonstrably greater physical and mental health needs than the housed, and yet often have difficulty accessing primary health care. Medical 'reluctance' to look after homeless people is increasingly suggested as part of the problem. Medical education may have a role in ameliorating this. OBJECTIVES: This paper reports on the development and validation of a questionnaire specifically developed to measure medical students' attitudes towards the homeless. METHOD AND RESULTS: The Attitudes Towards the Homeless Questionnaire, developed using the views of over 370 medical students, was shown to have a Pearson test-retest reliability correlation coefficient of 0.8 and a Cronbach's alpha coefficient of 0.74. CONCLUSIONS: The Attitudes Towards the Homeless Questionnaire appears to be a valid and reliable instrument, which can measure students' attitudes towards the homeless. It could be a useful tool in assessing the effectiveness of educational interventions.

'Urine testing is a waste of time': newly diagnosed Type 2 diabetes patients' perceptions of self-monitoring

Aims To date, there is no convincing evidence that non-insulin treated patients who undertake self-blood glucose monitoring (SBGM) have better glycaemic control than those who test their urine. This has led to a recommendation that non-insulin dependent patients undertake urine testing, which is the cheaper option. This recommendation does not take account of patients' experiences and views. This study explores the respective merits of urine testing and SBGM from the perspectives of newly diagnosed patients with Type 2 diabetes. Methods Qualitative study using repeat in-depth interviews with 40 patients. Patients were interviewed three times at 6-monthly intervals over 1 year. Patients were recruited from hospital clinics and general practices in Lothian, Scotland. The study was informed by grounded theory, which involves concurrent data collection and analysis. Results Patients reported strongly negative views of urine testing, particularly when they compared it with SBGM. Patients perceived urine testing as less convenient, less hygienic and less accurate than SBGM. Most patients assumed that blood glucose meters were given to those with a more advanced or serious form of diabetes. This could have implications for how they thought about their own disease. Patients often interpreted negative urine results as indicating that they could not have diabetes. Conclusions Professionals should be aware of the meanings and understandings patients attach to the receipt and use of different types of self-monitoring equipment. Guidelines that promote the use of consistent criteria for equipment allocation are required. The manner in which negative urine results are conveyed needs to be reconsidered.

A corpus of 714 full-color images of depth-rotated objects

A set of full-color images of objects is described for use in experiments investigating the effects of in-depth rotation on the identification of three-dimensional objects. The corpus contains up to 11 perspective views of 70 nameable objects. We also provide ratings of the "goodness" of each view, based on Thurstonian scaling of subjects' preferences in a paired-comparison experiment. An exploratory cluster analysis on the scaling solutions indicates that the amount of information available in a given view generally is the major determinant of the goodness of the view. For instance, objects with an elongated front-back axis tend to cluster together, and the front and back views of these objects, which do not reveal the object's major surfaces and features, are evaluated as the worst views.

A composite framework for the strategic alignment of information systems development

Information systems are corporate resources, therefore information systems development must be aligned with corporate strategy. This thesis proposes that effective strategic alignment of information systems requires information systems development, information systems planning and strategic management to be united. Literature in these areas is examined, breaching the academic boundaries which separate these areas, to contribute a synthesised approach to the strategic alignment of information systems development. Previous work in information systems planning has extended information systems development techniques, such as data modelling, into strategic planning activities, neglecting techniques of strategic management. Examination of strategic management in this thesis, identifies parallel trends in strategic management and information systems development; the premises of the learning school of strategic management are similar to those of soft systems approaches to information systems development. It is therefore proposed that strategic management can be supported by a soft systems approach. Strategic management tools and techniques frame individual views of a strategic situation; soft systems approaches can integrate these diverse views to explore the internal and external environments of an organisation. The information derived from strategic analysis justifies the need for an information system and provides a starting point for information systems development. This is demonstrated by a composite framework which enables each information system to be justified according to its direct contribution to corporate strategy. The proposed framework was developed through action research conducted in a number of organisations of varying types. This suggests that the framework can be widely used to support the strategic alignment of information systems development, thereby contributing to organisational success.

Privatization : problems of implementation in Egypt

This study aims to investigate to what extent the views of the managers of the enterprises to be privatized are a barrier to smooth implementation of privatization as opposed to other problems. Accordingly, the research tackles two main issues: Identification and analysis of the major problems encountered in the implementation of the Egyptian privatization programme and at which level these problems exist while proposing different approaches to tackle them; and views of public sector top and middle-level managers regarding the main issues of privatization. The study relies upon a literature survey, interviews with stakeholders, a survey of managers' attitudes and several illustrative case studies. A model of "good practice" for the smooth and effective implementation of privatization has been designed. Practice in Egypt has then been studied and compared with the "good practice" model. Lack of strictness and firmness in implementing the announced privatization programme has been found to be a characteristic of Egyptian practice. This is partly attributable to the inadequacy of the programme and partly to the different obstacles to implementation. The main obstacles are doubtful desirability of privatization on the part of the managers at different implementation levels, resistance of stakeholders, in adequately of the legal framework governing privatization, redundant labour, lack of an efficient monitoring system allowing for accountability, inefficient marketing of privatization, ineffective communication, insufficient information at different levels and problems related to valuation and selling procedures. A large part of the thesis is concerned with SOE (State Owned Enterprise) managers' attitudes on and understanding of the privatization (appraised through surveys). Although most managers have stated their acceptance of privatization, many of their responses show that they do not accept selling SOEs. They understand privatization to include enterprise reform and restructuring, changing procedures and giving more authority to company executives, but not necessarily as selling SOEs. The majority of managers still see many issues that have to be addressed for smooth implementation of privatization e.g. insufficiency of information, incompleteness of legal framework, restructuring and labour problems. The main contribution to knowledge of this thesis is the study of problems of implementing privatization in developing countries especially managers' resistance to privatization as a major change, partly because of the threat it poses and partly because of the lack of understanding of privatization and implications of operating private businesses. A programme of persuading managers and offsetting the unfavourable effects is recommended as an outcome of the study. Five different phrases and words for the national Index to theses are: Egypt, privatization, implementation of privatization, problems of implementing privatization and managers' attitudes towards privatization.

Trade unions and productivity:the impact of union presence on labour productivity in Korean manufacturing

This thesis examines the theoretical and empirical relationship between trade unions and productivity in the Korean auto and cement manufacturing industries, during the 1980s. It challenges the tenets of the existing debate by stressing the contingent nature of this relationship. In particular this thesis pinpoints inadequacies of econometric analysis as the only method of judging this association between union presence and productivity, because this ignores national and historical industrial relations contexts. Moreover, the polarity between positive and negative views of trade union influences on productivity is seen as needlessly limited, failing as it does to consider the full context of labour-management dynamics within the employment relationship. Empirically, this thesis focuses on the unionism and productivity during two contrasting political periods: the first a time of constraint on union action and the second a period of relative freedom. It examines these periods using a full range of quantitative and qualitative analysis. Of particular significant is the inclusion of attitude surveys of the relationship between the presence of unions and productivity conducted amongst workers, managers and trade union officials. The broad conclusion of the thesis is a rejection of the validity of continuing to examine the relationship between trade unions and productivity without locating this within national and historical industrial relations contexts.

The role of analogy in spelling in English primary school children - a partial intervention study

The English writing system is notoriously irregular in its orthography at the phonemic level. It was therefore proposed that focusing beginner-spellers’ attention on sound-letter relations at the sub-syllabic level might improve spelling performance. This hypothesis was tested in Experiments 1 and 2 using a ‘clue word’ paradigm to investigate the effect of analogy teaching intervention / non-intervention on the spelling performance of an experimental group and controls. The results overall showed the intervention to be effective in improving spelling, and this effect to be enduring. Experiment 3 demonstrated a greater application of analogy in spelling, when clue words, which participants used in analogy to spell test words, remained in view during testing. A series of regression analyses, with spelling entered as the criterion variable and age, analogy and phonological plausibility (PP) as predictors, showed both analogy and PP to be highly predictive of spelling. Experiment 4 showed that children could use analogy to improve their spelling, even without intervention, by comparing their performance in spelling words presented in analogous categories or in random lists. Consideration of children’s patterns of analogy use at different points of development showed three age groups to use similar patterns of analogy, but contrasting analogy patterns for spelling different words. This challenges stage theories of analogy use in literacy. Overall the most salient units used in analogy were the rime and, to a slightly lesser degree, the onset-vowel and vowel. Finally, Experiment 5 showed analogy and phonology to be fairly equally influential in spelling, but analogy to be more influential than phonology in reading. Five separate experiments therefore found analogy to be highly influential in spelling. Experiment 5 also considered the role of memory and attention in literacy attainment. The important implications of this research are that analogy, rather than purely phonics-based strategy, is instrumental in correct spelling in English.

Pre-conception care : current practice and methods of provision

This thesis examines the present provisions for pre-conception care and the views of the providers of services. Pre-conception care is seen by some clinicians and health educators as a means of making any necessary changes in life style, corrections to imbalances in the nutritional status of the prospective mother (and father) and the assessment of any medical problems, thus maximizing the likelihood of the normal development of the baby. Pre-conception care may be described as a service to bridge the gap between the family planning clinic and the first ante-natal booking appointment. There were three separate foci for the empirical research - the Foresight organisation (a charity which has pioneered pre-conception care in Britain); the pre-conception care clinic at the West London Hospital, Hammersmith; and the West Midlands Regional Health Authority. The six main sources of data were: twenty five clinicians operating Foresight pre-conception clinics, couples attending pre-conception clinics, committee members of the Foresight organisation, staff of the West London Hospital pre-conception clinic, Hammersmith, District Health Education Officers working in the West Midlands Regional Health Authority and the members of the Ante-Natal Care Action Group, a sub-group of the Regional Health Advisory Group on Health Promotion and Preventive Medicine. A range of research methods were adopted. These were as follows: questionnaires and report forms used in co-operation with the Foresight clinicians, interviews, participant observation discussions and informal meetings and, finally, literature and official documentation. The research findings illustrated that pre-conception care services provided at the predominantly private Foresight clinics were of a rather `ad hoc' nature. The type of provision varied considerably and clearly reflected the views held by its providers. The protocol which had been developed to assist in the standardization of results was not followed by the clinicians. The pre-conception service provided at the West London Hospital shared some similarities in its approach with the Foresight provision; a major difference was that it did not advocate the use of routine hair trace metal analysis. Interviews with District Health Education Officers and with members of the Ante Natal Care Action Group revealed a tentative and cautious approach to pre-conception care generally and to the Foresight approach in particular. The thesis concludes with a consideration of the future of pre-conception care and the prospects for the establishment of a comprehensive pre-conception care service.

Spain:countries of the world

Spain has been the home of some of the world's great artists and has museums and galleries to match. In the cities, narrow twisting old streets suddenly open up to views of the daring modern architecture, as a culture of old and new mix and mingle in the city's nightlife. There are endless tracts of wild and crinkled sierra to explore, as well as some spectacularly rugged stretches of coast. Culturally, the country is littered with superb old buildings, from Roman aqueducts to Gothic cathedrals, and almost every second village has a medieval castle. With more than 115 years exploring the globe with its writers, photographers, and research expeditions, "National Geographic" is uniquely positioned to introduce your readers to everything they need to know about the countries of the world.