Dissertations / Theses on the topic 'Harvard Community Health Plan'

ABSTRACT Oceano Community Health Plan Phillip Brennan Recent, mounting research shows that chronic disease, the leading causes of death and primary driver of health care costs, cannot be effectively addressed through education or preventative health alone. A physical environment that promotes health—through access to healthy food, opportunities for physical activity, quality housing, transportation options, and safe schools—is an integral part of making our communities healthier. This research and accompanying Healthy Community Plans will serve as a way for the County to begin looking in-depth at the ways the built environment (our streets, parks, and neighborhoods) contribute or detract from the health of the community. Though the creation of a healthy general plan may be unattainable for the County in the short term, a focus on a small yet cohesive part of the county presents an opportunity to affect these changes. Under the direction of the SLO County Health Agency and the Health Commission, we have written Healthy Community Plans for the unincorporated communities of Cayucos and Oceano, California. Both of these plans were greatly informed by their respective communities through input garnered through outreach, interviews, surveys and personal interactions with community members. This project examines the relationship between the built environment and public health, and explores ways planning professionals are beginning to address health issues through infrastructure, land use, creative zoning, and planning strategies that promote health and active living in policy. The planning documents, modeled after health elements currently being included in general plans throughout California, have integrated the fields of planning and public health to provide Cayucos and Oceano an assessment of its residents’ health, a description of the current built environment conditions that may be helping or hindering physical activity and access to nutritious food sources, as well as establish goals, policies and implementation strategies that will set a course of action toward healthier communities. Key Words: planning, public health, physical activity, built environment, community, active transportation

Recent, mounting research shows that chronic disease, the leading causes of death and primary driver of health care costs, cannot be effectively addressed through education or preventative health alone. A physical environment that promotes health—through access to healthy food, opportunities for physical activity, quality housing, transportation options, and safe schools—is an integral part of making our communities healthier. This research and accompanying Healthy Community Plans will serve as a way for the County to begin looking in-depth at the ways the built environment (our streets, parks, and neighborhoods) contribute or detract from the health of the community. Though the creation of a healthy general plan may be unattainable for the County in the short term, a focus on a small yet cohesive part of the county presents an opportunity to affect these changes. Under the direction of the SLO County Health Agency and the Health Commission, we have written Healthy Community Plans for the unincorporated communities of Cayucos and Oceano, California. Both of these plans were greatly informed by their respective communities through input garnered through outreach, interviews, surveys and personal interactions with community members. This project examines the relationship between the built environment and public health, and explores ways planning professionals are beginning to address health issues through infrastructure, land use, creative zoning, and planning strategies that promote health and active living in policy. The planning documents, modeled after health elements currently being included in general plans throughout California, have integrated the fields of planning and public health to provide Cayucos and Oceano an assessment of its residents’ health, a description of the current built environment conditions that may be helping or hindering physical activity and access to nutritious food sources, as well as establish goals, policies and implementation strategies that will set a course of action toward healthier communities.

A college community health improvement plan (CHIP) focusing on the indicators of nutrition and weight status, and physical activity and fitness is designed with the goal of reducing obesity risk, improving health, and preventing chronic disease. The precede proceed model, logic model, innovative care for chronic conditions model, self-care theory, and Bandura's social cognitive learning theory were used as a research design framework for assessing, planning, and managing sustainability through a two-year college health clinic. The research questions were: what are the current health promotion inputs and activities in terms of environment, ecology, education, and policy and what could be supplemented to improve outputs and health outcomes? An integrated review of the literature, observation of the site, regulatory investigation, and focus group sessions were the methods of data collection. The precede-proceed model provided the analytical strategies to assess initiatives and resources, and to determine supplementary initiatives and resources. Results showed that environmental, educational, administrative, and policy resources were available but limited and not well promoted. Conclusions were that health promotion, wellness staffing, and education exist, but are underutilized, under promoted, and funding is necessary. Recommendations include a wellness program, increased activity initiatives, case management, grant funding, and increased community partnerships. The contribution to nursing is to fill a gap-in-practice for health planning in 2-year colleges. The implications for positive social change are improved knowledge, sustained health behaviors, decreased amount of obesity, improved health outcomes and quality of life, decreased chronic diseases, and lower healthcare costs.

Policy and professional guidance in England have emphasised the importance of Therapeutic Relationships (TRs) in community mental health care, yet there is no comprehensive model to guide practice or understand the process through which stronger TRs are generated. This thesis investigated TRs in community mental health for individuals with psychotic disorders and was embedded within the CRIMSON trial: a randomised controlled trial of the Joint Crisis Plan (JCP) intervention. JCPs contain service users’ treatment preferences for future care, which are jointly decided with clinicians. Qualitative analyses addressed participants’ views of TRs and JCPs. Quantitative analyses addressed the predictive utility of TRs for outcomes, associations of TRs and the effect of JCPs on service user and clinician-rated TR. Results suggested that significant ambiguity persists regarding what can and should be provided in community mental health, resulting in unhelpful experiences for service users and clinicians. A new model of TRs - Consistent Respect - was developed; it presents TRs as bi¬directional processes, jointly affected by clinicians’ and service users’ experiences of interactions and their roles defined by the wider context; the latter often being a barrier to the development of strong TRs. JCPs significantly improved service users’ appraisals of TRs by providing a structured protocol through which routine role enactments were limited and clinicians could demonstrate Consistent Respect. Positive effects were lost when there were deficiencies in the implementation of JCPs and/or engagement of clinicians. In conclusion, improving TRs through JCPs could facilitate better outcomes and more satisfactory treatment experiences for service users and clinicians. Changes in policy and practice are indicated to facilitate transparent goals and roles for clinicians and respectful interactions with service users.

The membership and participation within Indianapolis Challenge (I-Challenge) has increased significantly over the past year through diversification of both members and organizations. We have developed into a well balanced countywide-represented coalition. This local action plan for the Indianapolis Challenge represented a culmination of efforts and support of the group by major institutions within Marion County. Groups offering support include the following: the Mayor's Office, the State Prosecutor's Office, the Community Service council, the united Way of Central Indiana, Marion County Justice Agency, the Greater Indianapolis Council on Alcoholism and Fairbanks Hospital.

Through their research, the Funding Committee, in conjunction with the Planning and Development Committee, were able to make known the needs of the community.

One major finding is that there is a moderate effort of coordination taking place in Marion County. Many of the major institutions have acquiesced in the I-Challenge mission by necessity; I-Challenge reviews grants to ensure consistency with the local comprehensive plan for the Department of Mental Health and the Department of Justice substance abuse funds.

The data from Marion County is insufficient and agencies have trouble addressing the needs of the community. This is particularly true of those agencies depending on public monies and whose primary mission is to serve the poor. I-Challenge is developing a county-wide strategic plan which will determine the actions necessary to meet the needs of the city.

Master of Science in Education

Abstract Introduction: Tobacco use continues to be the leading preventable cause of morbidity and mortality in the Appalachian Tennessee despite the nationwide decline in tobacco use. The main reason contributing to this nationwide decline in tobacco use is tobacco control applied to prevention, cessation and protection efforts. Evidence indicates that regions with comprehensive tobacco control policies and programs have lower tobacco use prevalence than those with fewer policies and less comprehensive programs, which is characteristic of Tennessee. Therefore, this study examines the current capacity that exists around the tobacco control protection in Appalachian Tennessee. Methods: During 2015-2016, a Population Health Improvement Plan (PHIP) study involving 222 community stakeholders and 91 organizations was conducted in Appalachian Tennessee to assess the capacity of the region in addressing the high burden of tobacco use. First, twenty (20) key informant interviews were conducted with tobacco control professionals within the eight counties in Northeast Tennessee. Afterwards, two community meetings were held in the northern and southern areas of the region with additionally identified stakeholders (n = 36) to gather input on current efforts and methods to increase community capacity for tobacco control in the region. The interviews and discussions were audio-recorded, transcribed, and analyzed using a multifaceted framework approach to tobacco control that focuses on prevention, protection and cessation. This study focuses on important themes identified related to tobacco protection for the Northeast region of Tennessee. Results: The PHIP assessment process found that most current activities around protection for tobacco control were related to national tobacco control policies such as the Non-Smokers Protection Act (NSPA). Also, differences were found between rural and urban areas in the extent of policy efforts, with better enforcement of existing policies found in more metro areas. Rural counties expressed the need for better education and awareness of current policies to help with enforcement efforts. Assessment of findings for barriers to protection/policy for tobacco control resulted in two themes; the existence of state preemption on tobacco control policies, which limits what policies local governments can enact, and the need for higher tobacco taxes. An overall barrier found for tobacco protection was a cultural tolerance of tobacco use including an intergenerational culture of use in Appalachian Tennessee. Conclusion: The Appalachian region of the US suffers disproportionately in health risks and adverse health outcomes, including tobacco-related diseases. For this reason, there is the need for comprehensive culturally-tailored and region-specific protection policies that address existing urban-rural disparities including the removal of the state preemption and increase of tax for tobacco products to effectively address the high burden of tobacco use in Appalachian Tennessee.

The study of health disparities and the social determinants of health has resulted in the call for public health researchers to investigate the mid- and upstream factors that influence the incidence of chronic diseases (Adler & Rehkopf, 2008; Berkman, 2009; Braveman P. , 2006; Braveman & Gottlieb, 2014; Krieger, 2011; Rose, 1985). Social ecological models (SEMs) provide important conceptual tools to inform this research and practice (Krieger, 2011; Golden & Earp, 2012; Story, Kaphingst, Robinson O'Brien, & Glanz, 2008; Glanz, Rimer, & Lewis, 2002). These models can help us look at the social and physical environments in rural Arizona communities and consider how health policies and environmental interventions address mediating factors, such as disparities in access to fresh food, that contribute to ill health in marginalized, rural, populations. Rural residents are at greater risk for obesity than their urban counterparts (Jackson, Doescher, Jerant, & Hart, 2006; Story, Kaphingst, Robinson O'Brien, & Glanz, 2008). And while human life expectancy has steadily increased over the past thousand years, current projections indicate that the rise in obesity-related illnesses will soon result in its decline (Olshansky, et al., 2005). One reason for this decline, may be the reduced availability of healthy food – an important predictor of positive health outcomes including reduced obesity and chronic disease - in many parts of the United States (Brownson, Haire-Joshu, & Luke, 2006; Ahen, Brown, & Dukas, 2011; Braveman & Gottlieb, 2014; Braveman, Egerter, & Williams, 2011). The United States Department of Agriculture (USDA) defines food deserts as geographic areas in which there is limited access to grocery stores and whose populations have a high rate of poverty. In Arizona, 24% of the rural census tracts are considered food deserts; compared to an average of eight percent of rural census tracts across the nation (United States Department of Agriculture, 2013). Food deserts are one example of the upstream factors influencing the health of rural populations. Local health departments have been encouraged through the National Association for City and County Health Officials (NACCHO) and through the Public Health Accreditation Board (PHAB) to conduct community health assessments (CHAs) in order to identify unique contexts and community resources, health disparities, and the social determinants of health as well as potential areas for advocacy, policy change, environmental interventions, and health promotion interventions. Public health challenges like chronic diseases, which have multiple causes, can be explored in-depth through CHAs. CHAs often contain recommendations for action and/or are followed by community health improvement plans (CHIPs) which help local health departments prioritize resources and set measurable goals. In Florence, AZ recommendations made in a CHA are being acted upon by a non-profit agency, the Future Forward Foundation (3F). This investigation explores two interrelated issues regarding the use of CHAs and CHIPs as practical tools to set public health priorities. First, what makes a CHA useful to rural public health practitioners? What methods of conducting a CHA and subsequently analyzing the data results in actionable policy recommendations and/or environmental level interventions? Second, to what extent can public health agencies engage nontraditional partners to work in partnership to address the social determinants of health? As an example, I will look at the impact of a volunteer-based non-profit agency, located in a rural food desert on improving the social and physical nutrition environment as recommended by a local CHA. This inquiry will provide insights to public health practitioners seeking to identify and implement policy and environmental change addressing complex, multi-causal, public health issues, and provide insights regarding engaging nontraditional partners who may not self-identify as public health agencies.

The aging population coupled with the complexity of the older adult patient has presented a significant challenge for the healthcare industry. The literature has shown that the elderly are the major consumers of healthcare expenditures in the United States. Caring for this population in the realm of healthcare reform will require new strategies to improve the health status of the older adult patient. The objective of this study was to complete a comprehensive literature review of geriatric care models and create a business plan applying the Nurses Improving Care for Healthsystem Elders (NICHE) program.

NICHE is a national nurse-driven geriatric program that provides the necessary resources and tools to assist healthcare organizations in enacting system-level changes, which will impact the care of the older adult patient.

Since June of 2013, Plan B and its generics have been available over-the-counter without age restriction nationwide. Even so, pharmacy-based economic, physical, and staff-associated barriers still exist, potentially leading adolescent customers to fail to obtain emergency contraception (EC) in a sufficiently timely manner to prevent pregnancy. This study explores these pharmacy-based barriers to EC in the state of Kentucky focusing on comparisons of urban and non-urban pharmacies and chain and private pharmacies. Using a secret-shopper survey technique, the researcher called 220 Kentucky pharmacies acting as a 15-year-old girl seeking information about EC. Among other findings, a logistic regression analysis revealed that private pharmacies were 97% less likely to carry EC compared to chain pharmacies (OR= .027; p

RESUMO: Em 2006, foi aprovada uma nova política governamental para a saúde mental intitulada “Uma Visão para a Mudança”, a qual está neste momento no sétimo ano de implementação. A política descreve um enquadramento para o desenvolvimento e promoção da saúde mental positiva para toda a Comunidade e para a prestação de serviços acessíveis, baseados na comunidade, serviços especializados para pessoas com doença mental. A implementação da política e o tornar a “Vision for Change” uma realidade têm sido problemáticos, com críticas consideráveis por parte dos intervenientes, relativas à lenta e desconexa implementação. Este estudo fornece informação sobre as características dos serviços de três importantes tipos de instituições de saúde mental comunitária a nível nacional, nomeadamente Hospitais de Dia, Centros de Dia e residências comunitárias operantes 24 horas. A pesquisa analisa objetivos e funções, perfis dos pacientes, atividades terapêuticas, a eficácia das redes de comunicação e beneficia da perspectiva dos funcionários sobre o que mudou no terreno ao longo dos últimos sete anos. As questões identificadas a partir das características dos três serviços dizem respeito a todos. Os participantes indicaram que o ethos da recuperação parece ter alcançado um papel mais central no tratamento do paciente na comunidade mas reconheceram que o desafio de integrar os princípios de recuperação na prática clínica se mantém presente. Parece ser reconhecida a importância da planificação do cuidado individual nos serviços comunitários e os entrevistados indicaram que existe um empenho para garantir o envolvimento do usuário do serviço. Há diferenças entre os „pontos de vista do pessoal‟ e os „pontos de vista dos representantes‟ sobre uma série de aspetos da prestação de serviços. Este é o primeiro estudo irlandês deste género a examinar a prestação de serviços das três principais instituições comunitárias de saúde mental num só estudo. Estes serviços representam um enorme investimento em recursos, quer a nível monetário, quer humano. O estudo examinou os desafios e as questões fundamentais que lhe são aplicáveis e que têm impacto nestes três tipos de prestação de serviços. Também forneceu informações sobre os elementos de mudança positiva, os quais se começam a focar lentamente na prestação do serviço, assim como na importância da centralidade do utilizador do serviço e na promoção de um ethos da recuperação.----------ABSTRACT: In 2006, a new Government policy for mental health “A Vision for Change” was endorsed and is currently in the seventh year of implementation. The policy describes a comprehensive framework for building and fostering positive mental health across the entire community and for providing accessible, community based, specialist services for people with mental illness. The implementation of the policy and turning “Vision for Change” into reality has been problematic with considerable criticism from stakeholders concerning slow and disjointed implementation. This study provides information on three key community mental health service settings, namely Day Hospitals, Day Centres and 24 Hour Community Residences at a national level. The research looks at aims and functions, patient profiles, therapeutic activities, effectiveness of key communication networks and gains an insight from staff on what has changed on the ground over the past seven years. Issues identified from the three service settings pertain to all. Participants indicated that the recovery ethos appears to have moved to a more central role in patient care in the community but acknowledged that the challenge of integrating recovery principles in clinical practice remains present. The importance of individual care planning appears to be recognised in community services and respondents indicated that efforts are being made to ensure service user involvement. There were differences between „staff views‟ and „advocate views‟ on a number of aspects of service provision. This is the first Irish study of its kind to examine service provision across the three main community mental health settings in one study. These services represent a huge investment in resources both on a monetary and human level. This study has examined the challenges and key issues which are applicable and impacting on all three types of service provision. It has also provided information on the elements of positive change, which are slowly embedding themselves in service provision such as the importance of the centricity of the service user and the promotion of a recovery ethos.

Thesis (PhD)--Stellenbosch University, 2014.
ENGLISH ABSTRACT: The long waiting lists for general anaesthesia and sedation services for children with Early Childhood Caries (ECC) at the Tygerberg Oral Health Centre highlighted the problem of ECC in this area. This was confirmed by a retrospective study of patient records at the Centre. ECC is largely caused by a combination of lifestyle factors, especially feeding and oral hygiene practices. Socio-economic status and parental factors such as education and employment have also been shown to play a role in the development of ECC. In order to address this problem, a study was designed to determine the prevalence of ECC in children from the lower socio-economic communities which drain to the Tygerberg Oral Health Centre and assess the knowledge of the caregivers of these children. A total of 659 children were examined at crèches and schools as well as community health clinics. The children examined at the clinics accompanied others and did not have any health reason for the visit themselves. As the aetiology is largely behaviour-driven and children are dependent on their caregivers to meet their basic needs, 366 caregivers attending the community health clinics with their children, were interviewed to determine their practices and knowledge of oral health. A total of 83 health care workers at these clinics were also interviewed to assess their knowledge of oral health matters and determine the role that they can play in the prevention of this disease. A cross-sectional community survey was carried out by means of clinical assessments and structured interviews with the aid of questionnaires. The survey was divided into 3 parts: 1. Prevalence of ECC amongst the children 2. Knowledge of the caregivers about oral health care 3. Knowledge of health care workers at the clinics in these communities about ECC The prevalence study revealed that 71.6% of children in the study population presented with caries. This is extremely high and highlights the need for serious interventions. Parents/ caregivers were shown to be ill-informed regarding their children’s oral health care needs which include dietary and oral hygiene practices as well as how this disease can be prevented. It is clear that caregivers need to be educated regarding feeding practices, weaning time, dietary content and the importance of basic oral health. The importance of preserving the primary dentition and regular dental attendance also needs to be emphasized in this community where dental health does not seem to be a priority. Health care workers such as nurses who come into contact with children from an early age would be the ideal vehicle to impart this information. However, as revealed from the results of this study, there is a serious lack of knowledge amongst these professionals regarding oral health matters. Time and resources therefore have to be invested to improve their knowledge and lessen their load so that more emphasis can be placed on prevention. Small changes can make a big difference towards addressing the burden of this disease on the health care system.
AFRIKAANSE OPSOMMING: Die lang waglyste vir algemene narkose en sedasiedienste vir kinders met Vroeë Kinderkaries (VKK) by die Tygerberg Mondgesondheid Sentrum het die probleem van VKK in die area uitgelig. Dit is bevestig deur 'n retrospektiewe studie van pasiënterekords by die Sentrum. VKK word grootliks veroorsaak deur 'n kombinasie van lewenstyl- faktore, veral voeding en mondhigiëne praktyke. Daar is ook aangetoon dat sosio-ekonomiese status en ouerlike faktore soos opvoeding en werkstatus 'n rol speel in die ontwikkeling van VKK. In 'n poging om hierdie probleem aan te spreek is 'n studie onderneem om die prevalensie van VKK in kinders van laer sosio-ekonomiese gemeenskappe wat van die Tygerberg Mondgesondheid Sentrum gebruikmaak te bepaal. Die kennis van mondgesondheid van die vernaamste toesighouers van die kinders in die studie is ook bepaal. 'n Totaal van 659 kinders is by crèches en skole sowel as gemeenskapsklinieke ondersoek. Die kinders wat by die klinieke ondersoek is, het nie self 'n gesondheidsrede vir die besoek gehad nie maar het saam met ander mense gekom. Die etiologie van VKK word hoofsaaklik deur gedrag gedryf en kinders is van hulle toesighouers afhanklik vir hulle basiese behoeftes. Dus is 366 toesighouers wat gemeenskapsklinieke besoek het ondervra oor hulle praktyke en kennis rakende mondgesondheid. 'n Totaal van 83 gesondheidswerkers by die klinieke is ook ondervra oor hulle kennis van mondgesondheid om die rol wat hulle kan speel in die voorkoming van hierdie siekte te ondersoek. 'n Dwarsdeursnit gemeenskaps-opname is uitgevoer deur middel van kliniese ondesoeke en gestruktureerde onderhoude met behulp van vraelyste. Die opname is in drie dele aangepak: 1. Prevalensie van VKK onder die kinders 2. Kennis van die toesighouers oor mondgesondheidsorg 3. Kennis van gesondheidsorgwerkers by die klinieke in hierdie gemeenskappe oor VKK Die prevalensiestudie het getoon dat 71% van kinders in die studiepopulasie karies gehad het. Dit is baie hoog en het die behoefte aan ernstige ingryping beklemtoon. Ouers/ toesighouers het geblyk om baie swak ingelig te wees oor hulle kinders se mondgesondheid-behoeftes wat dieet- en mondhigiëne praktyke ingesluit het, asook hoe die siekte voorkom kan word. Dit is duidelik dat versorgers onderrig moet word oor voedingspraktyke, die beste tyd vir soog, dieetinhoud en die belang van basiese mondgesondheid. Die belang van die behoud van primêre dentisie en gereelde tandsorgafsprake behoort ook in hierdie geneemskappe beklemtoon te word, gesien in die lig van die lae prioriteit wat hierdie gemeenskappe op mondgesondheid plaas. Gesondheidsorgwerkers soos verpleegpersoneel wat reeds in kontak kom met hierdie kinders op 'n jong ouderdom is die ideale persone om sulke inligting te versprei. Dit het egter uit die studie geblyk dat daar 'n ernstige gebrek aan kennis by hierdie professionele persone bestaan oor mondgesondheid. Tyd en hulpbronne sal belê moet word en hulle werkslading verlig moet word om hulle kennis te verbeter sodat meer klem op voorkoming gelê kan word. Klein veranderinge kan 'n groot verskil maak om hierdie siektelas op die gesondheidsorgstelsel te verlig.

Weight gain due to poor diet and lack of exercise is responsible for over 300,000 deaths each year (U.S. Department of Health and Human Services, 2010). Obese adults have an increased risk for serious health conditions including high blood pressure and cholesterol, type 2 diabetes, coronary heart disease, stroke, gallbladder disease, osteoarthritis, sleep apnea, respiratory problems, and certain cancers (National Cancer Institute, 2012). Participation in exercise can help control weight, strengthen muscles and bones, and reduce the incidence of cardiac events, stroke, hypertension, type 2 diabetes, colon and breast cancers, osteoporotic fractures, gallbladder disease, obesity, depression, anxiety, and delay mortality (ACSM, 2009). The purpose of this study was to determine the effectiveness of exercise participation during weight loss on a high protein-low carbohydrate diet plan during a 12-week span in females aged 15 to 25 years. Specifically, this research study was a comparison of markers of health such as weight, fat mass, percent body fat, and fat-free mass in females who consistently exercised during the diet (Exercisers) from those who did not participate in consistent exercise (Non- Exercisers). The population in this study was selected due to the transition from high school to college being a critical period because it is associated with many identity choices and lifestyle changes that can lead to weight gain (Anderson, Shapiro, & Lundgren, 2003). The data indicate participation in regular exercise, while consuming a high protein-low carbohydrate diet plan, increases the loss of body weight, fat mass, and percent body fat when compared to participating in the diet plan alone. There was no significant difference in fat-free mass reduction between the groups. One implication for practice is recommending moderate to vigorous exercise for a minimum of 30 minutes at a time, totaling a minimum of 150 minutes per week, for females trying to achieve weight loss. Based from the results of this research study, in order to achieve a greater amount of body weight, fat mass, and percent body fat reduction one should consider incorporating exercise participation and high protein-low carbohydrate dieting into their weight loss plan.

Background: Policy, systems and environmental (PSE) approaches can sustainably improve opportunities for healthy eating (HE) and active transportation (AT). PSEs require cross-sector collaboration. Adopting and implementing PSEs is complex and not well understood. Methods: First, using a national probability survey dataset of US local health departments (LHD), inclusion of HE and AT PSE strategies in local community health improvement plans (CHIPs) was examined. Next, a content analysis of current CHIP documents provided data for multilevel latent class analyses to identify classes of CHIPs based on patterns of PSE-strategy alignment with six key activities that facilitate change. Lastly, semi-structured interviews informed a qualitative exploration of early stage Complete Streets policy implementation in Worcester, Massachusetts. Results: Less than half of US LHDs reported developing a CHIP containing any HE policy (32%) or AT (46%) strategies. Two classes of CHIPs were identified: CHIPs in Class A (HE: 71%; Physical Activity (PA): 79%) simply identified a PSE solution; Class B CHIPs (HE: 29%; PA 21%) mostly included PSE strategies that comprehensively addressed multiple key activities. Six themes emerged as factors for early Complete Streets implementation. Conclusions: This mixed methods study provides a novel understanding of the status, development and implementation of PSE strategies in relation to collaborative strategic health improvement planning efforts. CHIPs are underutilized to promote PSE strategies and few CHIPs in our study developed strategies that comprehensively address the process of PSE-change. Among other factors, CHIPs may provide a guiding structure for policy adoption and implementation.

>Magister Scientiae - MSc
Physiotherapy services for disabled children and their families have conventionally been received at a hospital or school for children with special educational needs in the main towns and cities of South Africa. Community-Based Rehabilitation (CBR) programmes were proposed and established as an additional approach to Institutional-Based Rehabilitation to address the need for accessible resources for these families. In this study the author evaluated two CBR programmes for disabled children and their main caregivers in two separate low socioeconomic peri-urban areas of Cape Town. The programme, a weekly group meeting, included physiotherapy interventions to assist the development and functional abilities of the children by means of activities that the caregivers could include in daily home care. They handled their own children following demonstrations and correction of handling skills by the author. The majority of the caregivers were mothers. Their children, less than 13 years old, were severely intellectually impaired. Some with concomitant physical disabilities. The author implemented the interventions of the CBR programme and she required to understand the impact on the particpants in a study using qualiative research methods. In the pilot programme the attendant members were individually interviewed, after her withdrawal, for their opinions of the outcomes. Evaluation documentation.ofjheir children and CBR programme records were related to the caregivers' responses. From the pilot study experiences the author felt that additional methods of data collection would result in a greater understanding of the impacts of the interventions. Expanded methods of research were utilised in the study of the second group. During the interventions at group meetings the author used field notes to record observations. Participant observation allowed the author to analysis the responses of the participants. Focus group interviews assisted in understanding external factors influencing the participants as well as their needs. Individual interviews, after the closure of the CBR programme, allowed the participants to express their views of the interventions. Documentation of the individual evaluation of each child was related to the views expressed by the caregivers. Common meanings and themes were explored in the analysis of the various data collected. Analysis revealed that interventions of education and training for the caregivers improved their knowledge and understanding of the impairments and disability of their children. The children benefited functionally from their families increased skills and knowledge. Through discussion with other families at group meetings, the caregivers had an understanding of other disabilities in children and developmental outcomes possible for their own child. The caregivers were more confident to address the negative perceptions of disability in their communities. It is recommended that physiotherapists implementing any interventions for disabled children should ensure that the caregivers are partners in planning and selection of interventions and that their needs are addressed. Community participation in Community-Based Rehabilitation programmes was required for the participants to become self-reliant and solve their own needs as well as for the programme to be sustainable. This was demonstrated in only one of the programmes.

This thesis explores the various meanings and implications of transparency in architecture and in learning environments in particular. Architectural transparency, achieved through choice of materials and principles of formal composition, creates a diversity of relationships and can facilitate visual, conceptual, and functional clarity as well as offering simultaneous perception of different spaces. It offers a range of phenomenological qualities and so provides an opportunity to explore and complicate such dichotomies as translucency and opacity, openness and closure, and public space and private space. While celebrated throughout modern and contemporary architecture, transparency raises issues of privacy and safety even as it breaks down hierarchies and social boundaries. The research-based design of transparency in a school building necessitates careful planning to achieve a balance between the access to views, natural light, fresh air, and social interaction that transparency may bring and the continuing obligation to provide a safe, secure environment for schoolchildren.

碩士
國立陽明大學
臨床暨社區護理研究所
101
Abstract Community organizations in Taiwan, where to invest resources and manpower, and strive to bottom-up echoes of the needs of the people and to promote relevant health plan has been around for ages. This study aimed to explore leaders’ perspectives for their experience of promoting community health plan in order to understand reasons why they were be involved in the process of community development process and barriers/facilitators during the process. The study design of qualitative research was used to interview community leaders from snowball purposive sampling method in New Taipei City. After content analysis, the following themes were retrieved: triggers for them to be involved in or lead community development work, barriers for them to promote community work, wisdom came from during the promoting community work process, and the aspiration for them devoted in the community work continually. According to results of this study, suggestions proposed to the related organizations were: to arrange the good example of communities for sharing their experiences regarding to the process of community development with other community leaders, to sep up counselling centers for leaders to ask for help or counselling information when they have the need, to build a exchangeable information and resource centers, and to strength the conflict resolution ability for community leaders.

The purpose of this study was to describe factors that influence the enrolment of dairy farmers to a Community Health Insurance scheme for better access to healthcare. Quantitative, descriptive, contextual, cross-sectional research was conducted and the Health Insurance for the Poor framework was used to describe these factors. Data collection was done using a structured interview guide. The sample consisted of 135 farmers who supplied milk to a dairy cooperation in western Kenya. Among the sample were respondents (n=17) who were enrolled to the Tanykina Community Healthcare Plan (TCHP). The findings revealed that lack of information and unfamiliarity with TCHP, lack of affordability and the distance from the TCHP centres might prevent farmers from registering for the Tanykina Community Healthcare Plan. Improved marketing strategies and establishing more health centres which are more accessible are among the recommendation made to increase the membership to the TCHP
Health Studies
M.A. (Public Health)

碩士
國立中央大學
客家政治經濟研究所
99
Abstract Strategic enterprise social responsibility is the extension of enterprise social responsibility. The selection of appropriate social topics is an unique behavior that separates from the competitors, additionally, it meets social demands by lowering cost and satisfying consumers’ needs. Taiwan is experiencing the aging of the society, aging and various chronic diseases have formed the factors that jeopardize people’s health. Hence, creating a society that integrates the concepts of enhancing health and medical service is a topic to be emphasized. Since enterprise social responsibility has the tendency to emerge steadily, this study was focusing to explore local cares driven by enterprise social responsibility. The community health creation plan implemented by T hospital was used as an example to demonstrate how enterprises promoting local cares through its social responsibility. The forming, coordination and implementation of the community health creation plan were studied first, the actual performance of the community health creation was then reviewed. In the planning of the community future outlook, enterprise can support the empowerment community through resources to build a highly autonomous community health creation plan. This study also discussed the core concepts of the enterprise leaders that leads the operation of the enterprise, and understood the influences from the medical institutes located in Hakka regions to Hakka factors.

M.Cur.
The entire country is currently in a process of reconstruction that inevitably lead to reconstruction within the health care system. The ANC (African National Congress) formulated a National Health Plan based on primary health care that is a practical expression of providing an effective and equitable health care to all inhabitants of the country. Recognising the need for transformation, a process was initiated by the African National Congress (ANC) to develop an overall National Health Plan based on the Primary Health Care approach (ANC, 1994: 7) . In the light of these present needs, the vision is to develop a strategy to empower our professional nurses that can effectively implement primary health care whilst operating within the limitations of the existing resources (Human Resource Committee for Health, 1994:5). The context of the study is applicable to the Northern Region of the North West Province. There are various courses available to empower professional nurses to primary health care, but for the purpose of the study is the Diploma Course in Clinical Nursing Science, Health Assessment, Treatment and Care described

Purpose: The Purpose of this research was to design, implement and evaluate a patient centered asthma intervention pilot program directed by physicians and administered by community pharmacists to a group of Managed Care contracted Oregon Health Plan asthmatics. The evaluation was to determine if the proposed intervention could improve the enrolled asthma patient's related education and quality of life while simultaneously creating economic benefit for the sponsoring health plan. Methods: The study was designed to be a prospective, six month pre and posttest quasi-experimental evaluation combined with a Solomon-like two-control group comparison. All patients in the sponsoring health plan twelve years of age and older who had six months of continuous enrollment were eligible. Enrollment of the target patients was voluntary and the time period of the evaluation (November, 1997 to May, 1998) was purposely conducted to capture the notoriously difficult asthma trigger cold and allergy seasons. Information regarding the cost and frequency of pre and post emergency room visits, hospitalizations, physician's office and medications use and Health Related Quality of Life (HRQL) was collected for the intervention group and control group. Satisfaction information for the major actors was collected and analyzed at posttest. Within group comparisons were conducted using the paired T-test and the unpaired T-test was used for between group comparison. Results: Patients in the intervention group who had their physician and pharmacist fully participate in respectively directing and administering the study protocol showed associated improvements in their quality of life measures. Economic benefit to the health plan is suggested by a cost benefit ratio of 1:5.71 resulting from favorable decreases in health care related resources and improved asthma related medication utilization. Analysis of the satisfaction measures suggests that all the major participants were very satisfied with the intervention. Conclusion: Even though the sample size in this pilot study was relatively small, the resulting information should not be immediately discounted. The evidence suggests that in those cases where the study protocol was followed, favorable economic, HRQL and satisfaction is comparable to larger, previously conducted studies.
Graduation date: 2000

abstract: This study aimed to understand the factors that influence Chinese American older adults’ advance care planning (ACP) on end-of-life care. The Theory of Planned Behavior (TPB) and Health Belief Model (HBM) were primarily applied to explain Chinese American older adults’ intentions toward two behaviors: 1) discussion of end-of-life care plans with family members and 2) completion of an advance directive (AD). Additionally, acculturation and family cohesion were considered to examine their impacts on the TPB and HBM. A cross-sectional survey was conducted through face-to-face interviews on a sample of 298 community-dwelling Chinese-American adults aged 55 and older living in the metropolitan Phoenix area of Arizona. Based upon random assignment, 161 participants answered questions regarding discussing end-of-life care plans with family members, while 137 participants answered questions related to the completion of an AD. Hierarchical multiple regression analysis was used to focus on the influence of TPB and HBM measures on behavioral intentions toward the two behaviors. Results indicated that both the TPB and HBM had predictive power to explain the target population’s intentions. However, the predictability of TPB and HBM measures varied across the two behaviors. Acculturation moderated the relationship between attitudes and intentions to complete an AD negatively. Family cohesion moderated the relationship between perceived benefits and intentions to discuss end-of-life care plans with family members negatively. These findings would help inform future interventions for improving the target population’s ACP awareness and engagement.
Dissertation/Thesis
Doctoral Dissertation Communication 2018

ABSTRACT: Worldwide, 12% of total disability adjusted life years lost (DALYs) are caused by mental and behavioral disorders, which exceeds the global burden caused by cardiovascular conditions (9.7%) and malignant tumors (5.1%) (WHO, 2001). Despite the fact that mental disorders have considerable negative effects on the quality of life, low- and middle-income countries spend less than 2% of total national health care budget and large share of spending is diverted towards institutional psychiatric care. Georgia is a middle income country, where drastic reforms in the national mental health policy started from 2014. One of the key directions of those reforms was to transform post-soviet style institutional-based care into more community-based services. This paper looks at policy development process around mental health in Georgia and documents and analyses its key directions. One of the key aims of mental health reforms in Georgia was to support deinstitutionalization process. The key objectives of the strategy and policy development work to drive these reforms were to:  construct integrated chain of needs-based services  improve quality of life of mentally ill people  reduce stigma and protect human rights of mentally ill people This study concluded that the mental health policy and strategy development process in Georgia has been grounded on the best international practice and evidence. The strategic document that has been developed ensures the implementation of the deinstitutionalization process and future re-arrangement of the mental health system into a universal, flexible, equitable accessible, and sustainable model. The new model also respects the right to participate in decision-making, human dignity, nondiscrimination, transparency and accountability, and aims at promoting high standards of care and treatment and fair distribution of financial burden.

碩士
國立陽明大學
臨床暨社區護理研究所
103
According to population trended to elder society and public health issue has been changed. Elderly health issue has been focus for years, especially psychological issue. As a result, there is a great amount studies pointed out the individual relationship between demographic, health status, oral function and depressive symptom. However, there is short of study to investigate the relationship between demographic, health status, oral function and depressive symptom. So, this study is going to investigate the relationship between demographic, health status, oral function and depressive symptom. The result can use to elderly psychological problem prevention, and proving elderly psychological health. The study is a cross-sectional study, and assessed 955 participants aged 65 years and older, derived from the ‘Elder veteran health status long-term follow plan’ study. Using self-made questionnaire collected demographic, health status and oral function data. Depressive symptom is collected by BSRS-5. Data analysis used Chi-square, univariate logistic regression and multivariate logistic regression. The prevalence of elderly depressive symptom is 9.9%.After controlled demographic data, self-reported health status, self-reported teeth status and self-reported chewing problem are trended to have depressive symptom.

As a social worker practising in long-term residential care for people living with dementia, I am alarmed by discourses in the media and health policy that construct persons living with dementia and their health care needs as a threatening “rising tide” or crisis. I am particularly concerned about the material effects such dominant discourses, and the values they uphold, might have on the collective provision of care and support for our elderly citizens in the present neoliberal economic and political context of health care. To better understand how dominant discourses about dementia work at this time when Canada’s population is aging and the number of persons living with dementia is anticipated to increase, I have rooted my thesis in poststructural methodology. My research method is a discourse analysis, which draws on Foucault’s archaeological and genealogical concepts, to examine two contemporary health policy documents related to dementia care – one national and one provincial. I also incorporate some poetic representation – or found poetry – to write up my findings. While deconstructing and disrupting taken for granted dominant crisis discourses on dementia in health policy, my research also makes space for alternative constructions to support discursive and health policy possibilities in solidarity with persons living with dementia so that they may thrive.
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macsuz@shaw.ca