Dissertations / Theses on the topic 'Barriers to service access'
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Schiwal, Alexandra T. "Rural Aging: The Geographic Reach of Service Access in Utah, Identifying Barriers and Solutions." DigitalCommons@USU, 2019. https://digitalcommons.usu.edu/etd/7639.
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This dissertation includes two studies of rural age-related services in the state of Utah. The first study combines geospatial, demographic data (number of people over 55) and age-related services (hospitals, hospice providers, nursing homes, senior centers, and Areas Agencies on Aging) at the county level and census-tract level to determine localized differences in proportional access to age-related services. Higher and lower proportions are then predicted by contextual factors including rural/urban gradient, economic industry, and broadband access. Results demonstrate that broadband access was significantly associated with higher access to age-related services, but being a retirement destination (increase in people over 65 in county from 2000-2010) was associated with lower spatial access to age-related services. The second study involved in-depth interviews with stakeholders from communities across Utah, and qualitative analysis to identify specific barriers to age-related service access in their communities. This approach generated knowledge about challenges to accessing services and stakeholder-supported starting points and solutions for overcoming some of the identified barriers to age-related services in these communities. Taken together, the spatial data and responses from persons living and serving older adults in rural communities complement an understanding of facilitators and barriers to service access, paired with solutions.
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MacRae, Jayden. "Using a natural experiment to assess the effect of spatial barriers on health service utilization." Thesis, University of Canterbury. Geography, 2014. http://hdl.handle.net/10092/9346.
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The closure of the Manawatu Gorge in August 2011 caused a change in the travel time for patients living in the eastern area of the MidCentral Health District to their main hospital and health services located in Palmerston North. This presented an opportunity to study the effect a change in travel time and spatial access had on a population before and after such an event. This study used a retrospective cohort design, using routinely collected data from general practice, emergency department, hospital admissions and outpatient services. The investigation was completed using novel geospatial information systems methods to produce high fidelity data for analysis with free and open source software by developing and validating two new methods of improving geocoding data quality and a new travel time prediction model. Potential and realised spatial accessibility measures were calculated for 101,456 patients over 3.5 years while the gorge was both open and closed. Catchment sensitivity analysis and two-step floating catchment area using distance decays presented complimentary evidence of accessibility change during the Manawatu Gorge closure. Analysis of utilisation measures in both primary and secondary care were correlated with travel time. Utilisation of general practice services appeared to be negatively impacted by increased travel time when comparing realised accessibility in a control and intervention group during the gorge closure. It appeared as though other factors affected access to health services to a greater degree than an increase of up to fifteen minutes travel time.
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Finger, Robert [Verfasser]. "Barriers to Access Cataract Surgery Services in India / Robert Finger." Aachen : Shaker, 2006. http://d-nb.info/1170533736/34.
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Jamerson, Dianne. "Breast Cancer Disparities among African American Women Corresponding to Health Service Barriers." ScholarWorks, 2018. https://scholarworks.waldenu.edu/dissertations/5483.
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African American women tend to experience higher health disparities in cancer-related illness than any other female population in the United States. The purpose of this qualitative case study was to identify and examine access-related barriers that play a significant role in the decision-making process of this population when seeking breast cancer health services. The central research question explored the effect that barriers to health care have on African American women in the Southeastern region of the United States. Secondary research questions explored the role the Patient Protection and Affordable Care Act of 2010 has on improving access to affordable, quality breast cancer screening services for the sample population. A critical theory lens of racism and ethnicity provided conceptual framework for this case study. Significant findings identified barriers to accessing breast cancer related health services as personal, community, social, systemic, and institutional. Personal barriers identified were related to access, autonomy, and benefits of the Affordable Care Act. Social barriers corresponded to cultural, financial burden, funding, health conditions, insurance, role within the family self-discovery, and spirituality. Community barriers included access, advocacy, and autonomy. Systemic and institutional barriers consisted of doctor listening, doctor's rapport, doctor treatment, lack of trust, and benefits of the Affordable Care Act. Implications for social change included bringing awareness of the need to establish a Breast Cancer Resource Center in the region to engage this population in preventive measures, improve health outcome and reduce health disparities.
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Jallow, M., Melanie Haith-Cooper, Jae Hargan, and M.-C. Balaam. "A systematic review to identify key elements of effective public health interventions that address barriers to health services for refugees." Springer, 2021. http://hdl.handle.net/10454/18444.
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YesAim: Refugees often face barriers to accessing health services, especially after resettlement. The aim of this study is to identify key elements of effective public health interventions that address barriers to health services for refugees. Methods: Key online databases were searched to identify studies published between 2010 and 2019. Six studies met the inclusion criteria: two qualitative, one quantitative and three mixed-methods studies. An adapted narrative synthesis framework was used which included thematic analysis for systematic reviews. Results: Five themes were identified: peer support, translation services, accessible intervention, health education and a multidisciplinary approach. Conclusion: These key elements identified from this review could be incorporated into public health interventions to support refugees’ access to health services. They could be useful for services targeting refugees generally, but also supporting services targeting refugee resettlement programmes such as the Syrian resettled refugees in the UK. Future research is needed to evaluate the impact of public health interventions where these elements have been integrated into the intervention.
The full-text of this article will be released for public view at the end of the publisher embargo on 23 Mar 2022.
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Ngobi, John Baptist. "Access Barriers to Reaching Human Immunodeficiency Virus Testing Services in Ottawa: Mixed Methods Study." Thesis, Université d'Ottawa / University of Ottawa, 2019. http://hdl.handle.net/10393/39635.
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Barriers to reaching human immunodeficiency virus (HIV) testing prevent Canada from achieving The Joint United Nations Programme on HIV and AIDS (UNAIDS) target of 90 percent of undiagnosed people living with HIV knowing their HIV status by 2020 and receive treatment.(1) Fourteen percent (9,090 of 63,100) of Canadians living with HIV were unaware of their status by the end of 2016.(1)(p.9)Individuals exposed to HIV through heterosexual contact are overrepresented (28%) among the undiagnosed people living with HIV in Canada compared to other groups, such as men who have sex with men (18%) and people who inject drugs (20%).(2)(par.15)The reasons preventing this population to present themselves for testing in Ottawa, Ontario, remain poorly understood in the literature. Most of the literature on barriers to accessing HIV testing focuses on the traditional key groups who are likely to test, and limits analysis of these barriers on one or two levels. Equally, health service providers rarely understand challenges behind HIV testing for particularly young heterosexual African migrant men. These challenges may be contributing key barriers to HIV testing. On other hand, late presentation to treatment remains a global issue. Psychosocial outcomes especially after a new positive diagnosis can delay reaching early treatment and prevention services. Indeed, all test results negative or positive have consequences. Even those with a new negative test can return to risk taking behaviour if they delay accessing prevention education. Yet no systematic study exists in this area essential for quality improvement. Programming more equitable HIV testing services will require more comprehensive evidence about challenges and barriers behind accessing HIV testing and treatment to achieve UNAIDS target of 90 percent of undiagnosed people living with HIV knowing their status and receive treatment. This research aimed to contribute to this evidence through two phases. Phase 1 used the Joanna Briggs Institute methods to implement a scoping review on psychosocial outcomes and their measurements immediately following a new HIV diagnosis. This review considered all participants who tested for HIV – whether their results were positive or negative, as any test results have consequences, and regardless of age, sex, or setting – reported in published articles between 2007 -to the present date. Paper 1 presents the scoping review. Phase 2 relied on a qualitative methodology using Grounded Theory informed by a socio-ecological framework and a framework of access to healthcare to understand experiences of accessing HIV testing services in two parts: 1) to examine barriers to reaching HIV testing among young heterosexual African migrants, focusing on young men, in Ottawa (Paper 2); and 2) to identify challenges experienced by health service providers who make accessible HIV testing services to this population in Ottawa (Paper 3). There is some ambiguity in the use of the terms “first generation immigrants” and “second generation immigrants” (or children of first immigrants). In this study, the term migrants referred to both. Selecting participants from both groups (first and second generation) was important to include a wide variety of experiences and interpretations that reflect the study population. Furthermore, the term “health service providers” was used to refer to both healthcare providers and frontline service providers. Healthcare providers referred to those who conduct HIV testing in health facilities, whereas frontline service providers referred to those who provide care and support services needed by members in their communities before and after testing within AIDS organizations and community-based organizations.
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Ritter, Regina [Verfasser]. "Access and Barriers to Health Care Services in rural Malawi / Regina Ritter." Bonn : Universitäts- und Landesbibliothek Bonn, 2021. http://d-nb.info/1230878580/34.
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Miller, Paige Lynn. "Barriers Preventing Access to Health Care Services for Women in Rural Samoa." Ohio University / OhioLINK, 2005. http://rave.ohiolink.edu/etdc/view?acc_num=ohiou1136389101.
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Kohlenberger, Judith, Isabella Buber-Ennser, Bernhard Rengs, Sebastian Leitner, and Michael Landesmann. "Barriers to health care access and service utilization of refugees in Austria: Evidence from a cross-sectional survey." Elsevier, 2019. http://dx.doi.org/10.1016/j.healthpol.2019.01.014.
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This paper provides evidence on (1) refugees' subjective well-being, (2) their access and barriers to health care utilization and (3) their perception of health care provision in Austria, one of the countries most heavily affected by the European "refugee crisis". It is based on primary data from the Refugee Health and Integration Survey (ReHIS), a cross-sectional survey of roughly five hundred Syrian, Iraqi and Afghan refugees. Results indicate that refugees' self-rated health falls below the resident population's, in particular for female and Afghan refugees. Whereas respondents state overall high satisfaction with the Austrian health system, two in ten male and four in ten female refugees report unmet health needs. Most frequently cited barriers include scheduling conflicts, long waiting lists, lack of knowledge about doctors, and language. Although treatment costs were not frequently considered as barriers, consultation of specialist medical services frequently associated with co-payment by patients, in particular dental care, are significantly less often consulted by refugees than by Austrians. Refugees reported comparably high utilization of hospital services, with daycare treatment more common than inpatient stays. We recommend to improve refugees' access to health care in Austria by a) improving the information flow about available treatment, in particular specialists, b) fostering dental health care for refugees, and c) addressing language barriers by providing (web-based) interpretation services.
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Li, Longwei. "A Study on International Cultural Sensitivity: How to Eliminate Barriers of Chinese International Students at DAAP to Access Better Mental Healthcare." University of Cincinnati / OhioLINK, 2019. http://rave.ohiolink.edu/etdc/view?acc_num=ucin156199649507075.
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DeSa, Sarah C. "Barriers and Facilitators to Access Mental Health Services Among Refugee Women in High-Income Countries: A Systematic Review." Thesis, Université d'Ottawa / University of Ottawa, 2021. http://hdl.handle.net/10393/41878.
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Background
Based on the Global Trends report from the United Nations High Commissioner for Refugee, in high-income countries, there are 2.7 refuges per 1,000 national population, girls and women account for nearly 50 percent of this refuge population. In these high-income countries, compared with the general population refuge women have higher prevalence of mental illness. To our knowledge this is the first systematic review that addresses access to mental health services for refugee women in high-income countries. Thus, this review was conducted to examine the barriers to and facilitators of access to mental health services for refugee women in high-income countries for refugee resettlement.
Methods
MEDLINE, EMBASE, PsycINFO, and CINAHL databases were searched for research articles with qualitative component (including mixed-method or multi-method with qualitative component), in order to examine barriers and facilitators related to accessing mental health services. Relevant studies were collected on March 14, 2020 and were extracted and critically appraised by multiple authors. A narrative synthesis was conducted with the included studies to gather key synthesis evidence.
Results
Of the four databases searched, 1258 studies were identified with 12 meeting the inclusion criteria. The major barriers identified were language barriers, stigmatization, and the need for culturally sensitive practices to encourage accessing mental health care within a religious and cultural context. There were several studies that indicated how gender roles and biological factors played a role in challenges to accessing mental health services. The major facilitators identified were service availability and awareness in resettlement countries, social support and the resilience of refugee women to ease access of mental health services.
Conclusion
This review revealed socio-economic factors contributed to barriers and facilitators to accessing mental health among women refugees and asylum seekers. Addressing those social determinants of health can reduce barriers and enhance facilitators of access to mental health care for vulnerable populations like refugee women. Although there is a difference in health access policy among the top resettlement courtiers, the review found that there are no significant differences in accessing mental health for refugee and asylum seeker women among leading resettlement countries. The review findings suggest the need for further research on this topic given the potential significance of the findings on refugee and asylum seeker women mental health.
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Vitale, Michele. "Evaluating access barriers to primary health care servcies for Hispanic residents in toombs County, Georgia." Auburn, Ala., 2007. http://repo.lib.auburn.edu/2007%20Spring%20Theses/VITALE_MICHELE_14.pdf.
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Smouse, Trisha Nicole. "Assessing the Needs of Human Trafficking Awareness, Services, and Barriers to Access in Central Ohio." The Ohio State University, 2010. http://rave.ohiolink.edu/etdc/view?acc_num=osu1275405066.
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Ceron, Janett. "Barriers Among Latino Children in Accessing and Utilizing Mental Health Services." CSUSB ScholarWorks, 2017. https://scholarworks.lib.csusb.edu/etd/512.
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Latino children make up the largest ethnic group in the United States today. Latino children are also the ethnic group less likely to access and utilize mental health services. As a result, Latino children have higher rates of unmet mental health needs. There is limited research focusing on the mental health services needs of Latino children and lack of access and use of such services. This qualitative study explored barriers among Latino children in accessing and utilizing mental health services. This study conducted face-to-face and Skype interviews with eight mental health providers who work or have worked with Latino children with mental health needs. The eight interviews were transcribed and analyzed to identify common themes regarding barriers Latino children face in accessing and utilizing mental health services in participant responses. The major themes identified by this study included: cultural values, insurance, socioeconomic status, lack of bilingual providers, agency days and hours of operation, immigration status, and lack of awareness of mental health. Through identifying such barriers, this study may raise social worker awareness of barriers Latino children face and better equip social workers to plan and implement approaches to address identified barriers in efforts to increase Latino children’s access and use of mental health services to meet their mental health needs.
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Okeorji, Samuel C. Godwin. "Counselors' Perceptions on Adolescent Access and Use of School-based Mental Health Services." ScholarWorks, 2018. https://scholarworks.waldenu.edu/dissertations/6255.
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The role of school-based mental health counselors (SBMHCs) is essential in addressing the mental health needs of U.S. adolescents. The purpose of this phenomenological study was to examine SBMHCs' perceptions about factors that affect the use of SBMH services by adolescents from a school district in Connecticut. SBMHCs were chosen for this study because they provide direct mental health services to adolescents. Mechanic's general theory of help-seeking provided the framework to interpret research findings using the 10 interrelated constructs. Fifteen SBMHCs participated in face-to-face semistructured interviews. Colaizzi's 6-steps-guide was used to organize, code, and identify common themes. The following themes were identified: (a) there was no uniform process to identify and refer a student for services, which makes it time-consuming for SBMHCs to identify students in need; (b) there was a lack of established trusting relationship between adolescents and SBMHCs; (c) adolescents with persistent truancy at school had issues associated with poverty, housing, and family security that negatively affect access to use SBMH services; (d) financial resources were needed to support schools to hire more qualified professionals, create programs, and assist families of adolescents who may need SBMH services. Barriers to the use of SBMH services were identified as the lack of parental engagement, SBMHCs time constraints, and social stigma. Study findings may raise awareness to mental health access factors and barriers faced by adolescents and SBMH professionals and help improve access to critical SBMHCs and use of mental health services as needed.
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O'steen, Brianna. "Access and Barriers to Services for Dependent and Non-Dependent Commercially Sexually Exploited Children in Florida." Scholar Commons, 2016. http://scholarcommons.usf.edu/etd/6341.
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“Human trafficking” has become part of the everyday lexicon in the United States and globally over the last fifteen years. The issue has made its way into political platforms, scholarly work, church congregations, and international aid agendas. Florida is currently recognized as third in the nation for number of cases of human trafficking. This thesis employs ethnographic interviews and observations to understand one portion of Florida’s human trafficking problem referred to as domestic minor sex trafficking. This type of trafficking affects mostly teenage girls from marginalized populations, such as those that have experienced the child welfare system, homelessness, and impoverished circumstances. In 2013 the state passed the Florida Safe Harbor Act, modeled after the New York State Safe Harbour for Exploited Children Act, to address the needs of this population through legislation. The Act specifies certain policy and procedural changes, as well as the role of the Department of Children and Families. Further, it prohibits minors from facing prostitution charges, recognizing that they cannot consent to commercial sex because of their age.
This study investigates the Safe Harbor Act’s impact on agencies and the public in terms of raising awareness about domestic minor sex trafficking. With no immediate funding attached to the bill, or dedicated in the state budget, Florida is still struggling to provide adequate care for this population. In addition to policy analysis, this study examined existing services, assessed current needs in the field, and created an interactive map to locate services for professionals working in the field. While Florida has clearly improved its ability to manage these cases over the last three years, there is still much work to be done to address domestic minor sex trafficking. Based on these findings, this thesis offers recommendations for policy and further research on successful practices in working with this population’s specific needs.
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Soto, Sally Alejandra. "Utilization of Mental Health Services Among Hispanics." CSUSB ScholarWorks, 2016. https://scholarworks.lib.csusb.edu/etd/359.
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ABSTRACT
In the United States, Hispanics have the same prevalence of mental illness as any other group however researchers have found that they are less likely to seek mental health services. This population’s lack of mental health utilization is due to various barriers hindering the population’s need for help, a substantial for social work practitioners. To better understand the factors that lead up to that, the current study explored and identified perceptions toward seeking and receiving mental health services among Hispanic members. Using a qualitative data collection, ten participants were interviewed to elicit their perceptions about mental health services ranging from what they believed addressed their lack of seeking services and what they thought about services. Data analysis revealed five core themes among the participants’ responses: Closeness to Family as a reason for people not seeking professional help. Another theme found was environment as a reason for Mental Illness making them feel that there is no need to seek services since they can simply remove the environmental stressor and the illness will seize to exist. Existing support systems were found such as involvement in church as a form of therapy, they talked about their faith providing them a form of support for stressors. Shared culture was a theme that was found to be a necessity for therapy, they felt they did not seek services because they felt mental health practitioners would not validate their culture. The final theme was access and that theme encompassed : not knowing mental health services existed in their community, to lack of Spanish speaking clinicians. The recognition of these themes could potentially guide social work practitioners’ when they are trying to engage the Hispanic community to receive mental health services. Social workers can be aware of the obstacles toward engaging this population into professional therapy, by having an understanding of what they believe about therapy and helping to alleviate or use some of those perceptions as a form of engagement and validating existing strengths that the population has causing them to feel professional services are not needed.
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Ramírez, Moreno Diana Carolina, and Yokota Carla Natalia Rossi. "Factors associated with the perception of architectural barriers for access to health services in people with motor disabilities in Peru." Bachelor's thesis, Universidad Peruana de Ciencias Aplicadas (UPC), 2021. http://hdl.handle.net/10757/656545.
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Objectives: Determine the factors associated with the perception of architectural barriers in health services for people with motor disabilities.
Methods and Materials: An analytical cross-sectional study was performed based on a secondary data base obtained from a specialized national disability survey (ENEDIS) in 2012. The participants were people older than 18 years who had motor disability. The architectural barriers considered were the absence of access ramps, security guardrails, adequate elevators, hygienic services for people with disabilities, places that provide information or information posters in health centers. For the analysis of our study, the complex nature of the sample was considered and prevalence rates with a 95% confidence interval were used. Chi-square and Student t tests were also used and, finally, an analysis of multiple regression variables was carried out. Poisson with robust variance where crude and adjusted PR were calculated.
Results:
The main results show that in 2012, people aged 65 years and older perceive access ramps and safety railings as barriers in an approximate 40% less probability compared to those who are 18 – 24 years old. In addition, people with a higher educational level (University, Masters and doctorate) perceive the access ramps and safety railings in health centers as barriers in an approximate 80% less probability compared to those who have no educational level. Finally, those who live in rural areas are associated with access ramps, safety railings, adequate elevators, and bathrooms for people with disabilities (p<0.001)
Conclusions:
In this study we have found that older people (mainly older adults) and with higher educational level perceive less arquitectural barriers in health care centers where they are treated. However, people living in rural areas are more likely to perceive architectural barriers compared to people in urban areas.Objetivos: Determinar los factores asociados a la percepción de barreras arquitectónicas en los servicios de salud en el Perú de las personas con discapacidad motora. Métodos y Materiales: Se realizó un estudio transversal analítico basado en una base de datos secundaria obtenida de una encuesta nacional especializada de discapacidad (ENEDIS) del año 2012. Los participantes lo conformaron personas mayores de 18 años que registraron tener discapacidad motora. Las barreras arquitectónicas consideradas fueron la ausencia de rampas de acceso, barandas de seguridad, ascensores adecuados y servicios higiénicos para personas con discapacidad. Para el análisis de nuestro estudio se consideró la naturaleza compleja de la muestra y se utilizaron tasas de prevalencia con intervalo de confianza del 95%. También, se utilizaron pruebas de Chi cuadrado y t-student y finalmente se realizó un análisis de múltiples variables de regresión de Poisson con varianza robusta donde se calcularon los PR crudos y ajustados. Resultados Los principales resultados manifiestan que en el año 2012 las personas de 65 años a más perciben las rampas de acceso y las barandas de seguridad como barrera en un aproximado de 40% de menos probabilidad en comparación con los que tienen 18-24 años de edad. Además, las personas de mayor nivel educativo (Universitario, Maestría y Doctorado) perciben las rampas de acceso y las barandas de seguridad en los centros de salud como barrera en un aproximado 80% de menos probabilidad en comparación con los que no tienen ningún nivel educativo. Por último, los que viven en zona rural tienen asociación con las rampas de acceso, barandas de seguridad, ascensores adecuados y servicios higiénicos para personas con discapacidad (p < 0.001). Conclusiones: En este estudio hemos encontrado que las personas de mayor edad (principalmente adultos mayores) y de mayor nivel educativo perciben menos las barreras arquitectónicas en los centros de atención de salud donde se atienden. Sin embargo, las personas que viven en zonas rurales tienen más probabilidades de percibir barreras arquitectónicas en comparación a las personas de zonas urbanas.
Tesis
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Domapielle, Maximillian K. "Extending health services to rural residents in Jirapa District : analyses of national health insurance enrolment and access to health care services." Thesis, University of Bradford, 2015. http://hdl.handle.net/10454/14803.
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This thesis sheds light on differences in health insurance enrolment determinants and uptake barriers between urban and rural areas in the Jirapa district of Ghana. The National Health Insurance Scheme in Ghana has made significant progress in terms of enrolment, which has had a commensurate increase in utilization of health care services. However, there are challenges that pose a threat to the scheme’s transition to universal coverage; enrolment in the scheme has not progressed according to plan, and there are many barriers known to impede uptake of health care. Interestingly, these barriers vary in relation to locality, and rural residents appear to carry a disproportionate portion of the burden. A mixed method approach was employed to collect and analyse the data. On the basis of the primary qualitative and quantitative results, the thesis argues that the costs of enrolling and accessing health care is disproportionately higher for rural residents than it is their urban counterparts. It also highlights that the distribution of service benefits both in terms of the NHIS and health care in the Jirapa district favours urban residents. Lastly, the thesis found that whereas rural residents prefer health care provision to be social in nature, urban residents were more interested in the technical quality aspects of care. These findings suggest that rural residents are not benefitting from, or may not be accessing health services to the extent as their urban counterparts. Affordability, long distance to health facilities, availability and acceptability barriers were found to influence the resultant pro-urban distribution of the overall health care benefit.
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Roe, Miranda, and manroe@aapt net au. "FAMILIES AT RISK � A CRITICAL ANALYSIS OF IMPLICATIONS FOR POLICY AND SERVICES." Flinders University. Politics and International Studies, 2006. http://catalogue.flinders.edu.au./local/adt/public/adt-SFU20061025.100933.
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This thesis examines policy and service delivery issues in the development of health and support for families at risk. The research focuses on families with children less than 7 years of age living in some of the most disadvantaged neighbourhoods of metropolitan Adelaide. The thesis draws on evidence of (a) barriers to service support perceived by these families and (b) their strengths and resources in order to identify and develop arguments related to key issues of policy and service delivery.
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Erskine, Nathaniel A. K. "Barriers to Healthcare Access and Patient Outcomes After a Hospitalization for an Acute Coronary Syndrome and Other Acute Conditions." eScholarship@UMMS, 2017. https://escholarship.umassmed.edu/gsbs_diss/930.
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Background: Guideline-concordant therapies for survivors of an acute coronary syndrome (ACS) hospitalization require healthcare access, something that millions of Americans lack.
Methods and Results: Using data from a prospective cohort study of over 2,000 survivors of a hospitalization for an ACS in central Massachusetts and Georgia from 2011 to 2013, the first two aims of this thesis sought to identify the post-discharge consequences for survival and health status of having: 1) financial barriers to healthcare, 2) no usual source of care, and 3) transportation barriers. We found that patients lacking a usual source of care and having a transportation barrier were more likely to have died within two years following hospital discharge compared to those without such barriers. Also, patients with financial barriers to healthcare were more likely to experience clinically meaningful declines in physical and mental health-related quality of life over the six months after hospital discharge. The third aim sought to better understand factors influencing the success of care transitions home after an unplanned hospitalization through a qualitative study of 22 patients. Participants described how adequate healthcare access, particularly having insurance and transportation to clinical appointments, facilitated the receipt of follow-up care and adherence to treatments.
Conclusions: Limitations in healthcare access may contribute to poorer survival, health-related quality of life, and survival. Additional research is needed to identify interventions to improve healthcare access and test whether improved access leads to better patient outcomes.
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Leinaar, Edward, Billy Brooks, Leigh Johnson, and Arshman Alamian. "Perceived Barriers to Contraceptive Access and Acceptance Among Reproductive-Aged Women Receiving Opioid Agonist Therapy in Northeast Tennessee." Digital Commons @ East Tennessee State University, 2020. https://dc.etsu.edu/etsu-works/8152.
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strong>Objectives: Women with substance use disorders experience unique challenges to contraceptive obtainment and user-dependent method adherence, contributing to higher than average rates of unintended pregnancy. This study estimated the prevalence of barriers to contraception and their associations with contraceptive use and unwanted pregnancies among women receiving opioid agonist therapy (OAT) in northeast Tennessee.
Methods: A cross-sectional survey was piloted among female patients aged 18 to 55 years from 2 OAT clinics. Logistic regression was used to evaluate associations between contraceptive barriers and current contraceptive use and previous unwanted pregnancies among women receiving OAT.
Results: Of 91 participants, most experienced previous pregnancies (97.8%), with more than half reporting unwanted pregnancies (52.8%). Although 60% expressed a strong desire to avoid pregnancy, ambivalence toward becoming pregnant was common (30.0%). Most experienced ≥1 barriers to contraceptive use or obtainment (75.8%), the most prevalent being aversion to adverse effects (53.8%), healthcare provider stigmatization (30.7%), scheduled appointment compliance (30.3%), and prohibitive cost (25.0%). Experience of any contraceptive barrier (adjusted odds ratio [AOR] 8.64, 95% confidence interval [CI] 2.03–36.79) and access to a contraceptive provider (AOR 5.01, 95% CI 1.34–18.77) were positively associated with current use of prescribed contraceptives, whereas prohibitive cost was negatively associated (AOR 0.28, 95% CI 0.08–0.94).
Conclusions: Although most participants desired to avoid pregnancy, ambivalence or uncertainty of pregnancy intention was common. Most experienced barriers to contraception, which were more strongly associated with previous unwanted pregnancy than current contraceptive use. The provision of long-acting reversible contraceptives and contraceptive education at OAT clinics represents an opportunity to reduce the incidence of neonatal abstinence syndrome.
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Leinaar, Edward, Billy Brooks, Leigh Johnson, and Arsham Alamian. "Perceived Barriers to Contraceptive Access and Acceptance Among Reproductive-Aged Women Receiving Opioid Agonist Therapy in Northeast Tennessee." Digital Commons @ East Tennessee State University, 2019. https://dc.etsu.edu/etsu-works/8182.
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backgroundWomen with opioid use disorder (OUD) experience unique barriers to contraception, contributing to higher than average rates of unintended pregnancy. Rates of neonatal abstinence syndrome (NAS), a drug withdrawal syndrome resulting from antenatal drug exposure, are higher in Tennessee than the nation. Few studies have quantified experience of contraceptive barriers or their associations with contraceptive use among women with OUD.
objectives This study estimated prevalence of barriers to access/acceptance of contraceptive services and their associations with current contraceptive use and unwanted pregnancy among reproductive-aged women in Northeast Tennessee receiving opioid agonist therapy (OAT).
methods A cross-sectional survey was administered to female patients aged 18-55 from two OAT clinics. Logistic regression was used to evaluate associations between contraceptive barriers and current contraceptive use and previous unwanted pregnancies.
results Of 91 participants, most were insured (84.4%), experienced at least one barrier (75.8%), and more than half reported unwanted pregnancies (52.8%). Most desired to avoid pregnancy (60.0%) or were ambivalent (30.0%). Common barriers were side effect aversion (53.8%), provider stigmatization (30.7%), appointment compliance (30.23%), and cost (25.0%). Experience of any barrier (AOR=11.6, 2.25-59.8) and access to a contraceptive provider (AOR=9.78, 1.34-71.7) were positively associated with use, while cost was negatively associated (AOR=0.27, 0.07-0.98). Eight barriers were significantly associated with unwanted pregnancies.
conclusionWhile most participants desired to avoid pregnancy, contraceptive barriers were common. Barriers were more strongly associated with previous unwanted pregnancy than current contraception. Contraceptive provision at OAT clinics may reduce incidence of unwanted pregnancy and NAS in Northeast Tennessee.
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Ganle, John Kuumuori. "Free but not accessible to all : free maternity care, access, equity of access, and barriers to accessing and using skilled maternal and newborns healthcare services in Ghana." Thesis, University of Oxford, 2013. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.644878.
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Limited and inequitable access to skilled maternal and newborn healthcare has been identified as a major contributory factor to poor maternal and newborn health in sub-Saharan African countries, including Ghana. To address the problem of access, the government of Ghana, in 2003, pioneered and is implementing a new maternal healthcare policy that provides free maternity care at the point of delivery in all public and mission health facilities to ensure increased and equitable access and use of skilled maternal and newborn healthcare services. The aim of this doctoral study is to explore how the introduction of the free maternal health policy in Ghana affects access, equity of access, and to investigate barriers to accessibility and utilization of skilled maternal and newborn health services. It does this using data from the Ghana Maternal Health Survey 2007, in combination with qualitative data generated from ethnographic style in-depth interviews and focus group discussions that the author originally conducted with a total of 185 expectant and lactating mothers, and 20 health care providers and policy-makers in six communities in Ghana between November 2011 and June 2012. Survey data suggest that accessibility to, and utilization of skilled antenatal care, delivery in a health facility, delivery with a skilled birth attendant, as well as other post-natal care services have increased by an average of 8% since the introduction of the policy (i.e. between 2003 and 2007).
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Hunt, Halley Lambert. "IMPROVING EQUITY IN HOSPICE ACCESS BY REDUCING CULTURAL BARRIERS IN HOSPICE SERVICES AND HOSPICE DISCUSSIONS FOR NONWHITE US GROUPS." Master's thesis, Temple University Libraries, 2017. http://cdm16002.contentdm.oclc.org/cdm/ref/collection/p245801coll10/id/432978.
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Urban BioethicsM.A.
Though there is ample evidence in existing literature demonstrating racial inequity in end-of-life care, there is minimal examination of how the culturally mainstream values of hospice contribute to inequity and reduced access for nonwhite populations. This paper reviews participatory action research, interviews and chart reviews of nonwhite populations including African Americans, Latinx, Asians and Native Americans to determine what end-of-life values these groups report and how they differ from the values of hospice and western biomedicine. All of these groups reported unmet cultural needs with respect to hospice access ranging from differing communication style preferences to different religious beliefs to different ideas about what they dying process should look like. Contributing to these barriers was practitioner ignorance about cultural variance in end-of-life preferences, demonstrated by studies of physicians to identify barriers to effectively providing end-of-life care. To help foster better knowledge and understanding between practitioners and nonwhite patients whose cultural needs are not being met, I have created a value-assessment tool to add to the standard structure of end-of-life conversations. Using this tool with patients in end-of-life conversations could improve physician confidence in understanding the needs of patients and provide patients an opportunity to freely communicate their needs and therefore increase access to the hospice services that can meet those needs.
Temple University--Theses
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Aniteye, Patience. "Understanding the barriers to, and opportunities for, improving access to safe, legal abortion services in Ghana : a policy analysis." Thesis, London School of Hygiene and Tropical Medicine (University of London), 2012. http://researchonline.lshtm.ac.uk/768505/.
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Unsafe abortion continues to be a major public health problem in Ghana. It accounts for 22-30% of the maternal mortality in the country. Although Ghana is one of the countries in sub-Saharan Africa with a liberal abortion law, access to safe, legal abortion in public health facilities is limited. Women with unwanted pregnancies resort to unsafe abortion with the resultant heavy toll on their health and lives. This study set out to understand the barriers to and opportunities for improving access to safe, legal abortion services in Ghana. The study employed in-depth interviews with key stakeholders and analysis of relevant documents with a view to unravelling different dimensions of the problem for a deeper understanding of the situation. Key findings included the observation that Ghana's abortion law is relatively liberal but has gaps and inconsistencies making it liable for misinterpretation. There is need to provide safe, legal services; evaluation of these services might help to improve the law. Two main barriers confront provision of safe abortions: the service-related barriers constitute legal and policy ambiguities and inconsistencies, provider attitudes and lack of training. Important socio-cultural barriers were cultural values, social norms, moral and religious objection which create dilemmas in professional practice. Midwives were found to be conservative and reluctant to provide comprehensive abortion care. Most respondents, including religious people, saw `medical grounds' as legitimate for comprehensive abortion care. Medicalising abortion may help lift it out of the moral/religious sphere in people's minds, and therefore make it more acceptable. In conclusione, fforts shouldb ea imeda t future law reformt o takec areo f its current ambiguities that challenge application. In the short term, it would be better to sensitizem edicalp ractitionersto the flexibility of the law. It is essentialf or the GhanaH ealth Servicet o assisth ealthp rovidersa ndk ey stakeholdertso re-examine their values and change their attitudes towards abortion care to ensure that legal abortions are provided in public hospitals to help women in need of the services.
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Ebenezer, Catherine. "'Access denied'? : barriers for staff accessing, using and sharing published information online within the National Health Service (NHS) in England : technology, risk, culture, policy and practice." Thesis, University of Sheffield, 2017. http://etheses.whiterose.ac.uk/19826/.
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The overall aim of the study was to investigate barriers to online professional information seeking, use and sharing occurring within the NHS in England, their possible effects (upon education, working practices, working lives and clinical and organisational effectiveness), and possible explanatory or causative factors. The investigation adopted a qualitative case study approach, using semi-structured interviews and documentary analysis as its methods, with three NHS Trusts of different types (acute - district general hospital, mental health / community, acute – teaching) as the nested sites of data collection. It aimed to be both exploratory and explanatory. A stratified sample of participants, including representatives of professions whose perspectives were deemed to be relevant, and clinicians with educational or staff development responsibilities, was recruited for each Trust. Three non-Trust specialists (the product manager of a secure web gateway vendor, an academic e-learning specialist, and the senior manager at NICE responsible for the NHS Evidence electronic content and web platform) were also interviewed. Policy documents, statistics, strategies, reports and quality accounts for the Trusts were obtained via public websites, from participants or via Freedom of Information requests. Thematic analysis following the approach of Braun and Clarke (2006) was adopted as the analytic method for both interviews and documents. The key themes of the results that emerged are presented: barriers to accessing and using information, education and training, professional cultures and norms, information governance and security, and communications policy. The findings are discussed under three main headings: power, culture, trust and risk in information security; use and regulation of Web 2.0 and social media, and the system of professions. It became evident that the roots of problems with access to and use of such information lay deep within the culture and organisational characteristics of the NHS and its use of IT. A possible model is presented to explain the interaction of the various technical and organisational factors that were identified as relevant. A number of policy recommendations are put forward to improve access to published information at Trust level, as well as recommendations for further research.
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Falgàs, Bagué Irene. "Study and comprehension of barriers to mental health in Latino population. Social and cultural factors related to access and retention to mental health services." Doctoral thesis, Universitat Autònoma de Barcelona, 2017. http://hdl.handle.net/10803/461301.
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Introducció: La població llatinoamericana esta permanentment creixent als Estats Units i a Espanya, fet que planteja importants reptes als sistemes de salut pública en ambdós països, des de la limitada accessibilitat als serveis de salut mental i substancies fins a la baixa qualitat i la manca de continuïtat del tractament. La recerca sobre les barreres especifiques de la població llatinoamericana a l’accés i a la retenció als servies de salut mental i de substàncies i el seu rol a la hora de predir l’adherència al tractament es escassa. En aquest projecte de recerca, ens proposem identificar barreres d'accés i retenció i els factors clínics, socials i culturals relacionats a les barreres i als serveis. A més, avaluem com aquests factors i barreres en l'atenció afecten la retenció a un tractament integrador culturalment adaptat per a Llatins amb trastorns de salut mental i substancies.
Mètodes: aquest treball de doctorat inclou investigació clínica, amb un estudi d'observació i un d'intervenció i una revisió crítica del tema. Els participants han estat reclutats prospectiva ment a la comunitat en tres ciutats: Boston, Madrid i Barcelona. Després d'examinar els símptomes de salut mental i abús de substàncies, es van recollir dades sobre barreres percebudes, símptomes clínics, coneixements en salut, discriminació i variables sociodemogràfiques. Per el segon estudi, els participants elegibles van ser assignats aleatòriament per rebre el Programa d'Intervenció Integral per a Problemes Duals i Acció precoç (IIDEA), una intervenció de psicoteràpia culturalment sensible basada en la teràpia cognitiva-conductual (CBT), la psicoeducació i el “mindfulness” i es va avaluar l'adhesió a aquesta intervenció. El primer article publicat es un estudi observacional que descriu les barreres a la retenció als serveis de salut mental i substancia en la població llatina i compara diferencies entre els dos països. El segon estudi presenta l’avaluació de la relació entre les barreres percebudes prèviament a rebre el tractament i l’adherència a la intervenció al programa IIDEA. Finalment, es presenta una revisió crítica de la literatura que valora l'accés i la retenció a l'atenció dels immigrants que complementa el projecte de recerca.
Resultats: les barreres que reflecteixen l'autosuficiència "Voler solucionar el problema un mateix", la desconfiança en els serveis de salut mental i de substancies, "Pensant que el tractament no funcionarà" i "No estar segur d'on anar o qui ha de veure" van ser els les barreres més freqüentment registrades per als immigrants llatins. Es van trobar diferències en les barreres segons el lloc d’estudi. També es van trobar dues barreres específiques associades a l'ús de serveis de salut mental i de substancies. Pel que fa a la retenció a la intervenció de l'IIDEA, els Llatins que van que presentaven més de tres barreres van mostrar una major finalització del programa en comparació amb els que en presentaven menys, una diferència que va ser significativa. La barrera que reflectia una falta de confiança en els serveis de salut mental i substancies va resultar significativament associada a una major retenció i fins i tot a la finalització del programa. La Educació i la discriminació percebuda van resultar esser predictors per completar el programa IIDEA. La revisió critica de la literatura presenta algunes solucions i alternatives per millorar l’accés i la retenció als serveis de salut mental i de substàncies per a la població immigrant.
Conclusions: Aquesta tesi destaca la importància d'avaluar les barreres en l'atenció sanitària en la població immigrant. Es necessària una millor adaptació dels serveis de salut mental i substancies a la població immigrant per tal de superar barreres com l’autosuficiència i la desconfiança i així millorar l'accés i la retenció en l'atenció als serveis de salut mental i substancies.Background: Growing Latino population in U.S. and Spain poses important challenges for public health systems in both countries, from limited accessibility of behavioral health services to low quality and lack of continuity of care. There is a paucity of research that identifies the specific barriers and their role on predicting adherence to mental health and substance abuse treatment within Latino populations and investigates whether these variables change depending on the host country. In this research project, we aim to identify barriers to access and retention and the clinical, social and cultural factors related to them. Moreover, we assess how these factors and barriers in care influence treatment retention of a culturally adapted integrative therapy for Latinos with behavioral disorders. Methods: This research work included a clinical research body, with an observational and an interventional component and a critical review on the topic. Participants were recruited prospectively in the community in three sites; Boston, Madrid and Barcelona. After being screened for mental health and substance abuse symptoms, data on perceived barriers, clinical symptoms, health literacy, discrimination and socio-demographic variables was collected. Eligible participants were randomized for receiving the Integrative Intervention for Dual Problems and Early Action program (IIDEA), a cultural sensitive psychotherapy intervention based on Cognitive Behavioral Therapy (CBT), psychoeducation and mindfulness. Adherence to this intervention was assessed. The observational study that described barriers to retention to treatment among Latinos was first published. A second study assessing the relationship between previously reported barriers to care and adherence to the IIDEA intervention was written and submitted for publication. Finally, a critical review of the literature assessing access and retention to care among Latino immigrants complemented the research project. Results: Barriers that reflect self-reliance “Wanting to handle the problem on one’s own”, mistrust on behavioral health care systems, “Thinking that treatment would not work”, and “Being unsure of where to go or who to see” were the most frequently reported barriers for Latino immigrants. Differences in reported barriers were found across sites. Two specific barriers were also found to be associated with use of behavioral services. Regarding retention to the IIDEA intervention, Latinos who reported at least one barrier at baseline presented a higher retention to the program compared to those participants who did not report any barrier. Participants that reported more than three barriers showed greater completion of the program compared to those who reported less than three barriers, a difference that was also significant. Mistrust in the behavioral services reported barrier was significantly associated with greater retention in the program. Education and perceived discrimination were found to be predictors for completing the IIDEA program. Conclusions: This thesis points out the importance of assessing barriers in health care. Efforts to improve behavioral health services must be tailored to immigrants ‘context, with attention to overcoming attitudes of self-reliance, cultural mistrust and outreach to improve access to and retention in care among Latino immigrants.
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Warton, Giselle. "Barriers to access to mental health care services in the Cape Metropole, faced by refugee and asylum seeker women who have been exposed to trauma." Master's thesis, University of Cape Town, 2013. http://hdl.handle.net/11427/4743.
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Includes abstract.Includes bibliographical references.
Through use of a phenomenological design, this qualitative study investigated barriers to accessing mental health care by female refugees living in the Cape Metropole who have mental health problems as a result of exposure to trauma. A high number of female refugees in the Cape Metropole have been exposed to trauma. This study aims to contribute to the limited literature on this topic. The objectives of the study were to identify whether female refugees faced barriers to accessing mental health services in the Cape and if they did, the nature of these barriers. The findings identified that at the service-delivery level, language, under-resourced mental health services, documentation barriers and lack of awareness of refugees' rights were the biggest barriers. The main barriers in the refugee communities were cultural and religious, fear and lack of awareness and work and childcare responsibilities. The study highlights that not only is the South African government obliged under international, regional and national laws to fulfil female refugees' right to access mental health services, but it is in the state's best interests to do so.
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Rezende, Marcelo Abrão. "Identificação de barreiras para atendimento oftalmológico dentro do Sistema Único de Saúde." Botucatu, 2018. http://hdl.handle.net/11449/154818.
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Orientador: Silvana Artioli SchelliniResumo: Introdução: O atendimento oftalmológico prestado pelas diferentes cidades no território nacional difere na oferta de serviços e complexidade. Além disso, a oftalmologia é uma especialidade altamente dependente de equipamentos para a prestação da assistência. Assim, os municípios menores e com menos recursos, muitas vezes, ficam desassistidos. Nesse sentido, a atuação de unidades móveis oftalmológicas (UMO) equipadas para a realização de exames refracionais poderiam reduzir a demanda para serviços terciários e reduzir algumas das barreiras para o atendimento oftalmológico dentro do Sistema Único de Saúde (SUS). No entanto, mesmo com o atendimento prestado pela UMO e encaminhamento dos casos mais complexos ao serviço terciário, alguns pacientes não comparecem ao serviço de referência. Objetivo: Verificar as causas para a não adesão ao encaminhamento ao serviço de referência para tratamento das possíveis causas de cegueira/ deficiência visual, detectadas na comunidade por meio de triagem oftalmológica realizada pela UMO. Material e Métodos: Estudo prospectivo e observacional realizado com pacientes atendidos pela UMO em 10 municípios do centro-oeste paulista no ano de 2015. Após atendimento realizado pela UMO nos municípios, os pacientes que necessitaram de cuidados no nível terciário foram encaminhados para o centro de referência da região, o Hospital das Clínicas de Botucatu (HC-FMB). Porém, alguns pacientes não aderiram ao encaminhamento e estes foram o objeto deste estudo. P... (Resumo completo, clicar acesso eletrônico abaixo)
Abstract: Introduction: Different cities differ according to the offering of ophthalmic care services and complexity in the national territory. Ophthalmology is a specialty highly dependent on equipment for the provision of healthcare. Thus, smaller and less resourceful cities often remain unattended. In this sense, the operation of mobile ophthalmologic units (MOU) equipped for refractive exams could reduce the demand for tertiary services and reduce some of the barriers to ophthalmologic care within the Unified Health System (in Brazil, SUS). However, even with the assistance provided by the mobile units and the referral of the more complex cases to the tertiary service some patients do not attend the referral service. Objective: To verify the causes of non-attendance to the referral service at the tertiary facility to treat possible causes of blindness / visual impairment detected in the community through ophthalmologic screening performed by the MOU. Material and Method: Prospective and observational study was carried out with patients assisted by the MOU in 10 municipalities in the center-west of São Paulo in the year 2015. After care given by the MOU in the cities, the patients who needed care at the tertiary level were directed to the referral center of the region, the Hospital das Clínicas de Botucatu (HC-FMB). However, some patients did not adhere to the referral and these were the object of this study which was developed to identify the reasons for non-adhesion and the barrie... (Complete abstract click electronic access below)
Mestre
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AragÃo, AntÃnia Eliana de AraÃjo. "Acessibility for the physically disabled to hospital services: architectonic barrier evaluation." Universidade Federal do CearÃ, 2004. http://www.teses.ufc.br/tde_busca/arquivo.php?codArquivo=157.
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CoordenaÃÃo de AperfeiÃoamento de NÃvel SuperiorCoordenaÃÃo de AperfeiÃoamento de Pessoal de NÃvel Superior
O projeto de pesquisa âAcessibilidade da pessoa portadora de deficiÃncia fÃsica e / ou sensorial aos serviÃos de saÃde: estudo das condiÃÃes fÃsicas e de comunicaÃÃoâ tem por objetivos identificar as barreiras arquitetÃnicas que dificultam ou impedem o acesso do portador de deficiÃncia aos serviÃos bÃsicos de saÃde e aos hospitais gerias, procura, ainda, estudar as dificuldades de comunicaÃÃo entre estas pessoas e membros da equipe de saÃde. A participaÃÃo nesse projeto despertou para o tema e originou esta dissertaÃÃo, que tem por objetivo mapear as condiÃÃes arquitetÃnicas de acesso do portador deficiÃncia fÃsica aos serviÃos hospitalares na cidade de Sobral-Ce. O referencial teÃrico apÃia-se na Lei n 7.853 de 24/10/1989 que estabelece normas que asseguram o exercÃcio dos direitos individuais e sociais das pessoas portadoras de deficiÃncia e sua efetiva integraÃÃo social. Estudo quantitativo que utilizou instrumento de coleta de dados tipo cheque lista elaborado consultando a lei, foram incluÃdos no estudo os quatro hospitais gerias da cidade, a coleta ocorreu no mÃs de maio de 2004 e foram alguns dados documentados fotograficamente. A anÃlise estatÃstica constatou no que se refere Ãs suas adjacentes aos hospitais a ausÃncia de faixas, para pedestres e de rebaixamento de meio fio em pontos estratÃgicos (25 %); obras pÃblicas e particulares desprotegidas de tapumes (100%) , avenidas livres de buracos (50%); calÃadas que nÃo estÃo livres de buracos e desnivelamento (100%), placas de sinalizaÃÃo de trÃnsito visÃveis (75%); o percurso para a instituiÃÃo està sinalizado (100%); mas nÃo hà semÃforos em pontos estratÃgicos (100%). Quanto ao acesso ao hospital, possuem rebaixamento de guias (50%); ausÃncia do sÃmbolo internacional de acesso (100%); hà rampas de acesso (100%); escadaria sem corrimÃo (50%); as portas possuem a largura ideal (100%); as de vai e vem nÃo possuem visor (100%). As caracterÃsticas internas dos hospitais mostram que as Ãreas de circulaÃÃo possuem obstÃculos (100%), o piso das rampas à antiderrapante (50%); as rampas e escadas possuem corrimÃo (50%), mas fora do padrÃo legal. Um hospital tem apenas um pavimento os outros trÃs contam com 13escadas internas com degraus ideais; os balcÃes atendem a legislaÃÃo (80%) e assentos pÃblicos tambÃm (32%). Os bebedouros sÃo acessÃveis, mas os telefones nÃo. Conclui-se que hà barreiras arquitetÃnicas no percurso casa/hospital, no acesso direto ao hospital e nas suas dependÃncias internas. A legislaÃÃo vigente que garante o acesso do portador de deficiÃncia fÃsica aos serviÃos de saÃde està sendo desrespeitadas o que demonstra desconhecimento e descaso do serviÃo pÃblico, bem como, dos profissionais da saÃde que sÃo co-responsÃveis na garantia do exercÃcio da cidadania desta populaÃÃo.
The search plan of the Nursing Department of the Federal University of Cearà called: accessibility of physically and/or sensorial deficient people to health care: the object of physical conditions and communication study is to point out any architectonic obstacles making difficult or obstructing any physically deficient people (pdp) to access basic health cares and general hospitals and study the communication problems amongst such people and health caring team members. My participation in such a plan called my attention to such a theme and gave rise to this dissertation, the objects of which are to map the architectonic conditions for the physically deficient people to access any hospital cares in the city of Sobral-CE and point out any internal architectonic obstacles and also in the hospitals for the physical move of PDPs. The theoretical system of reference is based on Law No. 7,853, dated 10/24/1989, which sets up rules to ensure the exercise of individual and social rights of physically deficient people and the effective social integration thereof. Such study is quantitative and used an instrument of data collection of check-list type made by consultation under law. Four general hospitals of the city were included in such study and data collections were performed in the month of May 2004. Some of them have been documented on photos The statistic analysis found out in connection with the areas around hospitals that there no crosswalks (100%) and lowering of curb at strategic points (75%); public and private works with no fence made of planks (100%); pavements with holes and unlevellings (100%); avenues with no holes (50%); visible transit signs (75%); the way going to the institution is signaled (100%), but there are no traffic lights at strategic points (100%). Concerning access to hospitals, there is no lowering of curbs (75%); there is no parking area for PDPs signalized with the International Access Symbol (100%); there is sloping roadway (100%), flight of stairs with no handrail (50%); doors are well sized (100%); swing doors has no appropriate visors (100%); the inner features of the hospitals show that the transit areas have obstacles (100%); the pavement on the outer sloping roadways are non skid. (100%); the inner sloping roadways and stairs have handrails available (50%) but not in compliance wit the lawful standard. One of the hospitals has one floor but the other three ones have three inner stairs; counters are in accordance with legislation (80%) and the public seats as well (33%). Drinking places and telephones are not accessible (95.5%) It was concluded that there are architectonic obstacles in the way from house to hospital, in the direct access to hospital in the inner rooms thereof. The legislation in force assuring the physically deficient people to access the health care has not been complied with. This means that the public service has obviously not been aware of such legislation and has been negligent. The health caring professionals who are also responsible for assuring the citizenship of such portion of population to be exercised have been negligent as well.
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Moss, John Gordon Robert. "Personal financial planning advice : barriers to access." Thesis, University of Birmingham, 2015. http://etheses.bham.ac.uk//id/eprint/6016/.
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With the move towards a society where responsibility has been placed upon the individual to make financial provision for future events, comes the need for individuals to be able to interact with the financial services sector and make informed decisions regarding their financial choices. This research focuses on the barriers that influence why and how consumers access advice from Regulated Financial Advisers. Three key variables are highlighted by this research that each affect the consumer’s ability to access regulated financial advice; Firstly, knowledge, where sub-themes relating to need, knowledge of services and ‘finding an adviser’ were identified. These highlighted the concept of advice not generally being the ‘subjective norm’. Secondly, trust, where the concepts of ‘general trust’ and ‘individual trust’ emerged along with the issues surrounding consumers’ abilities to apply ‘critical trust’. Thirdly, affordability and cost, which includes the consumer’s appreciation of the value of advice. Finally, this research asks whether consumers are overwhelmed by the extent of the provision they need to make to shape their financial future. It therefore begs the question as to whether the degree to which the welfare state has already been rolled back has resulted in financial planning issues beyond the capabilities of most consumers.
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Rice, Judy A. "Breaking Down Barriers: Increasing Access to Psychotropic Medications." Digital Commons @ East Tennessee State University, 2018. https://dc.etsu.edu/etsu-works/7618.
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Rigbye, J. L. "Barriers to treatment access for young problem gamblers." Thesis, Nottingham Trent University, 2013. http://irep.ntu.ac.uk/id/eprint/259/.
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The rate of problem gambling is more than twice as high in adolescents as it is for adults (2%) (Ipsos MORI, 2009), and the younger the age of onset of problem gambling the more severe the problem can be in later life. It has been suggested that help-seeking for gambling problems is uncommon amongst young people (Gupta & Derevensky, 2000; Hardoon, Gupta & Derevensky, 2003) and a number of speculative reasons for this have been presented (Chevalier & Griffiths, 2004; Griffiths, 2001). However to date there is a paucity of empirical evidence which explore barriers to treatment access in young problem gamblers (Suurvali, 2009). The research aims were to generate empirical evidence to identify and explain barriers to treatment access for young problem gamblers in the UK. The main objectives were to i) Explore the attitudes and perceptions that young people hold towards problem gambling; ii) Investigate the potential barriers which may prevent young people from seeking treatment; and iii) To understand the salience of the identified barriers to treatment access amongst young problem gamblers. The research employed a mixed methods approach, incorporating exploratory studies, indepth interviews with problem gambling treatment professionals (n=11) and problem gamblers (n=6), and a study employing Q methodology to help understand the subjectivity of opinion on barriers to help-seeking (n=21). The main findings were that there are four main groups of barriers to treatment access for young people: treatment barriers; environmental barriers; social and motivational barriers and ‘gambler-centric’ barriers. These barriers are experienced in different ways by different participants, and the Q methodological study identified four main viewpoints among young problem gamblers as to why they may not seek treatment. This thesis makes an original contribution to knowledge, generating an empirical understanding of the subjective opinion on, and salience of barriers to, problem gambling help-seeking, as they are experienced by young problem gamblers, and empirically grounding previously identified barriers to treatment access in this population. A number of new barriers (emotional immaturity and poor verbal communication; lack of clinical skills in treatment providers; and lack of flexibility to suit client needs) were also identified.
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Lukefahr, Joseph W. "Service-oriented access control." Thesis, Monterey, California: Naval Postgraduate School, 2014. http://hdl.handle.net/10945/43948.
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Approved for public release; distribution is unlimitedAs networks grow in complexity and data breaches become more costly, network administrators need better tools to help design networks that provide service-level availability while restricting unauthorized access. Current research, specifically in declarative network management, has sought to address this problem but fails to bridge the gap between service-level requirements and low-level configuration directives. We introduce service-oriented access control, an approach that frames the problem in terms of maintaining service-level paths between users and applications. We show its use in several scenarios involving tactical networks typically seen in the military’s field artillery community.
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Nilsson, Olof. "Access Barriers - from a user´s point of view." Doctoral thesis, Mittuniversitetet, Institutionen för informationsteknologi och medier, 2005. http://urn.kb.se/resolve?urn=urn:nbn:se:miun:diva-5799.
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Abstract The aim of this thesis is to suggest a model to assist in the ability to judge access by private persons to Information Technology, IT, and to Public Information Sys-tems, PIS. It has its starting point in the Swedish Government´s endeavour to turn Sweden into the first information society for all. When the available statistics con-cerning the access to a PC and the Internet in Swedish homes are studied it is easy to think that this vision may soon be realised. Of course, access to the technical equipment is a fundamental condition in order to be able to use the Public Informa-tion Systems, but unfortunately, is not the only one. A number of studies have shown that it is not possible to equate possession and use. A number of access models or frameworks designed to judge whether or not a person has access to the ICTs do exist. However, it is my opinion that there is a de-ficiency in these models; they do not start out from the individual user´s prerequi-sites, but rather judge the external conditions available for possible access. Assisted by four empirical studies, interviews and questionnaires, a number of ac-cess barriers experienced by the users have been identified. The studies show that in addition to the technological hindrances, a series of more elusive ones also exist originating from prevailing norms and values in the environment the user lives in. The barriers are categorised into five groups; to have, to be able, to will, to may and to dare. Together these notions form the User Centred Access Model, UCAM, which is suggested for use in charting and communicating the necessary considera-tions that must be taken into account in the development of Public Information Sys-tems. KeywordsLanguagePI - Publika Informationssystem
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Ryan, Brittany. "Overcoming Barriers to Local Food Access: A Case Study." TopSCHOLAR®, 2013. http://digitalcommons.wku.edu/theses/1289.
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This thesis focuses on the idea that food insecurity and access are real issues in the lives of many Americans. Simply stated, food insecurity is when a person does not have enough food to eat or does now know where his/her next meal is coming from. More importantly when looking at food insecurity is the realization that healthy, local food access is even more prevalent an issue – with increasingly more under-resourced individuals and families being food insecure and unhealthy at the same time. This thesis includes a literature review on diet and nutrition in the United States, a chapter on methodology, history of Bowling Green, Kentucky, where this case study is focused, the benefits of shopping at farmers’ markets, perceived barriers to shopping at those farmers’ markets, and suggestions for overcoming these barriers. Local, sustainable food is the hope for a future of planet earth. It is what nourishes and sustains lives. And, it should not be a privilege. Through researching the benefits and barriers to farmers’ markets, examining these barriers, developing suggestions for overcoming these barriers, and implementing as many as these initiatives as possible in Bowling Green, Kentucky, I have not only compiled a detailed thesis, but I have also been a small part of creating change in the food community in Bowling Green. This thesis can serve as a nationwide model and describes the way to overcome food accessbarriers in urban/rural communities.
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Larsson, Kiara. "Barriers to Access to Antiretroviral Treatment in Babati, Tanzania." Thesis, Södertörns högskola, Institutionen för naturvetenskap, miljö och teknik, 2016. http://urn.kb.se/resolve?urn=urn:nbn:se:sh:diva-30711.
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Sub-Saharan Africa is the region in the world most severely affected by HIV, and Tanzania is among the most severely affected countries in the region. The introduction of antiretroviral treatment has offered hope to people living with HIV/AIDS, improving their quality of life significantly. Still, there are individuals living with HIV who either lack access to ART, or choose not to make use of the available treatments. The purpose of this thesis is to identify underlying factors perceived as barriers for HIV- positive individuals to initiate and maintain Antiretroviral treatment in Babati District, Tanzania. Twenty semi-structured interviews were carried out between the 15th of February and 6th of March 2016. The interviews were conducted with ART-patients, health workers and members of the community. An analysis was made within a theoretical framework based upon Goffman's notion of stigma and the Initial Behavioral Model by Andersen. The following obstacles to access to ART were indicated by the findings: HIV/AIDS related stigma issues, discrimination, economic barriers, ignorance due to lack of education, counseling on HIV treatment, and beliefs that HIV can be cured by traditional healers.
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PIETILÄ, OLLI. "Barriers to adopting mobile access solutions in hospitality organizations." Thesis, KTH, Skolan för industriell teknik och management (ITM), 2019. http://urn.kb.se/resolve?urn=urn:nbn:se:kth:diva-263217.
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This study aims to investigate factors that affect the attitudes towards mobile access control solutions among decision-making units (DMUs) in hospitality organizations in Finland to identify perceived benefits and barriers to adoption of mobile solutions. The first mobile access control solution was introduced in the early 2000s and is used successfully in, for example, public transport and in offices. Within the hospitality industry, these solutions are used to a much lesser extent and the reasons behind them have not been investigated. A mixed method is used to get as rich and nuanced a picture of the topic as possible and to get a good overall view based on the limited number of interviews that are carried out at decisionmaking units in both hotels and hostels. The quantitative and qualitative results complement each other, and the study aims to identify and explain the perceived benefits and barriers to adoption that the decision-making units state. The results show that the most important barriers to adoption are related to high cost, an insufficient solution, the requirement to have to download an app, that the solution will not bring more customers, monitoring and security problems, a fear of losing direct customer contact and the risk that especially foreign travelers and older people will not want to use the solution. The greatest possible benefits of the solution are that visitors do not have to queue at check-in to their hotel room and that the hotels no longer need a reception but at the same time offer 24/7 accessibility. The biggest differences between the decision-making units who favored the solution in comparison to those who did not perceive any benefits were that they wanted or could imagine not having a night reception in their reception, that there was no need to let the customers get in on at night and that they do not consider direct customer interaction as critical. Furthermore, the study shows that individuals who are more interested in information and communication technology have more payment applications on their smart device and are on average more likely to adopt the solution. The study indicates that decision makers in the hospitality industry are beginning to understand the benefits of mobile access control solutions and that the marketing of these solutions that has been going on for almost a decade may now yield results. The results of the study contribute partly to an increased understanding of the underlying reasons for decisionmaking units’ attitude towards mobile access control solutions in the hospitality industry, and partly to an increased knowledge of how companies selling mobile access control solutions can identify potential customers for their products.Denna undersökning syftar till att undersöka faktorer som påverkar attityderna till mobila passerkontrolllösningar bland beslutsfattare i besöksnäringsorganisationer i Finland för att identifiera uppfattade fördelar och hinder för adoption av mobila lösningar. Första mobila passerkontrolllösningen introducerades i början av 2000-talet och används framgångsrikt inom t ex kollektivtrafik och på kontor. Inom besöknäringen används dessa lösningar i betydligt mindre omfattning och skälen bakom har inte undersökts. En blandad metod används för att få så rik och nyanserad bild av ämnet som möjligt och för att få en bra helhetssyn utifrån det begränsade antalet intervjuer som genomförs hos beslutsfattare inom både hotell och vandrarhem. De kvantitativa och kvalitativa resultaten kompletterar varandra och studien syftar till att både identifiera och ge en förklaring till de uppfattade fördelar och hindren för adoption som besultsfattarna uppger. Resultaten visar att de viktigaste hindren för adoption är relaterade till hög kostnad, en otillräcklig lösning, kravet på att behöva ladda ner en app, att lösningen inte kommer att medföra fler kunder, övervaknings- och säkerhetsproblem, en rädsla för att förlora direkt kundkontakt och risken att särskilt utländska resenärer och äldre människor inte kommer vilja använda lösningen. De största möjliga fördelarna med lösningen anges vara att besökare inte behöver stå i kö vid incheckningen till sitt hotellrum och att hotellen inte längre behöver ha en reception men samtidigt erbjuda 24/7 tillgänglighet. De största skillnaderna mellan de beslutsfattare som ställde sig positiva till lösningen i jämförelse till de som inte uppfattade förmånerna handlade om att de ville eller skulle kunna tänka sig att inte ha nattmottagning i sin reception, att det inte fanns behov av att låta kunderna komma in på natten och att de inte uppfattar direkt kundinteraktion som kritisk. Vidare visar studien att individer som är mer intresserade av informations- och kommunikationsteknik har fler betalningsapplikationer på sin smarta enhet och är i genomsnitt mer benägna att adoptera lösningen. Studien indikerar att beslutsfattare inom besöksnäringen börjar förstå fördelarna med mobila passerkontrollösningar och att den marknadsföring av dessa lösningar som pågått i nästan ett årtionde nu kan komma att ge resultat. Resultaten från studien bidrar dels till en ökad förståelse om bakomliggande skäl till beslutsfattares attityd till mobila passerkontrollösningar inom besöksnäringsbranschen och dels bidrar den till en ökad kunskap om hur företag som säljer mobila passerkontrollösningar kan identifiera potentiella kunder för sina produkter.
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Yao, Xiaoxi. "Do Long Work Hours Impede Workers’ Ability to Obtain Health Services?" The Ohio State University, 2014. http://rave.ohiolink.edu/etdc/view?acc_num=osu1405356729.
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Burns, Nicola. "Access points and barriers to ownwer occupation for disabled people." Thesis, University of Glasgow, 2002. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.249987.
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Borders, Stephen Boyce. "Transportation barriers to health care: assessing the Texas Medicaid program." Texas A&M University, 2003. http://hdl.handle.net/1969.1/6016.
Full textAbstract:
Transportation is frequently cited as a barrier to health care, but rarely have
researchers analyzed the problems in depth. The purpose of this study was to assess the role
transportation plays in the utilization of preventive health care services among Medicaid
recipients ages 0 - 20 in Texas. This preventive care is known as Early Periodic Screening
and Diagnostic Testing (EPSDT), a comprehensive prevention and treatment program for
Medicaid eligible children.
Our computer assisted telephone interviewing based survey was administered to
Medicaid recipients selected from a representative sample through a stratified sampling
scheme. Binary logistic regression models were used to assess and predict factors associated
with utilization of the Texas Medicaid Transportation Program (MTP) and utilization of
EPSDT. We also used k-means cluster analysis to identify subgroups of Medicaid clients with
particularly acute transportation barriers.
Of the 1,214 Medicaid recipients interviewed, the overall odds of a Medicaid recipient
being a MTP non-user was 0.94. For clients with automobile access, the probability increases
to 0.98. Clients who experienced difficulties paying for gasoline decreased the overall odds to 0.86. When examining utilization of EPSDT, the overall probability of being a low utilizer was
0.59. Two factors, Spanish-speaking patients (0.21) and clients with more than one child at
home (0.54) decreased the overall odds of being a low utilizer, while those with difficulty
paying for gasoline increased the odds of being a low utilizer to 0.63.
Increasing EPSDT utilization among the millions of Texas Medicaid recipients is an
important policy objective. Because the Texas Medicaid population is large and diverse, no
single approach to increasing utilization is likely to address all needs. The group concept
provides a means to understand which Medicaid recipients do not access MTP services and
those with low utilization rates. These groupings can be useful in targeting Medicaid clients
with specific transportation difficulties. Instead of broad informational campaigns, policy
makers should devise targeted strategies to promote the most appropriate types of assistance.
In addition to expanding transportation options, policy makers should also examine the
locations in which care is delivered, considering telemedicine, mobile health and school-based
health clinics as options.
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Barcelos, Suzyane CortÃs. "The regionalization of access to health: facilitating flows or building barriers?" Universidade Federal do CearÃ, 2016. http://www.teses.ufc.br/tde_busca/arquivo.php?codArquivo=19179.
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FundaÃÃo Cearense de Apoio ao Desenvolvimento Cientifico e TecnolÃgicoCoordenaÃÃo de AperfeÃoamento de Pessoal de NÃvel Superior
Desde a consolidaÃÃo do Sistema Ãnico de SaÃde (SUS), hà um empenho de forÃas polÃticas e tÃcnicas em concretizar arranjos organizativos que expressem o desenho mais adequado para efetivar o acesso à saÃde em territÃrios com limites geogrÃficos continentais, como o do Brasil. PorÃm, historicamente, ao nos centrarmos nos trajetos assistenciais de usuÃrios que necessitam migrar da atenÃÃo bÃsica (AB) para a atenÃÃo especializada (AE), à perceptÃvel uma persistente departamentalizaÃÃo dos serviÃos de saÃde, o que fragiliza a integralidade da atenÃÃo e os fluxos dos usuÃrios. Dessa forma, o Estado tem investido na regionalizaÃÃo da saÃde como potente estratÃgia para aumentar o alcance dos serviÃos ofertados, de forma a atender Ãs necessidades dos usuÃrios com maior qualidade e menor custo de investimento. Sendo assim, esse estudo se propÃe a compreender como acontece a regulaÃÃo do acesso à atenÃÃo especializada, a partir de uma perspectiva regionalizada da saÃde. Trata-se de um estudo enraizado em solos epistemolÃgicos da pesquisa qualitativa, que tem como interesse as experiÃncias e processos de significaÃÃes de sujeitos inseridos no cenÃrio da saÃde. Foram entrevistados 9 usuÃrios e 5 gestores da Ãrea de saÃde de Russas, estado do CearÃ, no perÃodo de janeiro a abril de 2016. As entrevistas foram coletadas no serviÃo ambulatorial e especializado da regiÃo (policlÃnica). Realizaram-se entrevistas em profundidade, buscando reconstituir as trajetÃrias assistenciais dos usuÃrios. Ademais, utilizamos anotaÃÃes em diÃrio de campo e observaÃÃo dos serviÃos de saÃde. A construÃÃo da informaÃÃo teve como lente a perspectiva da fenomenologia empÃrica, a partir da qual se desvelaram trÃs unidades de significados. A primeira unidade de significado foi a organizaÃÃo dos fluxos de acesso regionalizado, apontando os fluxos institucionalizados pelos protocolos de acesso à AE implantados sob uma lÃgica muito estrutural e burocrÃtica, culminando em barreiras de acesso e levando os usuÃrios a trilhar vias paralelas. Na segunda unidade, o cerne das anÃlises girou em torno da gestÃo das prÃticas regulatÃrias regionais, desvelando as estratÃgias utilizadas pelos gestores para garantir fluxos de acesso regionalizado, tais como o controle sistemÃtico da oferta de vagas, matriciamento entre AE e AB, utilizaÃÃo das Tecnologias de InformaÃÃo e comunicaÃÃo no processo de regulaÃÃo do acesso regional. Por Ãltimo, apresentamos a gestÃo das prÃticas regulatÃrias com base na organizaÃÃo interna do serviÃo de referÃncia, discutindo principalmente â a partir das trajetÃrias assistenciais â o impacto que a acessibilidade geogrÃfica tem no acesso à saÃde dos usuÃrios, a importÃncia do transporte sanitÃrio e a priorizaÃÃo de municÃpios mais distantes. Conclui-se que a modelagem de serviÃos de saÃde, na perspectiva regionalizada de saÃde, à uma soluÃÃo necessÃria e inevitÃvel para um paÃs de dimensÃes continentais. Todavia, devem estruturar-se potentes sistemas logÃsticos e de apoio para que de fato se consiga alcanÃar a integralidade de todos os nÃveis de saÃde.
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Cenafils-Brutus, Doudelyne. "Perceived Barriers to Oral Health Care Access for Massachusetts' Underserved Parents." ScholarWorks, 2016. https://scholarworks.waldenu.edu/dissertations/2717.
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Poor oral care is detrimental to the overall health of the population. In the United States, oral health diseases affect millions of individuals, especially children and adolescents. Guided by the health belief model, the purpose of this study was to identify parents' perceived barriers to oral health care access among their 5- to 10-year-old children. A phenomenological approach was used to gather data and thematically analyze interview data from 20 parents who were recruited from a health center in the northeastern United States. All participants had at least one child between 5-10 years old and all identified as under-served. Data were coded and analyzed for emerging themes, with the assistance of Nvivo software. The findings demonstrated that lack of time, the location of dental facilities, and the lack of sensitivity of dental providers were issues for parents in managing their children's oral health. This study might be beneficial in eliciting positive social change at the individual and organizational levels by illuminating the constraints faced by the underserved population in Massachusetts.
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Osgood, Jean M. "Access to Care: Assessment of Barriers in Two Rural Iowa Communities." ScholarWorks, 2017. https://scholarworks.waldenu.edu/dissertations/4164.
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The ability to access primary care services within the local community has a direct impact on the health and wellness of the community. Individuals living in rural settings face multiple challenges when attempting to access care. The purpose of this retrospective project was to identify barriers in 2 rural, underserved communities and make recommendations for process changes that could reduce these barriers. Data were gathered from 2 critical access hospitals and 2 rural health clinics located in rural, underserved areas in Iowa. Both hospitals identified access to health services as an issue within their communities. Administrative data were gathered on nonemergent use of the emergency department, which revealed peak use from 10 a.m. to 11 a.m., 12 p.m. to 1 p.m., and 4 p.m. to 5 p.m. Clinic data included patient demographics, staffing and scheduling patterns, and the number of patient visits. One site provided expanded hours, yet very little difference in the number visits to the emergency room for nonemergent care was identified. Both clinic sites reported the need for additional providers to meet the needs of their patients and provide more same-day appointments. Recommendations made to increase access were open scheduling, staggered staff schedules to increase appointments over peak demand times, and use of a dedicated case manager to improve communication and coordination of care. Increased use of technology would allow the provision of care outside the clinic setting, enhance care coordination, and promote patient participation in care. With increased knowledge regarding the barriers facing rural communities when accessing care, process changes can be implemented to reduce barriers. The overall goal is to improve health and wellness through increased access.
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Bufton, Serena Anne. "Barriers to success? : access entrants and social class processes in higher education." Thesis, Sheffield Hallam University, 2001. http://shura.shu.ac.uk/4897/.
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The aim of this thesis is to explore social-class processes within higher education through a study of the experiences of mature, largely working-class, Access entrants. It draws on data from a qualitative, longitudinal study of twenty-seven such entrants to a pre-1992 university, a post-1992 university and a college of further and higher education, all in the South Yorkshire region. The central finding is that, whilst all mature students entering higher education may experience some degree of disjunction, this is frequently more intense for those from working-class backgrounds, although factors of age, entry qualification and gender interact in complex ways to shape the experiences of mature entrants. It is suggested that, despite important differences between higher education institutions in terms of access strategies, ethos, student composition and levels of student support, the academic stance on which they are all premised, with its distanced and nuanced impartiality, may constitute a subtle source of disjunction for working-class students because it necessitates a detachment from, and symbolic re-ordering of, their social worlds. As a consequence, working-class students in higher education are likely to feel that they are entering an alien world. Drawing on Bourdieu's analogy of social life as game playing, it is contended that the working-class habitus provides resources for dealing with the experience of higher education but that participation in the academic `game' has important consequences for selfhood and relationships with significant others, marking a potential betrayal of working-class roots and a loss of the `sense of one's place'. The theoretical framework adopted in the thesis rests upon a reformulation of Bourdieu's concepts and the methodological stance is one of critical realism. It is argued that social class operates at a number of distinct but interwoven levels. At the structural level, class is viewed as a real economic and cultural phenomenon with generative mechanisms of which social actors may not be aware. Working-class students in higher education may therefore only partially recognise the class-based nature of their disadvantage. Indeed, the processes of misrecognition and symbolic violence may encourage such students to believe that they lack the necessary skills and qualities to cope in this sphere. At the level of social action, however, class processes are implicated in the struggles for distinction in social life - material, cultural and symbolic - of purposive and active social agents, although social classes at this level may now operate more as modes of differentiation than as forms of collectivity (Savage, 2000). It is contended in this thesis that the relationships between the structural and cultural dimensions of social class, and between each of these and social agency, are contingent upon historical and social circumstances; these relationships can therefore only be specified in concrete, empirical contexts. (This is clearly demonstrated by the contingent combination of structural context, individual motivation and, in many cases, fortuitous events that lay behind the entry to higher education of the working-class students in this study. ) Following this, it is argued that the generative mechanisms of social class affect what happens in a contingent, rather than a necessary, way so that the outcomes of the struggles for distinction in social life are not fixed. For this reason, class processes may contribute to the reproduction of existing patterns of disadvantage but the potential is also there for change: in the context of this study, for a progressive demystification of higher education and an increasing awareness among working-class groups of its possibilities.
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Diaz, Tressa P. "Colorectal cancer screening among Chamoru on Guahan| Barriers and access to care." Thesis, University of Hawai'i at Manoa, 2018. http://pqdtopen.proquest.com/#viewpdf?dispub=10757731.
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Wong, Andrea N. "The model minority at risk| Barriers to mental health access for Chinese Americans." Thesis, California State University, Long Beach, 2013. http://pqdtopen.proquest.com/#viewpdf?dispub=1524130.
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This thesis examines the role of limited English proficiency (LEP) as a contributing significant barrier to the mental health access for Chinese living in America. The literature purports that language barriers do present significant challenges to providing timely and effective mental health services worldwide. Additionally, studies highlight two reoccurring themes on the mental health of Chinese Americans, including their underutilization of mental health services and the premature termination of treatment in comparison to other nonminority clients. Using the 2009 dataset from the California Health Interview Survey (CHIS) 2009 Adult Questionnaire, data was analyzed and it was concluded that a relationship exists between mental health status and language proficiency. Further study is necessary to determine where it may be best for health professionals to invest their efforts in the mental health care of this deserving population. It would behoove organizations, communities, and health care leaders to peer deeper into the interconnected relationship between mental health utilization and language proficiency.
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Shaffer, Claire. "EMERGENCY DEPARTMENT CROWDING: EXPLORING BIAS AND BARRIERS TO EQUITABLE ACCESS OF EMERGENCY CARE." Master's thesis, Temple University Libraries, 2018. http://cdm16002.contentdm.oclc.org/cdm/ref/collection/p245801coll10/id/487771.
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Urban BioethicsM.A.
The emergency department (ED) has often been considered the safety net of the American healthcare system. It earned this distinction because every person in the United States has access to a medical screening exam and stabilization at an ED regardless of their ability to pay. Unfortunately, over the past several decades, decreasing numbers of EDs and inpatient beds, coupled with increasing rates of ED usage, has led to crowding of EDs across the country. Crowding leads to unsafe conditions that may increase morbidity and mortality for patients, or cause patients to leave the ED without being evaluated by a physician. Essentially, crowding causes a barrier for patients to access their right to emergency evaluation. The problem of crowding is most pronounced in large urban communities, and these already frequently underserved patients suffer the most from the crowding burden. The main cause of crowding seems to be the boarding of admitted patients in the ED, however many often cite high rates of non-urgent patients presenting to the ED as a cause of crowding. Some have even suggested diverting non-urgent patients to help solve the problem of crowding. I became interested in this topic due to crowding concerns and initiatives to decrease the number of patients who left without being seen at my own institution. As I reviewed relevant research, I became aware of my own misconceptions and noted a trend of literature suggesting non-urgent patients are not the cause of crowding. Drawing on research from many different sources, paired with evaluation based on principles in bioethics, I have come to several conclusions. I believe the systematic diversion of non-urgent patients is unsafe, and that the unequal burden of ED crowding on urban communities represents an unjust barrier in access to care. We must continue to carefully research the demographics of patients frequently presenting to EDs to avoid perpetuating stereotypes about which types of patients are responsible for crowding. We should also look for ways to ease the crowding burden in urban communities. Additionally, we should take a qualitative assessment of our individual communities to determine if there are any particular reasons in our community that people choose to use the ED rather than other healthcare options. I believe these suggestions can be an important addition to the efforts already in motion to help reduce ED crowding and provide equitable access to emergency medical evaluation.
Temple University--Theses
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Anthony, Tomagene. "Barriers Limiting Access to Hospice Care for Elderly African Americans in Amarillo, Texas." Thesis, University of North Texas, 2001. https://digital.library.unt.edu/ark:/67531/metadc2855/.
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This study examines barriers limiting access to hospice care for elderly African Americans. Ethnic background plays a critical role in the development of attitudes, beliefs and expectations related to death and issues surrounding hospice care. The purpose of this study was to identify barriers that may limit access to hospice care for African Americans. A questionnaire was administered to 56 elderly African Americans in three religious settings and an African American senior citizens center. The questionnaire was designed to obtain information concerning African Americans' attitudes toward death and dying; religious beliefs; health beliefs; familiarity with hospice and prospective use of hospice. The results of the study indicate a number of barriers in access to hospice care for African Americans including: hospice knowledge barriers; education/outreach barriers; cultural knowledge barriers related to death/dying values; family/social support barriers; hospice organizational/provider barriers; health care organizational/provider barriers; and reimbursement barriers.