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Magadi, Monica Akinyi. "The determinants of poor maternal health care and adverse pregnancy outcomes in Kenya." Thesis, University of Southampton, 1999. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.310540.
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Asogwa, Celestine Emeka. "Poverty and sickness: The correlation of social inequalities and poor health." Thesis, Boston College, 2015. http://hdl.handle.net/2345/bc-ir:105002.
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Kyomuhendo, Grace Bantebya. "Treatment seeking behaviour among poor urban women in Kampala Uganda." Thesis, University of Hull, 1997. http://hydra.hull.ac.uk/resources/hull:4928.
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This thesis examines women's treatment seeking behaviour for their own illnesses and that of children underfive in Kamwokya . The focus is on the extent to which women's access to money and time use patterns affect treatment seeking. It has been argued that women's treatment seeking behaviour is influenced more by their time use than their access to and availability of money.The findings obtained through the use of case histories and in-depth interviews indicate that though women in Kamwokya have access to their own money, mainly through participation in income generating activities (business), illness management for children under-five and even more for the women themselves, remains problematic. Women are overworked and manage fragile businesses that require their personal attention and presence. Hence, treatment seeking is done in a manner that will ensure minimal disruption of businesses. Consequently children's health, and even more so, that of women , is compromised for the sake of other family needs.This thesis demonstrates that illness management is not context free, and that no one factor can explain the whole process ; it both affects and is affected by other things happening in the family. Due to the multiple roles women have to fulfil, "time use "is found to be the organising and central factor in illness management for both women and children in Kamwokya, whether from rich or poor households.The thesis concludes by suggesting that policy makers, health care providers and professionals ought to take into account the daily routines of family life in their plans and programmes. Strengthening of private sector health providers, health education programmes and increased awareness raising of male responsibilities towards their families are recommended as a way of improving the health of women and children in Uganda.
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Wall, Teri. "The challenge to Catholic healthcare caring for the poor, the uninsured and the underinsured /." Online full text .pdf document, available to Fuller patrons only, 2001. http://www.tren.com.
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Soud, Fatma Ali. "Medical pluralism and utilization of maternity health care by Muslim women in Mombasa, Kenya." [Gainesville, Fla.] : University of Florida, 2005. http://purl.fcla.edu/fcla/etd/UFE0010181.
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Rein, David Bruce. "Modeling the health care utilization of children in Medicaid." Diss., Available online, Georgia Institute of Technology, 2004:, 2003. http://etd.gatech.edu/theses/available/etd-06072004-131339/unrestricted/rein%5Fdavid%5Fb%5F200405%5Fphd.pdf.
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Black, Gerald David. "Health and medical care of the Jewish poor in the East End of London, 1880-1939." Thesis, University of Leicester, 1987. http://hdl.handle.net/2381/35534.
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The East End of London experienced an explosion of its Jewish population, from 35,000 in 1881 to 120,000 in 1910. The majority were poor, of foreign birth, living in overcrowded, sub-standard housing, and engaged in unhealthy occupations. Their arrival brought problems for both the indigenous population and the existing London Jewish community, threatening a crisis which could have overwhelmed the strained general medical services and irreparably damaged the Jewish community. A further problem was the attempt by various missionary societies to provide medical assistance at the cost of religious conversion. The crisis was averted, due to the efforts of the poor themselves and the wealthy established Jews - not always in harmony; and to simultaneous advances being made in public health, medicine, national insurance, and the improving Poor Law facilities. The major triumph of the immigrants, who preferred denominational institutions, was in establishing the London Jewish Hospital after a prolonged bitter battle against Lord Rothschild and many wealthy anglicised Jews, who considered the existing hospitals sufficient and wished to avoid jeopardising concessions already gained for Jews from the London Hospital and other medical centres. London, and the East End in particular, had many medical resources superior to those elsewhere in the country. The East End Jews enjoyed the added advantage of a comprehensive network of Jewish institutions and organisations, of which the Jewish Board of Guardians was foremost, which supplemented the Poor Law and voluntary systems and which had been created and funded largely by the rich of the community. In many areas of medical care Jewish organisations led the way. The initial effect was that the poor East End Jews, and especially their children, enjoyed better health than their non-Jewish neighbours in similar circumstances; but as the anglicisation of the immigrant increased, so the differences narrowed.
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Sutton, David A. "The public-private interface of domiciliary medical care for the poor in Scotland, c. 1875-1911." Thesis, University of Glasgow, 2009. http://theses.gla.ac.uk/1234/.
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This thesis explores domiciliary medical care for the poor in Scotland. Domiciliary care is understood as medical care provided in the home by qualified medical practitioners, or medical students. The poor are understood as those simply unable to ‘pay the doctor’ for the services they received. Focus is upon service provision, and therefore this thesis is a study of the different medical agencies engaged in the visitation of patients, and of the diverse ways medical practitioners as agents of different medical services facilitated or administered treatment. The period under focus is from 1875 to the National Health Insurance Act, 1911. Particular focus falls on urban Scotland, and Glasgow and Edinburgh. The interface between public and private provision is understood as the distinction between services provided for paupers, the legal poor, and services provided for the remainder, also unable to pay, and described as occupying ‘the boundary line between self-support and parish help’. Three types of service provider are identified: the poor law, medical charity, and medical missions. The thesis is divided into four main parts, buttressed by an introduction and conclusion. Chapter One sets the parameters to study of domiciliary medical care for the poor by identifying a literature of home visitation, and by identifying pressing issues concerning treatment in the homes of the poor of Glasgow and Edinburgh, like physical structure and family. Chapter Two is comprised of eight sections and looks at public provision in the form of the poor law medical services. Of particular interest are the local management, and the medical officers who provided the service. In turn focus is put upon the role of medical relief under the Poor Law (Scotland) Act, 1911; the structure of outdoor medical services in Glasgow and Edinburgh; the role of the local medical sub-committee of the parish board; and the parochial medical officers and their work. A prosopographical approach is taken to profile the parochial medical officers. Chapter Three, comprising five sections and conclusion, looks at private provision by medical charity. At issue is the range of charity dispensaries that provided outdoor services to the poor. A prospectus identifying the range of services is provided; outdoor medical services in Edinburgh and Glasgow are detailed; the interconnection between charity dispensary, domiciliary medical care, and medical educational requirements – particularly in Edinburgh – is investigated; and new developments occurring at the start of the twentieth century in health services requiring home visits are outlined. Chapter Four is comprised of nine main sections plus conclusion and looks at private provision by home medical missions. An overview of the literature of medical missions is provided, before focus falls, in turn, on medical missions in Edinburgh; medical missions in Glasgow; the medical work of medical missions; opportunities provided for women; how medical missions work was justified against criticisms; differences between providers; the response to provision from the Catholic immigrant community, and the work of the St Vincent de Paul Society.
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Ntamo, Precious Nomatende. "Poor attendance for outpatient physiotherapy by patients discharged from Mthatha General Hospital with a stroke in 2007." Thesis, Walter Sisulu University, 2011. http://hdl.handle.net/11260/d1006933.
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Background: Stroke is a major cause of disability in the world and its long term effects require good adherence to treatment protocols of physiotherapy. This will ensure optimal rehabilitation and reduce the burden of care in the society and the health service. Superficial analysis of existing data from the Physiotherapy Department of Mthatha General Hospital (MGH) revealed that there was poor attendance of outpatient physiotherapy by patients discharged from MGH with stroke and this had negative effects on outcomes and health care costs. Aim: To identify factors that influence poor attendance for outpatient physiotherapy by patients discharged from MGH with a stroke. Methods: Following approval from the Research Ethics Committee to conduct the study, an observational descriptive study design was used. The study population was 139 patients with stroke who attended for physiotherapy in MGH from January 2007 to December 2007. From a sample size of 103 randomly selected patients, 85 patients participated in the study with a response rate of 82%. Data collection was done using structured interviews and SPSS was used for data analysis. Results: The majority (86%) of patients did not attend physiotherapy until discharge from physiotherapy department. The major factors that influenced poor attendance were movement of patients to other areas (36%) and long distance from MGH (29%). Conclusion: The majority of stroke patients who attended for rehabilitation in MGH Physiotherapy Department lived in rural areas which were distant from Mthatha and could not attend physiotherapy at MGH as required by the physiotherapists. Recommendation: Development of a Provincial Rehabilitation Policy to address the unavailability of physiotherapy services at clinics and health care centers and ensure creation and filling of vacant physiotherapy positions at these levels of care.
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Yang, Hui, and 杨慧. "Shifting health care regimes in urban China and the impact on the urban poor." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2010. http://hub.hku.hk/bib/B45142002.
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Keenan, Lisa A. "The Application of a Health Service Utilization Model to a Low Income, Ethnically Diverse Sample of Women." Thesis, University of North Texas, 2000. https://digital.library.unt.edu/ark:/67531/metadc2570/.
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A model for health care utilization was applied to a sample of low income women. Demographic Predisposing, Psychosocial Predisposing, Illness Level, and Enabling indicators were examined separately for African American (n = 266), Anglo American (n = 200), and Mexican American (n = 210) women. Structural Equation Modeling revealed that for African American and Anglo American women, Illness Level, the only significant path to Utilization, had a mediating effect on Psychosocial Predisposing indicators. The model for Mexican Americans was the most complex with Enabling indicators affecting Illness Level and Utilization. Psychosocial Predisposing indicators were mediated by Illness Level and Enabling indicators which both directly affected Utilization. Implications of the results for future research are addressed.
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Deardorff, Karen Sickels. "Catalytic Innovations in Appalachia Ohio Health Care: The Storying of Health Care in a Mobile Clinic." Ohio : Ohio University, 2009. http://www.ohiolink.edu/etd/view.cgi?ohiou1245354639.
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Prosser, Trish. "Utilization of health and medical services: factors influencing health care seeking behaviour and unmet health needs in rural areas of Kenya." Thesis, Edith Cowan University, Research Online, Perth, Western Australia, 2007. https://ro.ecu.edu.au/theses/46.
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There are many factors that influence health and health care seeking. Although many of these factors are similar across populations, exactly how they interact and influence the actions of people is often unique to a population in the context of the environment they live in. The current study, a population-based cross sectional survey, identifies three specific geographically diverse populations in rural areas of Kenya, to gain information regarding overall influences on health care seeking, and also information specific to each geographical area to directly target the health needs of the individual population living there. Participants of the survey were interviewed for personal information and details regarding their activities in response to their health and ill-health. The subsequent data was then analysed to determine which factors affected the use of health and medical services within the study areas and whether the study participants believed their health needs were being met.
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Olsson, Sara, and Malin Oskarsson. "How nurses support self-care in patients diagnosed with malaria : A field study at a district hospital in Kenya." Thesis, Högskolan i Borås, Institutionen för Vårdvetenskap, 2011. http://urn.kb.se/resolve?urn=urn:nbn:se:hb:diva-20462.
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Malaria is a big problem and a major cause of death and illness among children and adults in tropical countries (World Health Organization, 2010). It is the biggest threat for children in Kenya and leads to death in approximately 36,000 children (<5 yrs) every year. When infected with malaria; the patient ends up with some kind of self-care deficit and need access to health care.Research about how nurses can support self-care in patients with malaria is lacking. If no plan for how to take care of a patient with malaria exits, treatment can differ, which in turn can result in poorer outcome for the patient. The aim of the study was to investigate how the nurses at Moi District Hospital in Voi support self-care in patients diagnosed with malaria. The study was carried out with five qualitative semi-structured interviews. Data was analyzed with a deductive content analysis. The result showed that nurses teached and encouraged patients to perform self-care; they identified patient status, they acted for the patient, guided him or her and tried to provide a developmental environment. Teaching was the most common way to support self-care, probably because of lack of recourses.Program: Sjuksköterskeutbildning
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Whitworth, Keith Hugh. "Health Care Among Low-income, White, Working-age Males in a Safety Net Health Care Network: Access and Utilization Patterns." Thesis, University of North Texas, 2006. https://digital.library.unt.edu/ark:/67531/metadc5334/.
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This study seeks to provide information relevant to public policy that will lead to increased access and utilization among this vulnerable population and to reinforce the validity of the behavioral model for vulnerable populations. This study is a secondary analysis of data collected in a study that examined adult, working-aged patients within the John Peter Smith Health Network, which is a large, urban, tax supported county health care system in Fort Worth, Texas. From a sampling frame of 10,000 patients, the study analyzed data for 243 low-income, white, working-age males, collected from computer assisted telephone interviews in 2000. Cross-tabulations and bivariate logistic regressions were used to analyze the effect of 8 independent variables (age, marital status, insurance, employment status, a usual source of care, competing needs, experiences with paperwork, and perceived health status upon 5 dependent variables pertaining to unmet health care, unmet prescription medicine needs, unmet dental needs, utilization of doctors in emergency departments, and overnight hospital stays. The results show the safety net system is failing to meet the needs of this vulnerable population. The findings indicate white men who found it necessary to forgo health care due to other needs were almost five (4.973) times as likely as those who did not find it necessary to forgo care due to other needs, to report having a problem getting the health care that they need (p = ≤ .001). The odds of having a problem getting needed dental care are about 66% lower for white men who have private insurance through work compared to those who do not have private insurance through work (p ≤ .05).
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Deedat, Raees. "Lessons learnt from a private sector business pilot targeting the primary healthcare needs of poor South Africans : the case of RTT Unjani Clinics." Thesis, Stellenbosch : Stellenbosch University, 2012. http://hdl.handle.net/10019.1/95693.
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Thesis (MBA)--Stellenbosch University, 2012.Railit Total Transportation (RTT) is a multinational corporation whose core business is to be a logistics and distribution partner to other multinational corporations. Many of RTT’s key clientele are in the healthcare and pharmaceutical industry, with various key relationships and networks being developed over many years of operation. RTT set the trend by becoming one of the first large South African companies to participate in and profit from the rest of the African continent at a time when it was not popular to do so. On a similar motivation, the current CEO of the RTT Group, Dr Iain Barton, believes that it is a strategic imperative to participate in the Base of the economic Pyramid (BoP), both for economic and developmental reasons. The BoP is not a new market, but recent interest in its potential profitability has being sparked in the business community by the works of management gurus such as the late C.K. Prahalad and the current sustainability champion Stuart Hart. This dissertation presents a case study that will analyse the phenomenon of developing a business model that targets the primary healthcare (PHC) needs of poor South Africans. This study will also extract lessons learnt from the case study in the context of existing BoP theory, primary healthcare in South Africa, and a similar initiative implemented in Kenya in the form of the Child and Family Wellness Clinics (CFW). The case study presents the reader with the pilot phase of RTT’s Unjani Clinic project, and contrasts the findings and lessons learnt from the two main pilot sites in Johannesburg’s Etwatwa and Wattville peri-urban BoP communities. This study also explores a smaller business model concept among Cape Town’s informal traders, also known as spaza shops. The data collection for the case study was undertaken in the qualitative research methodological format with a comprehensive set of interviews that aimed to triangulate the views of management, operational staff, community participants and patient participants. The strength of the case study findings is enhanced by the inclusion of comprehensive case study data, which includes verbatim transcripts of all interview participants and focus group participants. The database can be found at the end of this research report. Many lessons emerged that were both expected and unexpected, with three major themes coming to the fore: • The strategic funding of Unjani, within the dichotomy of profit and non-profit hybrid models • Challenges in achieving operational scale and efficiencies within the BoP • Marketing the value proposition to the BoP. RTT’s management has already begun to implement many of the lessons that have emerged. This includes the marketing mix that requires greater appreciation at a detailed ethnographic level of the dynamics of non-traditional BoP markets. The research report also provides other recommendations to stimulate demand in BoP markets as well as suggestions for the ideal funding and business partners to move this project forward. This research is unique in exploring the challenges of business model development specifically to service the healthcare needs of poor South Africans, and to contribute a small but significant part in the broader understanding of doing business in the South African BoP.
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Chemorion, Edith Khakasa. "Spiritual care to people living with HIV and AIDS within the context of the Reformed Church of East Africa’s Plateau Mission Hospital (Kenya)." Thesis, Stellenbosch : University of Stellenbosch, 2009. http://hdl.handle.net/10019.1/2422.
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Thesis (MTh (Practical Theology and Missiology))--University of Stellenbosch, 2009.The basic premise of this study is that a spiritual approach to care and support of people living with HIV, by means of a holistic pastoral model, would provide the Reformed Church of East Africa's Plateau Mission Hospital with an integrated dimension in their community-based care programme for people living with HIV/AIDS. This will go a long way in assisting the RCEA's diversification of the existing medical model, particularly in the Plateau Mission Hospital’s catchment area with its ever-increasing cases of infections, deaths, rejections, church-related stigma, orphans and vulnerable children. The researcher proposes the use of a spiritual model in dealing with PLWH in the Plateau Mission Hospital because this will help to address some of the unresolved theological issues that come to the fore when addressing matters concerning the health and illness of people living with HIV and AIDS. The researcher does this with acute awareness of the importance of integrating other approaches in the care and support of PLWH. For a holistic approach to be effected, the social development, medical, psychological and holistic systemic approaches to care must be considered. The holistic systemic approach used by the biomedical personnel and other caregivers should regard the person as a relational and social being acting within a cultural context. On the other hand, the biomedical model serves us with accurate diagnoses and sophisticated methods of treatment within which modern medicine is practiced. Similarly, the psychosocial model considers the influence of the social environment not only to the challenges that PLWH face, but also on the care they should receive. However, research has shown that there is an increasing need for holistic care in health care systems. This calls for the inclusion of spirituality within the developing bio-psycho-social approaches in addressing health and illness, particularly for people living with HIV and AIDS, in order for them to attain holistic healing. Plateau Mission Hospital, being a church-based institution within the jurisdiction of the RCEA’s southern presbytery, can be an effective vehicle for pastoral care of people living with HIV and AIDS. The organization is strategically placed and has the capacity (resource persons) to engage in a holistic ministry. The paper also aims at unlocking the RCEA’s resources to become more involved in all rounded existential issues of PLWH in the hospital’s catchment area. In this study, it is presupposed that, although the Hospital has a history of medical and social development work and chaplaincy office, it lacks emphasis on the spiritual dimension, and yet this focal point is important in terms of the immediate HIV/AIDS context at Plateau. The researcher established that the training that the personnel at the medical facility have undertaken promotes a clinical approach to all issues of health (prevention and treatment after prescription), even to people living with HIV/AIDS. Methodology. The first methodology for data collection that the research employed was literature review. In this case, library and church documents were reviewed to gather information on related matters. The areas reviewed were related to spirituality, care and healing in the context of HIV, pastoral care and theology in the context of HIV, and biomedical approaches in relation to the care of PLWH, and documentation (Plateau Hospital Reports, the RCEA’s constitution and Care Departmental Reports) on the RCEA’s approach to Hospital care to PLWH by means of the CBHC programme at the Plateau Mission Hospital in Eldoret. The websites were also consulted for purposes of data collection. The second method was conducting specific oral and written interviews with the Hospital’s CBHC staff, PLWH, congregational and church leadership on matters of the proposed spiritual care of PLWA. The areas interviewed were for the spiritual needs, those involved in the care and support of PLWH, improving existing interventions, the challenges encountered in the care for PLWH, the unfulfilled needs of PLWH and how spiritual care could improve the quality of the lives of PLWH. The third method of data collection was participant observation. The researcher was involved in the activities being studied. This method entailed participant observation during normal diaconal care activities in the RCEA’s Plateau parish congregations that the researcher implemented, for instance visiting people living with HIV/Aids, taking gifts to children affected by HIV. In meeting with volunteer caregivers during visits, while joining the CBHC team during follow-up meetings with PLWH in their homes, data was collected. The researcher had patient consultation during days for voluntary counseling and testing and informal meetings with volunteer caregivers. Presentation of the Thesis - Outline of Research This study is divided into five parts. Chapter 1 will examine the background to the study considering the problem statement, research questions, research objectives, hypothesis, justification, the scope of the research, the methodology used, limitations and delimitations. In Chapter 2 the paper will explore The Kenyan Scenario: Medical work and the involvement of the church within the community. This will cover the Kenyan national HIV updates, Uasin Gishu updates, Ainabkoi divisional statistics, the background to the Reformed Church of East Africa, Plateau Mission HIV ministry covering the psycho-social approach to community-based care of CBHC in the Reformed Church of East Africa in the Plateau Hospital catchment area. The paper will examine the medical care offered to people living with HIV/AIDS, such as the treatment of opportunistic diseases, administration of anti-retroviral drugs and the prevention of mother-to-child transmission and voluntary counseling and testing. The paper will also examine the social and developmental activities and services rendered to PLWA and the orphans and vulnerable children by means of compassionate care. CBHC networking with congregations, and Moi Teaching and Referral Hospital will also be highlighted. The paper will also highlight the gaps experienced as a result of the focus on medical and social developmental approaches to the care and support of PLWA and OVCs. Chapter 3 is largely the analysis of interview responses, and presents the findings of field research at the RCEA Plateau Mission Hospital’s selected area of study. This will indicate the seriousness of the unattended needs in this case the spiritual needs and the magnitude of the problem in the health facility but, by implication, affecting the church. This will need a change of stance, namely that of regarding HIV as a medical problem that the hospital needs to address, and view it as a collective need for all key players in church, hospital and community. Chapter 4 will look at the challenge HIV poses to the spiritual care of PLWH in Plateau Mission Hospital. The chapter will contain a literature review on the holistic approach in the care and support of people living with HIV. The section will look at understanding the needs of people living with HIV, pastoral care of people living with HIV, practical theology, biomedical and bio-psycho-social models in the care of PLWH. The study will also examine the relevance of God-images, systems approach, the role of the church and a spiritual care approach in the holistic healing for PLWH by means of pastoral care. Chapter 5 will conclude the paper and will shed light on the importance of the proposed approach to be integrated into the current strategy (pastoral care model with a spiritual-care approach). It is hoped that the recommendations that will be made at the end will strengthen the high demand for a holistic-care ministry to people living with HIV and the affected families in the RCEA Plateau Mission Hospital.
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Boyd, Christopher M. "Patterns of delay and non-use of prenatal care services among underclass women: a social psychological analysis." Diss., Virginia Tech, 1992. http://hdl.handle.net/10919/38628.
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This study attempted to determine the relation between womens' anticipation of Esteem-Threat, their level of satisfaction, and their utilization of prenatal care services in the public assistance setting. One-hundred twenty-six women completed a battery of questionnaires during an initial clinic visit. Measures of patient datisfaction were completed after a minimum of four clinic visits. Results showed a significant linear relation between womens' anticipation of Esteem-Threat and satisfaction with services. No relations were found between Esteem-Threat and the timing of entry into prenatal care. A small, statistically significant relation was found between Esteem-Threat and the number of appointments kept. Results are discussed in the context of the limitations of the sample and the psychometric properties of the measures. Future applications of the Esteem-Threat model are also discussed.Ph. D.
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Cuevas, Adolfo Gabriel. "Exploring Four Barriers Experienced by African Americans in Healthcare: Perceived Discrimination, Medical Mistrust, Race Discordance, and Poor Communication." PDXScholar, 2013. https://pdxscholar.library.pdx.edu/open_access_etds/615.
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For many health conditions, African Americans bear a disproportionate burden of disease, injury, death, and disability compared to European Americans. African Americans also use health services less frequently than do European Americans and this underuse of services contributes to health disparities in the United States. Studies have shown that some disparities are present not as a result of poor access to care, but, to a certain extent, as a result of the experiences patients have at their doctors' offices. It is, therefore, essential to understand African American patients' perspectives and experiences with healthcare providers. Past studies have shown that four barriers affect the quality of patient-provider relationships for African Americans: perceived discrimination, medical mistrust, race discordance, and poor communication. The studies, however, have not looked at how these barriers manifest when African Americans speak about their perspectives and experiences with health care providers. This project was a secondary data analysis of qualitative data provided by adult African American community members from Portland, Oregon with diabetes or hypertension or both, each of whom participated in one of 10 focus groups. The focus groups were conducted as part of a study that applied community based participatory research (CBPR) principles to understand patients' experiences with their doctors. Using a deductive approach, this analysis enhanced the understanding of how the barriers play a role in patient-provider relationships. Further, the analysis showed how the barriers are interrelated. In learning African American patients' experiences and perspectives on these four key barriers, the investigator proposes recommendations for healthcare providers as to how they can best deliver quality care for African Americans.
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Clark, Lauren. "Women's domestic health work in poverty: A comparison of Mexican American and Anglo households." Diss., The University of Arizona, 1992. http://hdl.handle.net/10150/186048.
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The purpose of this dissertation was to identify the components of women's domestic health work in networks surrounding poor Mexican American and Anglo households and compare women's experiences as domestic health workers. Women representing 10 Mexican American households and 10 Anglo households and their surrounding domestic networks were recruited for this study. Criteria for participation included the presence of at least one child in the household $\le$5 years of age and household income at or below the federally-defined weighted poverty threshold. Sources included, first, 66 interviews with women (n = 26) residing in the study households. Second, women kept 3-week daily health diaries on behalf of all household members. And third, women participated in an inventory of household medications. The study employed several analytic methods, including descriptive statistical analyses, phenomenological insight, taxonomic analyses of women's knowledge structures, life history analysis, thematic analysis, and narrative analyses. The results of the study emphasized several points, including the: (a) gendered but hotly contested nature of domestic responsibility for health, with responsibility negotiated between men and women in households, and disputed between households and social service agencies; (b) significant role played by women's informal networks in defining and evaluating the enactment of maternal responsibility; (c) workings of women's coalitions and cooperatives that protect women's threatened interests and redistribute resources among women; (d) influences governing the transmission of child health and illness knowledge and skills across generations of women; (e) double-edged nature of self-medication that appears as both a source of female autonomy and expertise, yet paradoxically and simultaneously can act as an inappropriate, self-palliating balm for the hurt incurred from inadequate accessibility to quality professional health care for poor women and children; and (f) cross-cutting influences of ethnicity and historical situation in each of the above domains. Women pieced together resources from their cultural background, femaleness, and sometimes their poverty; all these factors also entailed contradictory disadvantages in the production of household health. The health and social policy implications of this study were described in detail in the dissertation, as were the women's own visions for an approximation of utopia.
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Simon, Christian Michael. "Dealing with distress: a medical anthropological analysis of the search for health in a rural Transkeian village." Thesis, Rhodes University, 1990. http://hdl.handle.net/10962/d1001599.
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This study aims to characterize and understand the search for health in a rural Transkeian community. It begins with the observation that the people of Jotelo have to negotiate considerable hardships in their daily lives. These hardships include the impact of malnutrition, undernourishment and a wide range of diseases like tuberculosis, typhoid and gastro-enteritis. To survive ill-health, people develop numerous practical strategies. Most significantly, they attempt to maximise availalble resources, like cash, their relations with others and local medical facilities. Hence the study attempts to characterize how and why patients select various kinds of therapy in their search for health. By focusing on patients' recourses to treatment, the study reveals that the search for health is as much a personal experience as it is a social and economic one. This idea is developed in an analysis of the links betw'een work, illness and social reproduction. The point which emerges from this discussion captures the central theme of the study: the search for health is a profoundly personal, social and economic experience. This notion is strengthened by an examination of the historical and contemporary nature of local health and health care. It is observed that health and health care is intimately linked to the local and wider political economy. This not only serves to contextualise the discussion on patients' actual experiences, but points to the fact that these experiences are part of wider processes. By depicting the search for health in this way, the study hopes to have illustrated what people do in times of illness and why. Yet it also claims to have gone beyond such a depiction. By abstracting from its findings, it aims to conclude that the search for health is not merely caused by various local and wider processes, to which it has referred. In other words, it hopes to avoid a deterministic view of patients' experiences in times of distress. Instead, it is argued that the search for health is ultimately an integral part of the local and wider economic and political environment
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Zhang, Lei. "Uncompensated Care Provision and the Economic Behavior of Hospitals: the Influence of the Regulatory Environment." Diss., unrestricted, 2008. http://etd.gsu.edu/theses/available/etd-02242009-152847/.
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Thesis (Ph. D.)--Georgia State University, 2008.Title from file title page. Paul G. Farnham, committee chair; Patricia G. Ketsche , Douglas S. Noonan (Ga. Tech.), Shiferaw Gurmu, Karen J. Minyard, William S. Custer, committee members. Description based on contents viewed June 11, 2009. Includes bibliographical references (p. 146-153).
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Wiant, William C. "N-Acylethanolamine (NAE) Profiles Change During Arabidopsis Thaliana Seed Germination and Seedling Growth." Thesis, University of North Texas, 2006. https://digital.library.unt.edu/ark:/67531/metadc5333/.
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An understanding of the potential roles as lipid mediators of a family of bioactive metabolites called N-acylethanolamines (NAEs) depends on their accurate identification and quantification. The levels of 18C unsaturated NAEs (e.g. NAE18:2, NAE 18:3, etc.) in wild-type seeds (about 2000 ng/g fw) generally decreased by about 80% during germination and post-germinative growth. In addition, results suggest NAE-degradative fatty acid amide hydrolase (FAAH) expression does not play a major role in normal NAE metabolism as previously thought. Seedlings germinated and grown in the presence of abscisic acid (ABA), an endogenous plant hormone, exhibited growth arrest and secondary dormancy, similar to the treatment of seedlings with exogenous Nlauroylethanolamine (NAE12:0). ABA-mediated growth arrest was associated with higher levels of unsaturated NAEs. Overall, these results are consistent with the concept that NAE metabolism is activated during seed germination and suggest that the reduction in unsaturated NAE levels is under strict temporal control and may be a requirement for normal seed germination and post-germinative growth.
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Marsh, Victoria Mary Chuck. "Sharing findings on sickle cell disorder in international collaborative biomedical research : an empirical ethics study in coastal Kenya." Thesis, University of Oxford, 2012. http://ora.ox.ac.uk/objects/uuid:b693b762-5ce8-4109-82ea-4cf7ba38675e.
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Against the background of a dilemma experienced by researchers during a genomics study at an established biomedical research centre in Kenya, the broad aims of this thesis are to develop appropriate responses to important ethical questions on sharing information on a common and serious genetic condition, sickle cell disorder, and assess the responsibilities of researchers in this regard. Using an empirical approach to normative reflection across two phases of qualitative research, I explore the nature of important moral concerns related to sharing sickle cell disease information from researchers’ and community members’ points of view; and develop a bottom-up normative analysis around the questions generated. This analysis interweaves community experiences, processes of community reasoning and ex situ normative reflection; placing community views and values centrally while referencing these to wider ethical debates, commentaries and guidelines in the literature. Two main outputs of this thesis are to provide recommendations for information sharing on SCD findings in the genomics study in Kilifi; and to propose a set of key issues to consider for this type of information in other studies and geographic settings. I conclude that researchers have a strong responsibility to share SCD information on affected children with families as a form of ancillary service (validating tests, counselling and care); but less responsibility to actively share carrier information. Concurrent responsibilities are working collaboratively with the Ministry of Health/District General Hospital to plan and implement services for SCD; ensuring counselling services support family stability as far as reasonably possible; and to build forms of community engagement and informed consent that counter risks of diagnostic interpretations of research.
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Stewart, Steven. "An assessment of parent's beliefs about child development among families participating in the Comprehensive Health Investment Project." Thesis, Virginia Tech, 1992. http://hdl.handle.net/10919/45036.
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Extensive research suggests linkages among low income, erratic or ineffective parenting behaviors, and impaired health and development among children. Family support programs, offering a range of comprehensive services to low income families, have demonstrated positive health and life performance outcomes, both for children and parents. One such program, the Comprehensive Health Investment Project (CHIP) in Roanoke, Virginia, works to provide primary physician care to low income young children. One of CHIP's objectives is to enhance parenting skills so that parents can help maintain good health among their children.
This study attempted to assess parents' beliefs about child development among a sample of CHIP parents and a sample of parents from a similar SES group (drawn from CHIP's waiting list) using a Likert-style opinionnaire. Results from both between-group tests and within-group (CHIP sample) tests indicate homogenous and favorable reported beliefs about child development. Very little association was found between demographic variables and responses. Suggestions regarding the practical use of these findings and recommendations for future research are made.Master of Science
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Gurganus, Jill Renee. "An evaluation of educational literature distributed by the Child Health Investment Partnership." Thesis, Virginia Tech, 1993. http://hdl.handle.net/10919/46306.
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Educational literature distributed by the Child Health Investment Partnership (CHIP) staff to CHIP parents was identified and evaluated in terms of readability level and availability of information to assist with meeting the identified needs of CHIP parents. One-hundred percent (n=137) of the educational material available to CHIP staff through their library was analyzed. Readability levels were calculated by using the SMOG Readability Formula and the FRY Graph Reading Level Index.
A previous study (Brindle, 1992) was used to determine whether CHIP had adequate material to meet the educational needs of CHIP families. Forty-eight percent of CHIP parents cited health as their primary concern. Almost one-half of an educational literature stocked in CHIP's library relates to health. Thus, results indicate that CHIP has a more than adequate amount of educational literature relating to topics CHIP parents believed they needed assistance with the most. It was found, however, that other areas such as financial and job assistance were underrepresented in CHIP's library. While 36 percent and 35 percent of CHIP parents believed they needed assistance with finances and jobs, respectively, only 6 percent of CHIP's library was devoted to financial assistance and two percent was devoted to job assistance. The apparent need for assistance in these areas greatly outweighs CHIP's educational resources. Results also indicate that the average CHIP parents (one who has completed high school) has the education equivalent to or more than was required for reading the majority of CHIP's educational literature. While the mean Reading Level of educational materials was at the tenth grade level sixty percent of CHIP families surveyed had completed high school. Results and conclusions are discussed in detail.Master of Science
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Owusu, Gertrude Adobea. "Use of Preventive Screening for Cervical Cancer among Low-income Patients in a Safety-net Healthcare Network." Thesis, University of North Texas, 2003. https://digital.library.unt.edu/ark:/67531/metadc4191/.
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This study is a secondary analysis of survey data collected in fall 2000 from patients of a safety-net hospital and its eight community health outreach clinics in Fort Worth, Texas. The study examined three objectives. These include explaining the utilization of Pap smear tests among the sample who were low-income women, by ascertaining the determinants of using these services. Using binary logistic regressions analyses primarily, the study tested 10 hypotheses. The main hypothesis tested the race/ethnicity/immigration status effect on Pap smear screening. The remaining hypotheses examined the effects of other independent/control variables on having a Pap smear. Results from the data provide support for the existence of a race/ethnicity/immigration status effect. Anglos were more likely to have had a Pap smear, followed by African Americans, Hispanic immigrants, and finally, by Hispanic Americans. The persistence of the race/ethnicity/immigration status effect, even when the effects of other independent/control variables are taken into account, may be explained by several factors. These include cultural differences between the different groups studied. The race/ethnicity/immigration status effect on Pap smear screening changed with the introduction of age, usual source of care, check-up for current pregnancy, and having multiple competing needs for food, clothing and housing into the models studied. Other variables, such as marital status, employment status and health insurance coverage had no statistically significant effects on Pap smear screening. The findings of this study are unique, probably due to the hospital-based sample who has regular access to subsidized health insurance from a publicly funded safety-net healthcare network and its healthcare providers. Given the importance of race/ethnicity/immigration status for preventive Pap smear screening, public education efforts to promote appropriate Pap smear tests among vulnerable populations should target specific race/ethnicity/immigration status groups in the U.S. within the cultural context of each group. Furthermore, publicly funded health programs for underserved populations such as the John Peter Smith Connections and Medicaid should be maintained and strengthened.
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Ouendo, Edgard-Marius D. "Indigence et soins de santé primaires en République du Bénin: approche de solutions au problème d'identification des indigents dans les formations sanitaires publiques." Doctoral thesis, Universite Libre de Bruxelles, 2005. http://hdl.handle.net/2013/ULB-DIPOT:oai:dipot.ulb.ac.be:2013/211005.
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Introduction: Du fait des faibles résultats enregistrés par différents systèmes de santé dans le monde, la conférence d'Alma Ata de 1978 avait préconisé l’approche des Soins de Santé Primaires. Pour renforcer cette approche et faciliter l’accessibilité universelle aux soins, l’Initiative de Bamako fut adoptée en 1987. Cette initiative se fonde sur la participation financière des patients aux soins. L'une des conséquences est le coût financier des soins pour les bénéficiaires avec un risque d'exclusion de certains patients. Mais l’Initiative de Bamako suggère les dispositions à prendre pour éviter l'exclusion des indigents. Au Bénin, les comités de gestion des centres de santé ont la responsabilité de veiller à l'accès aux soins des indigents. Mais malgré cela, la prise en charge des indigents n’est pas effective. Les professionnels de la santé se plaignent de ne pas disposer de critères d'identification des indigents. Sur cette base, l'identification des indigents constitue la pierre angulaire de leur prise en charge. En conséquence, la mise en place d'une stratégie opérationnelle fondée sur l'identification des indigents par les personnes ressources de la communauté et soutenue par un outil quantitatif d'identification, permet une identification fiable des indigents en vue de leur prise en charge sanitaire. Méthode: Après un état des lieux de la situation des indigents dans le système de santé au Bénin, trois études ont été réalisées pour approfondir la question des indigents;
•\
Doctorat en Sciences de la santé publique
info:eu-repo/semantics/nonPublished
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Du, Plessis Ulandi. "Explaining the endurance of poverty and inequality : social policy and the social division of welfare in the South African health system." Thesis, Rhodes University, 2013. http://hdl.handle.net/10962/d1002002.
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This thesis examines the structure and flow of public funding between the public and private sectors in the South African health system and the consequences thereof for the achievement of equity. The conceptual framework used to undertake the analysis derives from Richard Titmuss’ core theoretical framework, the Social Division of Welfare. The application of the Social Division of Welfare applied to the South African health care context demonstrates how state resources end up benefitting the non-poor and, as a result, reproduce inequality. Those who access public institutions such as public health care are assumed to be ‘dependent’ on the state, whilst those who access private health facilities claim to be ‘independent’ of the state. However, this thesis shows that these assumptions are flawed. Access to the formal labour market, and subsequently the paying of taxes, authorises one to access state subsidies not available to those who do not. The application of the Social Division of Welfare shows that tax-paying private health care patients benefit considerably from state resources. This thesis argues that due to cost escalation in the private health sector, a consequence of the commodification of health care, these private health care ‘consumers’ as well as the private health industry in general are dependent upon state resources. This thesis analyses the role played by the profit motive present in the private health industry and the consequences for equity, quality, access and efficiency in health care provision
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Machado, Mariana de Abreu. "Cuidados paliativos e a construção da identidade médica paliativista no Brasil." reponame:Repositório Institucional da FIOCRUZ, 2009. https://www.arca.fiocruz.br/handle/icict/2329.
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Made available in DSpace on 2011-05-04T12:36:18Z (GMT). No. of bitstreams: 0
Previous issue date: 2009O objetivo desta dissertação consiste em investigar o processo de construção da identidade profissional de médicos que se dedicam à assistência a pacientes que apresentam doenças progressivas e ameaçadoras da continuidade existencial e que têm contribuído para o desenvolvimento dos Cuidados Paliativos no Brasil. Buscamos conhecer a trajetória profissional destes médicos desde a escolha da medicina como profissão até o encontro com a filosofia e a prática dos Cuidados Paliativos. Com este intuito, realizamos entrevistas semiestruturadas,colhidas segundo a metodologia de História Oral de Vida. Foram entrevistados seis médicos de diferentes especialidades que ocupam cargos diretivos em uma das associações profissionais voltadas para a disseminação e legitimação política e social dos Cuidados Paliativos no Brasil. Os depoentes se destacam no cenário nacional no que diz respeito às discussões sobre esta temática e mantêm contato com importantes instituições internacionais. Por esta razão, chamamos o conjunto de entrevistados de elite médica paliativista. Percebemos uma pobre interlocução entre os médicos paliativistas, o que se reflete na ausência de uma identidade integrada desse grupo profissional. Os entrevistados acentuaram as competências humanitárias necessárias ao bom exercício da Medicina Paliativa, mas, no entanto, não foram explicitadas as competências específicas a este campo profissional, que justificariam seu reconhecimento pelas entidades médicas competentes comouma nova área de atuação ou especialidade.
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Gatara, Maradona Charles. "Mobile technology-enabled healthcare service delivery systems for community health workers in Kenya: a technology-to-performance chain perspective." Thesis, 2017. https://hdl.handle.net/10539/24062.
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Thesis (Ph.D.)--University of the Witwatersrand, Faculty of Commerce, Law and Management, School of Economic & Business Sciences, November 2016Community Health Workers or “CHWs” are often the only link to healthcare for millions of people in the developing world. They are the first point of contact with the formal care system, and represent the most immediate and cost effective way to save lives and improve healthcare outcomes in low-resource contexts. Mobile-health or ‘mHealth’ technologies may have potential to support CHWs at the point-of-care and enhance their performance. Yet, there is a gap in substantive empirical evidence on whether the use of mHealth tools enhances CHW performance, and how their use contributes to enhanced healthcare service delivery, especially in low-resource communities. This is a problem because a lack of such evidence would pose an obstacle to the effective large-scale implementation of mHealth-enabled CHW projects in low-resource settings. This thesis was motivated to address this problem in the Kenyan community health worker context. First, it compared the performance of CHWs using mHealth tools to those using traditional paper-based systems. Second, it developed and tested a replicable Technology-to-Performance Chain (TPC) model linking a set of CHW task and mHealth tool characteristics, to use and user performance outcomes, through four perspectives of Task-Technology Fit (TTF), namely Matching, Moderation, Mediation, and Covariation. A quasi-experimental post-test only research design was adopted to compare performance of CHWs using an mHealth tool to those using traditional paper-based systems. A primary structured questionnaire survey instrument was used to collect data from CHWs operating in the counties of Siaya, Nandi, and Kilifi, who were using an mHealth tool to perform their tasks (n = 257), and from CHWs operating in the counties of Nairobi and Nakuru using traditional paper-based systems to perform their tasks (n = 353). Results showed that CHWs using mHealth tools outperform their counterparts using paper-based systems, as they were observed to spend much less time completing their monitoring, prevention, and referral reports weekly, and report higher percentages of both timeous and complete monthly cases. In addition, mHealth tool users were found to have more positive perceptions of the effects of the technology on their performance, compared to those using traditional paper-based systems. An explanatory, predictive, research design was adopted to empirically assess the effects of a ‘fit’ between the CHW task and mHealth technology (TTF) on use of the mHealth technology and on CHW user performance. TTF was tested from the Matching, Moderation, Mediation, and Covariation ‘fit’ perspectives using the cross-sectional survey data collected from the mHealth tool users (n = 257). Results revealed that there are various unique ways in which a ‘fit’ between the task and technology can have significant impacts on use and user performance. Specifically, results showed that the paired-match of time criticality task and technology characteristics impacts use, while that of time criticality and information dependency task and technology characteristics impacts user performance. Results also showed that the cross-product interaction of mobility task and interdependence technology characteristics impacts use, and that of mobility task and interdependence and information dependency technology characteristics, impacts user performance. Similarly, the cross-product interaction of information dependency task and time criticality technology characteristics impacts user performance. Moreover, results showed that a perceived ‘fit’ between CHW task and mHealth technology characteristics partially and fully mediates the effects of user needs and tool functions on use and user performance, whereas ‘fit’ as an observed pattern of holistic configuration among these task and technology characteristics impacts use and user performance. It was also found that the perfect ‘fit’ between CHW task and mHealth tool technology characteristics leads to the highest levels of use and user performance, while a misfit leads to a decline in use and user performance. Notably, an over-fit of mHealth technology support to the CHW task leads to declining use levels, while an under-fit leads to diminishing user performance. Of the four ‘fit’ perspectives tested, the matching and cross-product interaction of task and technology characteristics offer the most dynamic insights into use and user performance impacts, whereas user-perception and holistic configuration, were also shown to be significant, thus further reinforcing these effects. Tests of a full TPC model revealed that greater mHealth tool use had a positive effect on the effectiveness, efficiency, and quality of CHW performance in the delivery of patient care. Moreover, it was found that ‘facilitating conditions’ and ‘affect toward use’ had positive effects on mHealth tool use. Furthermore, a perceptual TTF was found to have positive effects on mHealth tool use and CHW performance. Of note, this perceived TTF construct was found to be simultaneously a stronger predictor of mHealth tool use than ‘facilitating conditions’ and ‘affect toward use’, and a stronger predictor of CHW performance than mHealth tool use. Consequently, TTF was confirmed as the central construct of the TPC. The findings constitute significant empirical insights into the use of mHealth tools amongst CHWs in low resource settings and the extent to which mHealth contributes to the enhancement of their overall performance in the capture, storage, transmission, and retrieval, of health data as part of their typical workflows. This study has provided much needed evidence of the importance of a ‘fit’ between CHW task and mHealth technology characteristics for enabling mHealth impacts on CHW performance. The study also shows how these inter-linkages could improve the use of mHealth tools and the performance of CHWs in their delivery of healthcare services in low-resource settings, within the Kenyan context. Findings can inform the design of mHealth tools to render more adequate support functions for the most critical CHW user task needs in a developing world context. This study has contributed to the empowerment of CHWs at the point-of-care using mHealth technology-enabled service delivery in low-resource settings, and contributes to the proper and successful ‘scaling-up’ of implemented mHealth projects in the developing world.
MT 2018
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Gore, Radhika Jayant. "Market reform, medical care, and public service: Dilemmas of municipal primary care provision in urban India." Thesis, 2017. https://doi.org/10.7916/D8M61XT0.
Full textAbstract:
Studies across low- and middle-income countries document quality shortfalls in both public and private sector health care. They notably highlight a “know-do” gap in primary care delivery: doctors possess requisite medical knowledge but do not expend adequate effort to treat patients. In explaining low quality, researchers have largely emphasized transactional aspects of health care, viewing doctors’ actions as shaped by their skills and incentives to perform and arguing that the micro-institutions that drive doctors’ clinical behavior are faulty.
In contrast, in this project I analyze the social and political conditions in which public sector doctors deliver primary care in urban India. Viewing the doctors as both medical practitioners and state agents, I argue that health service outcomes depend on how doctors interpret policy mandates and relate to the communities they serve. I conceptualize their actions not just as medical transactions but also as social acts, shaped by the meanings they attach to their experiences and informed by the institutional history and social imaginary of state-provided care.
During a year of ethnographic fieldwork (2013-2014), I observed clinical and non-clinical encounters of doctors employed in municipal government clinics and hospitals in a midsize Indian city; interviewed doctors, other health workers, elected officials, administrators, and staff of non-governmental organizations; and examined policies and administrative arrangements for urban health care since India’s independence.
I demonstrate that municipal doctors confront a trifecta of challenges: a legal obligation to deliver urban primary care from within an outdated urban governance structure; a largely unregulated private sector that residents widely prefer; and rising commercialization in medical practice, under which specialized medicine has crowded out primary care in popular ideas about “good” medical care. Unable to remedy the low legitimacy of their services, doctors circumscribe their actions, seeking, as one doctor put it, only to ensure the ordinary. My findings suggest that transaction-specific interventions to improve quality, such as focused on skills and incentives alone, may do little to circumvent these local effects of the policy neglect of urban health care.
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Pearce, Laurie Kathleen. "Pregnancy, class and biomedical power : factors influencing the prenatal care experiences of low-income women in an Oregon community." Thesis, 1993. http://hdl.handle.net/1957/28359.
Full textAbstract:
Low-income women in an Oregon city of approximately 35,000 inhabitants have
limited access to prenatal care services during their pregnancies. The purpose of this study
was to uncover the impacts of several factors on the experiences of twenty-seven health
department clients with public health department prenatal care practitioners and with local
private obstetricians. Ethnographic interviews were conducted with the clients, two health
department practitioners, two local obstetricians, and one local direct-entry midwife. The
focal finding that emerged from the research was that the clients preferred the care of the
health department practitioners to that of obstetricians, even though the health department
providers could not deliver the women's babies.
The major impacts on the clients' experiences included fragmented service delivery
and availability, economic and social restrictions on prenatal care options, biomedical
constructs of a healthy pregnancy, and provider role constructions and attitudes towards
Medicaid recipients and uninsured pregnant women. Local physicians' mechanistic
philosophy, professional dominance and profit orientation afforded them a narrow
understanding of the needs and identities of low-income women. Local public health
workers are less professionally autonomous than medical doctors but their service
orientation allowed them the potential to better serve low-income clients.
Based on the twenty-seven clients' perceptions of their care providers and the
services available to them, recommendations are made for more empowering,
comprehensive prenatal care services in this county. Recommended changes to the public
health system entail expanded funding for more appropriate programs and to establish
continuity of care for health department clients from pregnancy through the postpartum
period. The incorporation of direct-entry midwives into the prenatal and birthing care
options open to low-income women is also recommended. Senate Bill 1063, which creates
a process for direct-entry midwives to become state-licensed in order to be reimbursed by
the Office of Medical Assistance Programs for perinatal services, is considered in terms of
its implications for low-income women, the Oregon community of direct-entry midwives,
and the texture of Oregon reproductive health care.Graduation date: 1994
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Hagos, Zemichael Mekonen. "Evaluation of fee waiver scheme effectiveness in improving health care access to the poor segments of the population in Addis Ababa, Ethiopia." Thesis, 2019. http://hdl.handle.net/10500/27817.
Full textAbstract:
Background: Availing equitable and affordable health services for citizens is becoming a
problem for governments of developing countries. In Ethiopia, the government has been
implementing fee waiver scheme since 1998 to advance the health access by the poor,
though it is still a crucial challenge of the health sector.
Purpose: The intent of the study was to evaluate the effectiveness of fee waiver scheme
in improving access to health by the poor in Addis Ababa and to propose implementation
framework to improve its outcome.
Method: This study employed qualitative research approach to evaluate the program
effectiveness and to propose implementation framework in two phases. Exploratory and
descriptive case study designs, and Delphi techniques were utilized to evaluate the
scheme’s effectiveness and to validate the proposed implementation framework. The
researcher employed purposive and convenience sampling methods to sample the study
populations, and used Atlas ti 7.5 software to analyze the findings.
Result: This study revealed that the commencement of the scheme has benefited
considerable poor population in the city. However, its effectiveness in terms of
addressing the needy population, services coverage and protecting the poor from financial hardship is not yet achieved. Poor health facilities capacity, poor program
management and lack of comprehensive monitoring and accountability system were
found major factors that affected its success. As a result, the researcher proposed an
implementation framework with the aim of addressing these problems.
Conclusion: Achieving Universal Health Coverage without addressing the indigents’
health need is impossible. Lack of comprehensive health services, in adequate
population coverage and poor financial protection were among the major findings.
Hence, prior attentions should be given to equip health facilities with necessary
infrastructures and ensure the inclusion of all needy populations through effective
monitoring, governance and leadership mechanisms to improve its intended outcomes.
If utilized properly, the findings and the implementation framework of this study will serve
as valuable resources for immediate decisions and directions by the policy makersHealth Studies
D. Litt. et Phil. (Health Studies)
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Leventhal, Emily Anne 1972. "Factors affecting declines in Texas Medicaid enrollment." 2001. http://hdl.handle.net/2152/10677.
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Groot-de, Greef Tineke de. "Factors influencing enrolment of dairy farmers to a community health insurance for better access to health care." Diss., 2012. http://hdl.handle.net/10500/10505.
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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 TCHPHealth Studies
M.A. (Public Health)
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Johnson, Karen A. "A Syndemic Framework of Homelessness Risks Among Women Accessing Medical Services in an Emergency Department in New York City." Thesis, 2015. https://doi.org/10.7916/D8BC3Z87.
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Objective: Although factors that promote initial and recurring homelessness among inner city women have been long explored, impoverished women continue enter and re-enter shelters at troubling rates. This trend is projected to increase over time. This longitudinal study uses Sydemics as a framework to advance our understanding of the relationship between depression, PTSD, trauma and intimate partner violence and the loss of housing among impoverished women using inner city Emergency Departments. We hypothesized that depression, PTSD, childhood trauma and IPV are positively associated with homelessness at baseline and that women with higher rates of a combination of these variables (e.g. PTSD and IPV) in wave 1 will have higher odds of experiencing both an initial and repeat bout of homelessness in the second and/or third waves, controlling for all other variables in the study.
Method: Multivariate analyses and logistic regression, at baseline and longitudinally, were conducted to test study hypotheses with homelessness as the dependent variable. Six multivariate logistic regression models were used. Odds ratios (OR) with their 95% confidence intervals are reported.
Results: Depression and childhood trauma were individually associated with homelessness at the .05 level in this sample of low income women. IPV was marginally related to homelessness (p=0.0917). PTSD however was not. Importantly, although IPV and PSTD were not individually associated with homelessness in bivariate analyses, housed, never homeless women, and women who had previously experienced homelessness had a greater odd of becoming homeless than those who experienced only one of these risk variables. Specifically, housed, never homeless women who had PTSD and IPV had a 2.2 odd of becoming homeless for the first time in waves 2 and 3, whereas those who experienced PTSD only had a 1.3 odds of becoming homeless for the first time; never homeless participants who experienced IPV only a 1.7 greater odds of becoming homeless (CI.0.348, 14.84; p=0.385), adjusting for all other variables. Similarly, the odd of becoming homeless again among participants who had PTSD and experienced IPV was 1.7 whereas the odds of recurrent homelessness was 1.2 among those who experienced PTSD only and 1.1 among those who experienced IPV only (CI.0.397, 7.46; p=0.463), controlling for all other variables in the study.
Conclusion: Our findings confirm our hypotheses that low-income women who have PTSD, depression, histories of childhood trauma, and/or IPV have a higher odds of initial and recurrent homelessness when compared with women who do not have these risk variables. Our findings further confirm that women who have combinations of risk variables have even higher odds of future homelessness. Due to the low sample size of women with histories of homelessness in the study, there was lack of power. Despite this challenge, the results of these explorations (in determining heretofore unidentified effect sizes) utilizing Syndemics as a conceptual framework are promising. Future research with larger sample sizes (and sufficient power) are important to further the initial findings from this study.
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Opollo, Valerie Sarah Atieno. "Impact of HIV/AIDS scale-up on non-HIV priority services in Nyanza Province, Kenya." Thesis, 2017. http://hdl.handle.net/10321/2576.
Full textAbstract:
Submitted in fulfillment of the requirements for the degree of Doctor of Philosophy (PhD) Health Science, Durban University of Technology, Durban, South Africa, 2017.Background: The HIV pandemic has attracted unprecedented scale-up in resources to curb its escalation and manage those afflicted. Although evidence from developing countries suggests that public health systems have been strengthened as a result of scale-up, only anecdotes exist in other countries. Despite scale-up, the prevalence of HIV/AIDS is still high and the resultant mortality and morbidity demands a refocus. Furthermore, the HIV/AIDS epidemic has severely strained vulnerable health systems in developing countries leading to concerns among policy makers about non-HIV priority services. Although anecdotally, it is clear that HIV scale-up has had profound effects on health systems, available evidence does not allow for an assessment of the impact of such effects on health care access, service delivery or medical outcomes for non- HIV conditions. The aim of this study was to determine the impact of HIV/AIDS scale-up on non-HIV priority services in the former Nyanza Province, Kenya. Additionally we determined the benefits and detriments of HIV programmes, and identified the elements of successful HIV programs and their effect on scale-up and last but not least determined the perceptions, attitudes and experiences of health care staff towards scale-up and integration of health care services. The first part of the main sequential study reviewed practices during scale-up by looking at public health facilities within the Province at Nyanza in Kenya. This looked at health management information systems (HMIS) and routine health facility client records for five years, 2009-2013 with a comparison of trends in 2009 to that in 2013. This data was reviewed in order to show trends in delivery of HIV priority and non-HIV services. The second part of the study utilized a prospective cross sectional survey to determine perceptions, attitudes and experiences xi of facility personnel towards HIV/AIDS scale up. Randomly sampled facilities involved in the delivery of any aspects of HIV diagnosis care and treatment were investigated. Self-administered questionnaires and in-depth interviews were used to obtain information on impact of HIV services on non-HIV priority services on health managerial staff in the facilities and key informants who have shaped scale up. We created a qualitative codebook based on three major themes identified from the data: (1) Meaning and importance of HIV scale-up (2) Perspectives of scale-up on service delivery on non-HIV services and (Ministry of State for Planning) Health facility staff awareness. The findings indicate that the interventions that were utilized in the scale-up of HIV in 2009 resulted in significant increases in uptake of the service in 2013 (p<0.01) and total integration of HIV and non-HIV services at all the health facilities thereby contributing to improved health outcomes beyond those specifically addressed by HIV programs. This study has also shown that utilization of both HIV and non-HIV services increased significantly for both years after integrated HIV care was introduced in the health facilities (p<0.01). Notable increases were found for ANC utilization (p=0.09), family planning (p=0.09), screening for tuberculosis and malaria (p<0.01) and provision of support services (p<0.01) to HIV infected people. The scale up of HIV in the region had several human resource policy implications resulting from staff turnover and workload. Stakeholder engagement and sustainability are critical in the sustenance of these initiatives. Strategic alliances between donors, NGOs and the government underpinned the scale-up process. Policies around scale-up and health service delivery were vital in ensuring sustainability of scale- up and service integration. This study has attempted to provide evidence on the impact of HIV scale-up on non-HIV service delivery in three different settings, in two different time periods and it therefore concludes that the evidence is mixed with most of the impact being positive with some aspects that still needs development. It is critical to pursue the integration of HIV and non- HIV services in a strategic and systematic manner so as to maximize the public health impact of these efforts. The proposed model, best practices and practices requiring improvement will be communicated to the relevant ministries to ensure its integration into policy.
D
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Kennedy, Muthoka Joseph. "Exploring the practice of HIV self-testing among health care workers at Nyeri Provincial Hospital in Kenya." Diss., 2013. http://hdl.handle.net/10500/12064.
Full textAbstract:
The purpose of the study was to describe the determinants and practice of HIV self-testing
among health care workers (HCWs) in Nyeri provincial hospital, Kenya. A
descriptive cross-sectional study was conducted to determine the rate of HIV self-testing,
explore the factors influencing the practice and describe access to HIV
psychosocial support, care and treatment. The study was guided by the concepts of the
protection motivation theory. Data was collected from 348 HCWs and analysed by
means of logistic regression. Results showed that 65.8% of the HCWs had practiced
HIV self-testing among themselves. Age, self efficacy and response efficacy were found
to be significant predictors of HIV self-testing. Willingness to access HIV psychosocial
support (71.3%) and care and treatment (73.9%) was high. Self-testing is highly practiced by HCWs.HIV self-testing among health care workers at Nyeri Provincial Hospital in Kenya
HIV self-testing among health care workers
Public Health
M.A. (Public Health)
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Muthoka, Joseph Kennedy. "Exploring the practice of HIV self-testing among health care workers at Nyeri Provincial Hospital in Kenya." Diss., 2012. http://hdl.handle.net/10500/12064.
Full textAbstract:
The purpose of the study was to describe the determinants and practice of HIV self-testing
among health care workers (HCWs) in Nyeri provincial hospital, Kenya. A
descriptive cross-sectional study was conducted to determine the rate of HIV self-testing,
explore the factors influencing the practice and describe access to HIV
psychosocial support, care and treatment. The study was guided by the concepts of the
protection motivation theory. Data was collected from 348 HCWs and analysed by
means of logistic regression. Results showed that 65.8% of the HCWs had practiced
HIV self-testing among themselves. Age, self efficacy and response efficacy were found
to be significant predictors of HIV self-testing. Willingness to access HIV psychosocial
support (71.3%) and care and treatment (73.9%) was high. Self-testing is highly practiced by HCWs.Public Health
M.A. (Public Health)
41
Rasphone, Sitthiroth. "Marginal benefit incidence of public spending in Laos." Phd thesis, 2014. http://hdl.handle.net/1885/155887.
Full textAbstract:
The government of Laos has gradually increased its public spending on education and health during the last decade, aimed to eradicate poverty by 2020 and to reach the MDGs by 2015. The purpose of this thesis is to examine to what extent an increase in public spending on education and health benefits the poor. The Lao Expenditure and Consumption Survey from 2002-03 round (known as LECS III) and 2007-08 round (LECS IV) are employed in this analysis. The thesis begins with an overview of national and social development policies and examination of the pattern of public social spending and the progress of social outcomes. Then, the thesis reviews the analytical concept and literature of average and marginal benefit incidence analysis. In particular, two different methods of marginal benefit incidence of public education and health spending based on marginal odds of participation (MOP) and marginal behavioural response (MBR) are discussed and distinguished. The MBR approach combines two effects: (a) benefits received by new program participants and (b) additional benefits received by existing program participants. The MOP approach captures effect (a) alone. This thesis contains four analytical core chapters that examine the marginal benefit incidence of an expansion in public education and health programs. In the first core chapter, the marginal benefit incidence of an expansion in average participation of education and health programs is estimated using the MOP method and a cross-sectional household dataset. The next other two analytical core chapters use the MBR method to estimate the marginal incidence of public education and health spending using the panel dataset. The last analytical core chapter proposes a method for understanding the difference between, and compares the findings of, marginal incidence estimated from the MOP and MBR methods. Based on the MOP method, at the margin, the poorest quintile of the population receives a larger share of total benefits from an increase in the size of primary education and primary health care program than the richest quintile while the marginal rates of lower secondary school education and hospital health care programs are high for the richer quintiles. In contrast, the findings of marginal incidence using the MBR approach suggest the reverse conclusion compared to the findings based on MOP method. A strong effect (b) dominates the estimates of MBR, resulting in a pro-rich marginal incidence for all education and health programs. The different findings of marginal benefit incidence analysis derived from the MOP and MBR approaches depends on two factors: (i) The MOP method does not measure effect (a) correctly, because it ignores changes in program participation caused by factors other than an increase in public spending; (ii) MOP approach ignores effect (b). The results of this study show that in the case of Laos, an increase in public spending on education and health does not target the poor as well as is expected. Additional benefits received by existing program participants outweigh the benefits received by new program participants.
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Buffa, Jan L. "Medicaid prenatal care : testing the effectiveness of a prenatal intervention model." Thesis, 2005. http://hdl.handle.net/1957/29956.
Full textAbstract:
The study evaluates the effectiveness of a pregnancy intervention
model (PIM) developed to improve first trimester prenatal care utilization in a
population of 2,694 low-income Medicaid women. Engagement in prenatal care is
critical before prenatal care can occur. Early initiation of prenatal care is important
for low income pregnant women at risk for poor birth outcomes and the Medicaid
managed care organizations that enroll them. Once identified and enrolled the health
plan utilization medical management staff assessed these women for a myriad of high
risk and socially detrimental behaviors in order to facilitate, in a sensitive manner,
their access to drug treatment or any needed service. Interventions included a real
time identification, reporting, incentive model using medical informatics to
supplement existing clinical based assessment of high risk pregnant women and
nursing care coordination that included outreach, enrollment assistance, support
services, interagency coordination, home visits, transportation and medical home
assignment. A difference was found in the utilization of first trimester prenatal care
visits for all women who conceived after the intervention compared to those who
conceived prior to the intervention date. A difference was also noted in the "no
prenatal care" category due a decrease in the number of women who did not receive
prenatal care. PIM appears to be a cost effective, simple solution to a real world
problem.Graduation date: 2005
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Eliason, Erica Linn. "The Effects of Health Insurance Eligibility Policies on Maternal Care Access and Childbirth Outcomes." Thesis, 2021. https://doi.org/10.7916/d8-bwaq-kf37.
Full textAbstract:
This dissertation examines three health insurance eligibility policies and their impact on reproductive health outcomes for low-income women of reproductive age. The first paper examines the effects of expanded eligibility for Medicaid under the Affordable Care Act (ACA), on fertility among low-income women of childbearing age.
The second paper explores the effect of presumptive eligibility policies in Medicaid for pregnant women on access to prenatal care and health insurance coverage. Finally, the third paper exploits state-level differences in eligibility for public versus private insurance under the ACA, and the effects on perinatal coverage patterns, childbirth outcomes, and access to care.
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Usher, Kimberley. "The politics of health care reform: a comparative analysis of South Africa, Sweden and Canada." Diss., 2015. http://hdl.handle.net/10500/20077.
Full textAbstract:
Text in EnglishSouth Africa is currently in the process health care reform as the Government has undertaken the task of providing universal health care to all South Africans through the implementation of the National Health Insurance Scheme (NHI). This study took an in-depth look at the history and progression of the post-1994 South African health care policy, and applied the Power Resources Theory to the political economy of the current health care reform process in South Africa. Through a comparative study of the pivotal elements in the phases of health reform in Canada and Sweden this study drew lessons for the design and implementation of universal public health care provision in South Africa. This study found that a strong culture of care, strong political will, active civil society participation and a focus on equality as opposed to poverty in the creation of policy is essential to a successful implementation of universal health care.
Sociology
M.A. (Sociology)
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Usher, Kimberley Ann. "The politics of health care reform: a comparative analysis of South Africa, Sweden and Canada." Diss., 2015. http://hdl.handle.net/10500/20077.
Full textAbstract:
Text in EnglishSouth Africa is currently in the process health care reform as the Government has undertaken the task of providing universal health care to all South Africans through the implementation of the National Health Insurance Scheme (NHI). This study took an in-depth look at the history and progression of the post-1994 South African health care policy, and applied the Power Resources Theory to the political economy of the current health care reform process in South Africa. Through a comparative study of the pivotal elements in the phases of health reform in Canada and Sweden this study drew lessons for the design and implementation of universal public health care provision in South Africa. This study found that a strong culture of care, strong political will, active civil society participation and a focus on equality as opposed to poverty in the creation of policy is essential to a successful implementation of universal health care.
Sociology
M.A. (Sociology)
46
Gani, Shenaaz. "Factors influencing the financing of South Africa's National Health Insurance." Diss., 2015. http://hdl.handle.net/10500/19998.
Full textAbstract:
With the advent of the new National Health Act, health care in South Africa is at a critical point as this will be the first time in history that a National Health Insurance is being implemented in this country. Globally National Health Insurance has been around for more than a hundred years, however some countries with long established national health schemes are currently grappling with funding issues surrounding their health systems. South Africa should take note of these issues as it embarks on this journey.
The objective of this study was to perform a literature review on how South Africa’s National Health Insurance can be funded taking cognisance of the history of the country and experiences of other countries.
It is imperative for each country to achieve optimal health care funding to ensure the success and long-term sustainability of National Health Insurance. The analysis of the problems experienced by other countries revealed that balancing the three main funding options namely, allocated from the national revenue fund, user charges and or donations or grants from international organisations, is critical as the funds needed in a system to achieve coverage at an affordable cost is dependent on the current state of health care in a country. Considering South Africa’s history and current inequality in society and health care it is clear that the majority of funding for the National Health Insurance should be supplied by the national revenue fund. The required funds can either be raised by increasing existing taxes or introducing a new tax specifically aimed at financing the National Health Insurance. The use of user charges is important however, although not purely for a revenue collection point, but from a cost control point of view as well. Some studies have revealed that the lack of user charges results in a misuse of the system.Financial Accounting
M. Phil. (Accounting Science)
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Maxey, Hannah L. "Understanding the Influence of State Policy Environment on Dental Service Availability, Access, and Oral Health in America's Underserved Communities." Thesis, 2014. http://hdl.handle.net/1805/5993.
Full textAbstract:
Indiana University-Purdue University Indianapolis (IUPUI)Oral health is crucial to overall health and a focus of the U.S. Health Center program, which provides preventive dental services in medically underserved communities. Dental hygiene is an oral health profession whose practice is focused on dental disease prevention and oral health promotion. Variations in the practice and regulation of dental hygiene has been demonstrated to influence access to dental care at a state level; restrictive policies are associated lower rates of access to care. Understanding whether and to what extent policy variations affect availability and access to dental care and the oral health of medically underserved communities served by grantees of the U.S. Health Center program is the focus of this study. This longitudinal study examines dental service utilization at 1,135 health center grantees that received community health center funding from 2004 to 2011. The Dental Hygiene Professional Practice Index (DHPPI) was used as an indicator of the state policy environment. The influence of grantee and state level characteristics are also considered. Mixed effects models were used to account for correlations introduced by the multiple hierarchical structure of the data. Key findings of this study demonstrate that state policy environment is a predictor of the availability and access to dental care and the oral health status of medically underserved communities that received care at a grantee of the U.S. Health Center program. Grantees located in states with highly restrictive policy environments were 73% less likely to deliver dental services and, those that do, provided care to 7% fewer patients than those grantees located in states with the most supportive policy environments. Population’s served by grantees from the most restrictive states received less preventive care and had greater restorative and emergency dental care needs. State policy environment is a predictor of availability and access to dental care and the oral health status of medically underserved communities. This study has important implications for policy at the federal, state, and local levels. Findings demonstrate the need for policy and advocacy efforts at all levels, especially within states with restrictive policy environments.