Tesi: "Public Health and Health Services"

1

Faust, Linda A. "AIDS Public health implications /". Instructions for remote access. Click here to access this electronic resource. Access available to Kutztown University faculty, staff, and students only, 1991. http://www.kutztown.edu/library/services/remote_access.asp.

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Thesis (M.P.A.)--Kutztown University of Pennsylvania, 1991.
Source: Masters Abstracts International, Volume: 45-06, page: 2940. Abstract precedes thesis as [2] preliminary leaves. Typescript. Includes bibliographical references (leaves 94-100).

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Munro, Catherine A. M. "Developing a dialogue on health : user involvement in health and health services". Thesis, University of Glasgow, 2008. http://theses.gla.ac.uk/291/.

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In common with other areas of public services, recent years have seen a shift in the National Health Service (NHS), with increased power and authority transferring from professionals towards the users of services. As a result, user involvement has come to form a central element of government policy on public services, and health in particular, with a series of specific policy commitments to give users a stronger voice and to involve them in the health service having been published by both the Westminster and Scottish parliaments. These seek to increase users’ involvement in making decisions about their own care and treatment, in examining and improving the quality of services and in policy and planning activity. In doing so, this policy aspires to respond to the changing culture of personal and societal expectations of health and the health service; to build democratic participation in the difficult targeting and rationing decisions faced by health agencies and, thus, to help renew public trust and strengthen confidence in the NHS. These are ambitious aims with far-reaching implications as they represent a transformation in the interaction between users, health professionals and health policy makers. This thesis examined how this policy has been understood and implemented in the NHS by exploring the scope, relevance and quality of the user involvement processes available in three health service settings. In order to develop a better understanding of the issues in user involvement it explored the nature of user participation; the character of user representation and the barriers and facilitators to user involvement in maternity, gynaecological oncology and mental health services. The study examined the response to this policy within these three settings; the functioning of existing user involvement mechanisms and their capacity to involve users in determining their individual health care and in shaping health services and policy to their definition of need. From this examination it defined the key features of a model process for user involvement within the professional service culture and organisational ethos of the NHS. The study then drew conclusions on the capacity of these current user involvement processes to deliver on the policy directive to develop both individual treatment and health services in ways that are responsive and accountable to users. Finally, the thesis identified those areas that require further research before proposing the lessons for the further development of this significant and potentially influential policy directive.

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3

Yrjälä, Ann. "Public health and Rockefeller wealth : alliances strategies in the early formation of Finnish public health nursing /". Åbo : Åbo Akademi University Press, 2005. http://catalogue.bnf.fr/ark:/12148/cb40236478x.

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4

Saramunee, Kritsanee. "General public views on community pharmacy services in public health". Thesis, Liverpool John Moores University, 2013. http://researchonline.ljmu.ac.uk/6170/.

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Community pharmacists are increasingly providing public health services in response to government policies. Published literature regarding the views of the general public related to pharmacy public health services, although important in ensuring uptake of these services, was limited. This study series aim to explore the general public's perspective on how to maximise the appropriate utilisation of community pharmacy services for improving public health. A large study comprising four sequential phases was designed and conducted in Sefton borough. Initially, to gather background information, focus group discussions (FGDs) and semi-structured interviews were undertaken with the general public and key stakeholders. The second phase involved the development and testing of a questionnaire extracted from the qualitative findings and a literature review. The questionnaire focused upon seven pharmacy public health services related to cardiovascular risks as well as views on factors influencing pharmacy use and advertising/promotion techniques. Geodemographic concepts, widely recognised in public health, were also included to identify potential benefits to pharmacy practice research. Next, a large scale survey was administered among the general public using eight survey modes, to additionally evaluate the range of methods available/for gathering public views. Finally, survey findings were evaluated by representatives of survey respondents using a FGD. Results indicated that, although stakeholders considered that community pharmacy can make an extensive contribution in supporting public health, pharmacy public health services are used at a relatively low level by the general public and awareness of services is also low. Survey respondents indicated a willingness to use services in the future. Important factors influencing pharmacy use include loyalty, location and convenient accessibility. Appropriate promotional campaigns are a key facilitator to help raise the public's awareness. The findings will help the profession to increase uptake of pharmacy public health services. The variety of survey modes used proved beneficial in obtaining diverse population demographics, with street survey being the optimal technique, however, the potential for social desirability bias must be considered with this and other interviewer-assisted approaches. MOSAIC™ as a geodemographic tool is potentially useful in helping to target services for specific groups and is recommended for use in further research.

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5

Carter, Nakia, e Rick Wallace. "Collaborating with Public Libraries, Public Health Departments, and Rural Hospitals to Provide Consumer Health Information Services". Digital Commons @ East Tennessee State University, 2007. https://dc.etsu.edu/etsu-works/8682.

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East Tennessee State University Quillen College of Medicine Library (ETSUQCOML) developed a training program to enable public libraries, public health workers, and rural hospital staff to be consumer health information providers. Four NN/LM-developed classes were taught to public libraries. Regional public library directors were invaluable in obtaining the concurrence of their boards for release time for class attendance. Classes were also developed for the public health workforce and rural hospital staff. Five-hundred thirty-three students attended the classes. Fifty-two public library workers will receive the MLA's Consumer Health Information Specialist certification. Thirty-one public libraries have joined NN/LM. All ordered MedlinePlus marketing materials for their libraries from InformationRx.org.

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6

Baker, Stephanie. "Staff and service user experiences of forensic mental health services". Thesis, University of Warwick, 2017. http://wrap.warwick.ac.uk/90135/.

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This thesis consists of three chapters. Chapter one is a systematic review of the qualitative literature examining the experiences of clinicians working in mental health services with forensic service users (FSU). Following systematic searches and a process of quality assessment, a total of 14 articles were included and their findings were systematically compared. Staff members experienced both positive and negative emotional responses to their work, there are conflicting aspects to their role and additional challenges within the organisational context. Implications for clinical practice and further research are discussed. Chapter two uses Interpretative Phenomenological Analysis (IPA) to consider the experiences of FSUs diagnosed with Personality Disorder (PD) in Forensic Services and the meaning given to recovery within their accounts. The findings discuss the disempowered position of FSU participants and suggest that feeling safe within relationships in their environment is important for those with this diagnosis. There was evidence in their accounts of attempts to establish new identities but there also appeared to be multiple barriers to this. Chapter three offers a reflective account of the researcher’s experience of carrying out this study. It demonstrates the reflexive strategies used that allowed the competing subjective roles alongside that of ‘researcher’, to be examined and their influence on the research process explored.

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7

Eastman, Martha Anne. ""All for Health for All": The Local Dynamics of Rural Public Health in Maine, 1885-1950". Fogler Library, University of Maine, 2006. http://www.library.umaine.edu/theses/pdf/EastmanMA2006.pdf.

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8

Beatty, Kate, Michael Meit, Emily Phillips e Megan Heffernan. "Rural Health Departments: Capacity to Improve Communities' Health". Digital Commons @ East Tennessee State University, 2017. https://dc.etsu.edu/etsu-works/6838.

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Local health departments (LHD) serve a critical role in leveraging internal and community assets to improve health and equity in their communities; however, geography is an important factor when understanding LHD capacity and perspective. LHDs serve a critical role in leveraging internal and community assets to improve health and equity in their communities; however, geography is an important factor when understanding LHD capacity and perspective. Data were obtained from the NACCHO 2013 National Profile of Local Health Departments Study. LHDs were coded as “urban”, “micropolitan”, or “rural” based on Rural/Urban Commuting Area codes. Results demonstrate that rural LHDs differed from their urban counterparts. Specifically, rural LHDs relied more heavily on state and federal resources and have less access to local resources making them more sensitive to budget cuts. Rural LHDs also rely more heavily on clinical services as a revenue source. Larger rural LHDs provide more clinical services while urban health departments work more closely with community partners to provide important safety net services. Small rural LHDs have less partners and are unable to provide as many direct services due to their lack of human and financial resources. LHDs residing in urban communities were 16.6 times (95% confidence interval [CI], 5.3-52.3) and micropolitan LHDs were 3.4 times (95% CI, 1.1-11.3) more likely to seek PHAB accreditation than rural LHDs.

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9

Garske, Gary L. "Continuity planning for local public health agencies in northern Wisconsin : providing essential public health services after displacement /". Connect to online version, 2009. http://digital.library.wisc.edu/1793/37472.

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10

Werneck, Heitor. "Income-Related Inequalities in Utilization of Health Services among Private Health Insurance Beneficiaries in Brazil". Thesis, The George Washington University, 2016. http://pqdtopen.proquest.com/#viewpdf?dispub=10145789.

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Background: Throughout the twentieth century, Brazil developed a Social Health Insurance, providing coverage to formal workers and their dependents. In 1988, the country implemented a health reform adopting a National Health Service model, based on three core principles, universal coverage, open-ended benefit package and striving for health equity. During this transition, formal workers recomposed their privileged access to healthcare through private health insurance, resulting in a two-tier system represented by those with dual coverage—public and private—and those who must rely exclusively on the public insurance. Private health insurance coverage has a positive correlation with income, however, between 1998 and 2008 private coverage expanded vigorously among the poor, while remained stable among the rich. The health equity literature in Brazil consistently reports the presence of relevant inequalities in utilization of health services favoring privately insured individuals. A gap in this literature, however, is to determine whether inequalities in utilization of health services remain among insured individuals, i.e., does private insurance improve access regardless of individuals’ income?

Methods: The study relies on Andersen’s behavioral model as a theoretical framework to analyze data from two rounds (1998 & 2008) of a national household survey, assessing levels of utilization of fourteen dependent variables across income quintiles and calculating concentration indexes as summary measures of inequality. Dependent variable distributions across income are standardized by need using the indirect method. Concentration curves compare the evolution of inequality during that time. Curve dominance is formally tested between survey years. Decomposition analysis identifies the most relevant contributors to inequality. Physician services are analyzed as the probability of having a physician visit and the number of physician visits. Hospital services are analyzed as the number of hospital admissions, the probability of having a hospitalization, and the number of hospital days during the last hospitalization. The latter two variables are broken down according to their financing source, either public (SUS) or private insurance.

Results: Physician services present very low inequalities, although a statistically significant positive gradient persists in both survey rounds. Poor PHI beneficiaries have an advantage compared to national levels. SUS financed hospitalizations are a rare phenomenon among privately insured individual but strongly concentrated on the poor. Poor PHI beneficiaries utilize private hospital at lower levels than the rich. Compared at a national level, they are at a disadvantage. In 1998, this was not the case, suggesting that insurers may be developing mechanisms to deter hospital utilization among the poor. Premium value and income are the most relevant contributors to inequality in physician and hospital services.

Conclusions: The Brazilian government (ANS) needs to monitor utilization levels across income and develop policies to increase accountability of PHI products particularly preventing insurers from purposefully pushing their beneficiaries to use SUS hospitals. Greater availability on insurance policies segmented as ambulatory care only and inpatient services only would increase the range of options for consumers that could sort more adequate coverage according to their capacity to pay and healthcare needs.

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11

Scheu, Linda L. "Household health care expenditure and health services utilization decisions in Honduras". Thesis, The University of Arizona, 2003. http://hdl.handle.net/10150/278809.

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This study utilizes national household income and expenditure data from Honduras, collected by the Honduran Central Bank in 1998--99, to examine two distinct health issues. First a tobit censored regression model is estimated to identify the variables that affect monthly household expenditures on health. This analysis is then used to examine income elasticities for health goods. Secondly, a nested bivariate probit model is used to study the socio-economic and demographic variables that influence a Honduran household's decision to seek health services attention when a household member is acutely ill and, consequently, how they then choose between public and private health services.

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12

Lavoie, Josée G. (Josée Gabrielle). "Public health politics in Nunavik health care : shared concepts, divergent meanings". Thesis, McGill University, 1993. http://digitool.Library.McGill.CA:80/R/?func=dbin-jump-full&object_id=69633.

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In Nunavik, the question of self-determination in health care is becoming increasingly embedded in the community health discourse, which is used by both health planners and Inuit alike to negotiate diverging positions. While health planners envision northern health care as a subset of the Quebec system, Inuit perceive it as a vehicle to ends that transcend conventional health issues. This thesis will provide an overview of the development of Nunavik health services since the James Bay agreement, focusing on how the use of the community health discourse serves to promote, but also shapes and limits regional and community self-determination.

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13

Gremu, Chikumbutso David. "Building an E-health system for health awareness campaigns in poor areas". Thesis, Rhodes University, 2015. http://hdl.handle.net/10962/d1017930.

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Appropriate e-services as well as revenue generation capabilities are key to the deployment and the sustainability for ICT installations in poor areas, particularly common in developing country. The area of e-Health is a promising area for e-services that are both important to the population in those areas and potentially of direct interest to National Health Organizations, which already spend money for Health campaigns there. This thesis focuses on the design, implementation, and full functional testing of HealthAware, an application that allows health organization to set up targeted awareness campaigns for poor areas. Requirements for such application are very specific, starting from the fact that the preparation of the campaign and its execution/consumption happen in two different environments from a technological and social point of view. Part of the research work done for this thesis was to make the above requirements explicit and then use them in the design. This phase of the research was facilitated by the fact that the thesis' work was executed within the context of the Siyakhula Living Lab (SLL; www.siyakhulaLL.org), which has accumulated multi-year experience of ICT deployment in such areas. As a result of the found requirements, HealthAware comprises two components, which are web-based, Java applications that run in a peer-to-peer fashion. The first component, the Dashboard, is used to create, manage, and publish information for conducting awareness campaigns or surveys. The second component, HealthMessenger, facilitates users' access to the campaigns or surveys that were created using the Dashboard. The HealthMessenger was designed to be hosted on TeleWeaver while the Dashboard is hosted independently of TeleWeaver and simply communicates with the HealthMessenger through webservices. TeleWeaver is an application integration platform developed within the SLL to host software applications for poor areas. Using a core service of TeleWeaver, the profile service, where all the users' defining elements are contained, campaigns and surveys can be easily and effectively targeted, for example to match specific demographics or geographic locations. Revenue generation is attained via the logging of the interactions of the target users in the communities with the applications in TeleWeaver, from which billing data is generated according to the specific contractual agreements with the National Health Organization. From a general point of view, HealthAware contributes to the concrete realizations of a bidirectional access channel between Health Organizations and users in poor communities, which not only allows the communication of appropriate content in both directions, but get 'monetized' and in so doing becomes a revenue generator.

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Wykoff, Randy, e Kate E. Beatty. "Poverty & Health". Digital Commons @ East Tennessee State University, 2018. https://dc.etsu.edu/etsu-works/6859.

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Adeniran, Olayemi, e Kate E. Beatty. "The Role of Public Health Funding and Improvement of Health Status of Rural Communities". Digital Commons @ East Tennessee State University, 2017. https://dc.etsu.edu/etsu-works/6863.

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Local Health Departments (LHDs) are administrative unit of a local or state government, concerned with the health of a community or county. There are approximately 2,800 agencies or units that meet the profile definition of LHD. These LHDs vary in size and composition depending on the population they serve. However, all these communitybased agencies share a common mission of “protecting and improving community wellbeing by preventing disease, illness, and injury while impacting social, economic, and environmental factors fundamental to excellent health”. One of the ongoing challenge of a focus on community-level, population-based prevention is the manner in which local public health agencies have been funded. Most LHDs funding comes from federal funds, supplemented by state and local funds. Many of these funds come to LHDs through competitive grants programs. This study was therefore undertaken to investigate the sources of funding for the Local Public Health Agencies, according to geography specifically rurality. We utilized the data already compiled by the National Association of County & City Health Officials (NACCHO) in 2013. The population served by these health agencies were compared to the funding sources, and one –way ANOVA to estimate the significance between these variables. Our dependent variables were assigned to be the funding sources, while the independent variables were the two population categories –rural and urban. A categorical variable reflecting three levels of rurality was constructed using RUCA codes. “Urban” included census tracts with towns with populations >50,000. “Large rural” included census tracts with towns of between 10,000 and 49,999 population and census tracts tied to these towns through commuting. “Small rural” included census tracts with small towns of fewer than 10,000 population, tracts tied to small towns, and isolated census tracts. Furthermore, we also determined the proportion of revenue from these funding sources received by these three population groups. All analyses were completed using SPSS. There were no differences in the amount of revenues received by both the large and small rural and urban agencies from the State & Federal sources (p value = 0.182). However, urban agencies receive more funding from Medicare and Medicaid services (19.9%) compared to small rural with 6.9% (p<0.001). Comparatively, the amount of revenue generated by rural agencies is just a fraction of what the urban agencies generate. Residents of rural areas in the United States tend to be older and poorer, report more risky health behaviors, have more barriers to accessing health care, and have worse health status and health outcomes than do their urban counterparts. These rural LHDs have fewer resources and face strenuous challenges in carrying out their activities of keeping the community safe due to limited revenues. Until public health agencies are firmly connected to payment and funding mechanisms across the health system, communities, the overall health system and accountable care organizations will not see the true benefits of population-focused, community-based, prevention services.

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Jallow, M., Melanie Haith-Cooper, Jae Hargan e M.-C. Balaam. "A systematic review to identify key elements of effective public health interventions that address barriers to health services for refugees". Springer, 2021. http://hdl.handle.net/10454/18444.

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Yes
Aim: Refugees often face barriers to accessing health services, especially after resettlement. The aim of this study is to identify key elements of effective public health interventions that address barriers to health services for refugees. Methods: Key online databases were searched to identify studies published between 2010 and 2019. Six studies met the inclusion criteria: two qualitative, one quantitative and three mixed-methods studies. An adapted narrative synthesis framework was used which included thematic analysis for systematic reviews. Results: Five themes were identified: peer support, translation services, accessible intervention, health education and a multidisciplinary approach. Conclusion: These key elements identified from this review could be incorporated into public health interventions to support refugees’ access to health services. They could be useful for services targeting refugees generally, but also supporting services targeting refugee resettlement programmes such as the Syrian resettled refugees in the UK. Future research is needed to evaluate the impact of public health interventions where these elements have been integrated into the intervention.
The full-text of this article will be released for public view at the end of the publisher embargo on 23 Mar 2022.

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Meit, Michael, e Kate E. Beatty. "The Changing Role of Public Health. State Office of Rural Health Regional Partnership Meeting, Region B". Digital Commons @ East Tennessee State University, 2016. https://dc.etsu.edu/etsu-works/6842.

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18

Suksiriserekul, Somchai. "The cost-utility analysis of some Thai public health programmes". Thesis, University of York, 1994. http://etheses.whiterose.ac.uk/9822/.

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Beatty, Kate, Paul Campbell Erwin, Ross C. Brownson, Michael Meit e James Fey. "Public Health Agency Accreditation among Rural Local Health Departments: Influencers and Barriers". Digital Commons @ East Tennessee State University, 2018. https://dc.etsu.edu/etsu-works/6822.

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Objective: Health department accreditation is a crucial strategy for strengthening public health infrastructure. The purpose of this study was to investigate local health department (LHD) characteristics that are associated with accreditation-seeking behavior. This study sought to ascertain the effects of rurality on the likelihood of seeking accreditation through the Public Health Accreditation Board (PHAB). Design: Cross-sectional study using secondary data from the 2013 National Association of County & City Health Officials (NACCHO) National Profile of Local Health Departments Study (Profile Study). Setting: United States. Participants: LHDs (n = 490) that responded to the 2013 NACCHO Profile Survey. Main Outcome Measures: LHDs decision to seek PHAB accreditation. Results: Significantly more accreditation-seeking LHDs were located in urban areas (87.0%) than in micropolition (8.9%) or rural areas (4.1%) (P < .001). LHDs residing in urban communities were 16.6 times (95% confidence interval [CI], 5.3-52.3) and micropolitan LHDs were 3.4 times (95% CI, 1.1-11.3) more likely to seek PHAB accreditation than rural LHDs (RLHDs). LHDs that had completed an agency-wide strategic plan were 8.5 times (95% CI, 4.0-17.9), LHDs with a local board of health were 3.3 times (95% CI, 1.5-7.0), and LHDs governed by their state health department were 12.9 times (95% CI, 3.3-50.0) more likely to seek accreditation. The most commonly cited barrier was time and effort required for accreditation application exceeded benefits (73.5%). Conclusion: The strongest predictor for seeking PHAB accreditation was serving an urban jurisdiction. Micropolitan LHDs were more likely to seek accreditation than smaller RLHDs, which are typically understaffed and underfunded. Major barriers identified by the RLHDs included fees being too high and the time and effort needed for accreditation exceeded their perceived benefits. RLHDs will need additional financial and technical support to achieve accreditation. Even with additional funds, clear messaging of the benefits of accreditation tailored to RLHDs will be needed.

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Wolfe, Ingrid. "Child Health, Health Services and Systems in UK and other European countries". Doctoral thesis, Karlstads universitet, Institutionen för hälsovetenskaper, 2015. http://urn.kb.se/resolve?urn=urn:nbn:se:kau:diva-35856.

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Background This work in child population medicine describes child health problems, increases knowledge of health services, systems, and wider determinants, and makes recommendations for improvements. Aims To explore trends in UK child health and health service quality and highlight policy lessons from the UK and other European countries To study child health and health services in western Europe and derive lessons from different approaches to common challenges To enhance knowledge on child to adult transition care To describe trends in UK and EU15+ child and adolescent mortality and seek explanations for deteriorating UK health system performance, and make recommendations for improving survival Methods Population level measures of health status and system performance; primary and secondary research on policies and practice for health system assessments. Quantitative: mortality rate trends, excess deaths, DALYs, healthcare processes Qualitative: case reports, system descriptions, analyses Results European child survival has improved, but variably between countries. The UK has not matched recent EU mortality gains. There are 6,000 excess deaths annually in children under 15 years in EU14 countries. There are child survival inequities; countries investing in social protection have lower mortality. Children in the UK, compared with other EU countries, are more likely to be poor than adults. Non-communicable diseases are now dominant causes of child death, disease, and disability. Mortality, processes, and outcomes of healthcare amenable conditions varies between countries. Better outcomes seem to be associated with flexible health care models promoting cooperation, team working, and transition. Conclusions Child health in Europe is improving, but unevenly. Child health systems are not adapting sufficiently to meet needs. Recommendations are made for improving health systems and services.
How do European countries compare when it comes to child health statistics? How do different child health services, systems, and wider determinants impact long term influences for good or harm? Why do some countries seem to do better than others in safeguarding their children’s and young people’s health and wellbeing? And what can we do to make things better for children? This thesis explores some of these difficult but important issues, and despite describing some serious signals of concern about child health, offers recommendations and clear ways forward for countries to ensure healthier futures for children.

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Christian, Carmen Sue. "Access in the South African public health system: factors that influenced access to health care in the South African public sector during the last decade". University of the Western Cape, 2014. http://hdl.handle.net/11394/4211.

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Magister Commercii - MCom
The aim of this mini-thesis is to investigate the factors linked to access in the South African public health sector - using General Household Survey Data - in order to contribute to a better understanding of the role of access in achieving the National Department of Health’s primary goal of universal coverage. Even though the multi-dimensional interpretation of health system performance has gained acceptance and traction in recent years, much of the research linked to it remains supply-focused. The implicit truth is that demand-side health issues are largely ignored, under-researched and ominously absent from health policies. This is particularly true with regard to the access dimension of health performance, where research and policy focus almost exclusively on availability and affordability perspectives of access while neglecting demand-side aspects of health-seeking behaviour, such as acceptability. The study, therefore, pursues an in-depth exploration of access across its three dimensions - availability, affordability and acceptability - in the South African public health sector and aims to empirically investigate access to public health care from 2002 to 2012. It also identifies the underlying reasons for the observed trends, supplementing and reorienting the current understanding of access to public health care. The empirical findings reveal mixed results: it supports current literature by suggesting that equity has been achieved in terms of making public health care services more affordable, especially for the most vulnerable groups of South African society. However, acceptability and availability issues persist. It is safe to say that the availability of public health care – mainly a supply-side issue – is being addressed in the South African context with Government taking steps to address it. Unfortunately the same attention has not been given to issues of acceptability on the demand-side. Failure to fully understand the demand-side dimension of access and the role health-seeking behaviour plays in public health issues threatens to weaken health policies aimed at improving access. It is imperative that demand-side aspects of health-seeking behaviour and institutional responsiveness to health-demand occupy a more prominent role in South African public health debates, research and policy.

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Beatty, Kate, e Michael Meit. "Opportunities and Challenges Facing Rural Public Health Agencies". Digital Commons @ East Tennessee State University, 2018. https://dc.etsu.edu/etsu-works/6835.

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23

Liao, Hsin-Chung. "The Association of Spatial Accessibility to Health Care Services with Health Utilization and Health Status Among People with Disabilities". Cleveland State University / OhioLINK, 2010. http://rave.ohiolink.edu/etdc/view?acc_num=csu1295035743.

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24

Podoba, John E. "Unmet needs for community services among the elderly : impact on health services utilization". Thesis, McGill University, 2004. http://digitool.Library.McGill.CA:80/R/?func=dbin-jump-full&object_id=85636.

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Seniors 75 years of age and older, the majority of whom live in the community, constitute a segment of the population that is vulnerable to loss of autonomy. Indeed many community dwelling seniors have difficulty performing daily living activities, such as bathing, toileting, walking, preparing meals and housekeeping.
In the setting of a population based cohort study of community-dwelling seniors 75 years of age or older, we examined the effect of unmet needs for community services for activities of daily living (ADL) and instrumental activities of daily living (IADL) on health services utilization. Self-perceived unmet need status was determined using a baseline in-home interview. A total of 839 subjects were recruited from the Greater Montreal Region, Quebec, Canada, using random telephone number dialling.
Health services utilization data were obtained from administrative databases from the Quebec Health Insurance Board (Regie de l'Assurance-Maladie du Quebec - RAMQ). Multivariable negative binomial regression models were used to examine the association between unmet need status and health services utilization during the six month period following the baseline interview.
The results of this study indicate that unmet needs are associated with higher rates of emergency department visits, hospitalization and prescription drug use. No statistically significant association was found between unmet needs and physician utilization among single seniors, although married seniors with unmet needs in activities of daily living had 2.8 times the rate of medical specialist visits as compared to those who reported no unmet ADL needs.
Unmet need for community services among the elderly has implications for the use of more expensive acute and long-term health care services. The results of this research suggest that developing programs to address unmet needs in the elderly population can potentially reduce health services utilization by the elderly.

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Cancino, Ramon Samera. "Health services utilization of adult dual eligible patients with mental health illness, 2011". Thesis, Boston University, 2014. https://hdl.handle.net/2144/21129.

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Thesis (M.S.H.P.)
BACKGROUND: Dual eligible (DE) patients qualify for Medicare and Medicaid. There are approximately nine million DE patients in the United States, and healthcare costs for this population totaled 319.5 billion dollars in 2011. Behavioral health illness (BHI) is a risk factor for increased healthcare service utilization. The healthcare utilization of adult DE patients <65 years of age with BHI has been studied sparsely. This study sought to describe the adult DE patient population <65 years of age at an urban academic safety net health center and compare hospital and emergency department (ED) utilization of those with and without BHI. METHODS: The study was a secondary analysis of hospital administrative data. Inclusion criteria were patients with Medicare and Medicaid between ages 18 and 65 years, who utilized Boston Medical Center between 1/1/2011 and 1/1/2012. The independent variable was diagnosis of BHI, and the dependent variables were hospital admission and ED utilization. Chi-square and Wilcoxon rank-sum tests were used for descriptive statistics on categorical and continuous variables, respectively. Greedy propensity-score matching without replacement with a caliper distance of half of a standard deviation was used to control for confounding factors. Rate ratios (RR) and confidence intervals (CI) were determined after matching and after adjusting for those variables that remained significantly different after matching. RESULTS: Pre-propensity-score matched data showed significant differences in age, sex, race/ethnicity, marital status, education, employment, physical comorbidities, and Charlson Comorbidity Index score. Post-propensity-score matched analysis found significant differences in sex, Hispanic race, and other education and employment status. As compared to those patients without BHI, patients with BHI had RR 2.07 (CI: 1.81- 2.38) (p<.0001) of hospital admission and a RR 1.61 (CI:1.46-1.77) (p<.0001) of ED utilization. After adjustment, RR for hospital admission and ED utilization remained significantly different and even increased slightly, RR 2.14 (CI: 1.87-2.46) (p<.0001) and RR 1.64 (CI:1.49-1.81) (p<.0001), respectively. CONCLUSION: As compared to DE patients without BHI, those with BHI had significantly more hospital admission and ED utilization, even after controlling for confounding factors. Results suggest interventions for decreasing healthcare services utilization in this population should focus on those DE patients with mental health illness.
2031-01-01

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26

Lee, Jae Chul. "Health disparities in access to health care for older people with disabilities". Diss., Connect to online resource - MSU authorized users, 2008.

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Thesis (Ph.D.)--Michigan State University. Rehabilitation Counselor Education , 2008.
Title from PDF t.p. (viewed on July 2, 2009) Includes bibliographical references (p. 128-144). Also issued in print.

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Chau, Fangxiao Leena Wu. "Examining the delivery of mental health services in primary care and public health collaborations using a population health framework". Thesis, University of British Columbia, 2016. http://hdl.handle.net/2429/59989.

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Background: More than 6.7 million people in Canada experience a mental illness during a one-year period. Mental illnesses are highly influenced by the determinants of health, which are the social, economic, and physical environments that contribute to an individual’s health status. Addressing mental illnesses requires a population health approach involving joint action across multiple sectors to focus on the determinants of health. This thesis examines the extent to which Primary Care (PC) and Public Health (PH) collaborations incorporated a population health approach to address mental illnesses. Methods: A secondary analysis of data collected through a multi-province (British Columbia, Ontario, Nova Scotia) study that examined factors related to strengthening primary health care through PC and PH collaboration was conducted. Focus group data from four cases of PC-PH collaborations that addressed mental health were used to examine whether mental health activities incorporated a population health approach, as well as to identify the enablers and barriers to carrying out the activities. A qualitative descriptive approach and thematic analysis were used. A coding framework and themes were developed deductively, based on the Public Health Agency of Canada’s population health framework, and through inductive analysis. Results: Twenty-nine themes and eighteen subthemes were identified that correspond to the Public Health Agency of Canada’s population health framework. Key enablers included working in a multidisciplinary team, addressing the determinants of health, and engaging the community. Key barriers were poor data systems, a lack of service integration, and a lack of action on demonstrating accountability for outcomes. Conclusions: Findings highlighted the relevance of a population health approach and demonstrate that certain aspects of the population health framework are more actionable than others in the area of mental health, thus identifying areas for the framework’s further development. The research also identifies enablers and barriers to conducting mental health activities, offering guidance on how to facilitate population health implementation. The results could help provide insight at the program and policy levels for PC and PH as well as other sectors related to collaborative strategies that could strengthen the delivery of mental health services by incorporating a population health approach.
Medicine, Faculty of
Graduate

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Bartlett, Ben. "Origins of persisting poor Aboriginal health an historical exploration of poor Aboriginal health and the continuities of the colonial relationship as an explanation of the persistence of poor Aboriginal health /". Connect to full text, 1998. http://setis.library.usyd.edu.au/~thesis/adt-NU/public/adt-NU1999.0016/index.html.

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Thesis (M.P.H.)--Dept. of Public Health & Community Medicine, Faculty of Medicine, University of Sydney, 1999.
"An historical exploration of poor aboriginal health and the continuities of the colonial relationship as an explanation of the persistence of poor aboriginal health " Includes bibliographical references (leaves 334-349).

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Hsu, Tsung-Ta David. "Public Health Ecosystem Services and Potential Concerns of Freshwater Wetlands". The Ohio State University, 2015. http://rave.ohiolink.edu/etdc/view?acc_num=osu1439487401.

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30

Fleming, Robin Jo. "The role of school health services in reducing health and educational disparities : examining usage rates of student health services in the Seattle School District /". Thesis, Connect to this title online; UW restricted, 2008. http://hdl.handle.net/1773/7735.

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Beatty, Kate, Randy Wykoff e M. White. "Poverty & Health in Tennessee". Digital Commons @ East Tennessee State University, 2020. https://dc.etsu.edu/etsu-works/6858.

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Hanna, Elizabeth Gayle. "Environmental health and primary health care : towards a new workforce model /". Access full text, 2005. http://www.lib.latrobe.edu.au/thesis/public/adt-LTU20061110.152550/index.html.

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Thesis (Ph.D.) -- La Trobe University, 2005.
Research. "A Thesis submitted in total fulfilment of the requirements for the degree of Doctor of Philosophy [to the] School of Public Health, Faculty of Health Sciences, La Trobe University, Bundoora, Victoria". Includes bibliographical references (leaves 255-293). Also available via the World Wide Web.

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33

Pannarunothai, Supasit. "Equity in health : the need for, and the use of, public and private health services in an urban area in Thailand". Thesis, London School of Hygiene and Tropical Medicine (University of London), 1993. http://researchonline.lshtm.ac.uk/4646511/.

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The 'sun-rise' industry of private health care, especially private hospitals, in Thailand throws many questions to the health policy forum. Will the growth of the private health sector reduce public health expenditure, or will it increase total expenditure on health? The focus of this study is on equity in health and health care: in a country where private expenditure dominates total health expenditure and the government lets the private health sector flourish, in this scenario, are the poor or the underprivileged the victims of this limited privatisation policy? The main research objective was to assess the equity of coverage of public and private health in an urban area in order to identify policies of promotion and regulation which would lead to an equitable and efficient health service system. The study used Phitsanulok municipal area as a model to develop policy recommendations for other urban areas. There were three main methods of data collection: general household survey, health diary plus household health interview and a one-day bed census of patients in public and private hospitals in the municipality. The first two methods employed multi-stage random sampling with clusters of 12 and 3 households, respectively, as smallest sampling units and these neighbourhood households were divided into three groups to represent each season in a year. The main findings were that inequalities in health existed among different household income, education and occupational groups, including these attributes of the education and occupational groups adjusted according to the household head. Unequal accessibility to health care seemed to affect both reported rates of illness within the past two weeks and hospitalisation during the past 12 months. Inequity of health care financing was obvious in that the underprivileged (the poor, the uninsured and underinsured) paid out of pocket as a percentage of their household income higher sums than the privileged groups. The private health sector (private clinics and private hospitals) was the major provider of health care to urban dwellers for both outpatient and inpatient services. Users of public facilities were the lower income groups and civil servants, while users of the private health sector were the higher income groups, the higher occupational groups and the younger age groups. Inpatients of private hospitals were more likely to be covered by health benefit schemes (civil servant benefit, private insurance, etc.) than inpatients of public hospitals. Information on the utilisation and financing pattern of private health services reconfirmed inequity of health care financing. It is obvious that the Thai health care system needs changes to reduce inequity in health and health care. Universal coverage is a way towards more equitable health care financing. While Thai citizens (in urban areas) have enjoyed a wide choice of health utilisation, a public competition model could be applied to the public health sector to make public services more competitive and more efficient.

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34

Schira, Norma. "A Survey of Health Promotion Activities of Health Systems Agencies". TopSCHOLAR®, 1986. http://digitalcommons.wku.edu/theses/1980.

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The National Health Planning and Resources Development Act. Public Law 93-641, the last major step in the regulation of the health care system, created a network of health system agencies and state level health planning agencies. Subsequent legislation, the Health Planning and Resources Development Amendment 1929, Public Law 96-79, amended 1974 Law and changed the role and function of health systems agencies to include more regulatory activities. By 1981, the activities of Health System Agencies were being curtained by the action of the Reagan administration. The Health promotion/wellness movement which seeks to improve health has been developing as a compliment to medical medicine for several years. Previous research has determined that health systems agencies were active in health promotion and identified several planning and implementation activities related to this involvement. This is a survey of health systems agencies to determine their efforts in healthy promotions. Resources allocated to these activities, and opinions of the director relevant to agency involvement in health promotion. All active healthy system agencies listed in the 1980. Directory of Health System Agencies (DHSH) were surveyed by a mailed questionnaire. Reponses were receive from 112 agencies (57%) and the respondents were found to be representative of the population. The results revealed health systems agencies to be involved in health promotion. More than 90 percent of the responders listed some type of health promotion activity in their Healthy System Plans for the 1979-1980 planning year. Approximately half of the responders reported some community activity in health promotion. The majority of executive directors saw health systems agencies as being only moderately effective in controlling health care costs: considered healthy promotion as a viable means of controlling health care cost: and believed that modifications of individual life-styles had the greatest potential for improving health status. The survey revealed that Healthy System Agencies did not restrict the wellness/health promotion activities to traditional health facilities, but were defining health broadly and working with a variety of agencies to develop services.

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Walton, Kellana C. "Public Mental Health Spending, Services and Policy in Hamilton County, Ohio". University of Cincinnati / OhioLINK, 2012. http://rave.ohiolink.edu/etdc/view?acc_num=ucin1342104465.

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36

Kanu, Alhassan Fouard. "Health System Access to Maternal and Child Health Services in Sierra Leone". ScholarWorks, 2019. https://scholarworks.waldenu.edu/dissertations/7394.

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The robustness and responsiveness of a country's health system predict access to a range of health services, including maternal and child health (MCH) services. The purpose of this cross-sectional study was to examine the influence of 5 health system characteristics on access to MCH services in Sierra Leone. This study was guided by Bryce, Victora, Boerma, Peters, and Black's framework for evaluating the scaleup to millennium development goals for maternal and child survival. The study was a secondary analysis of the Sierra Leone 2017 Service Availability and Readiness Assessment dataset, which comprised 100% (1, 284) of the country's health facilities. Data analysis included bivariate and multivariate logistic regressions. In the bivariate analysis, all the independent variables showed statistically significant association with access to MCH services and achieved a p-value < .001. In the multivariate analysis; however, only 3 predictors explained 38% of the variance (Rï¿½ = .380, F (5, 1263) = 154.667, p <.001). The type of health provider significantly predicted access to MCH services (Î² =.549, p <.001), as did the availability of essential medicines (Î²= .255, p <.001) and the availability of basic equipment (Î²= .258, p <.001). According to the study findings, the availability of the right mix of health providers, essential medicines, and basic equipment significantly influenced access to MCH services, regardless of the level and type of health facility. The findings of this study might contribute to positive social change by helping the authorities of the Sierra Leone health sector to identify critical health system considerations for increased access to MCH services and improved maternal and child health outcomes.

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Quashie, Komlan Charles. "An analysis of the impact of public expectations on mental health care". Thesis, University of Huddersfield, 2000. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.327182.

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Kneeshaw, Jack. "Consulting the public : involving consumers and citizens in health care decision making". Thesis, University of Essex, 2003. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.268872.

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39

Mayanja, Rehema. "Decentralized health care services delivery in selected districts in Uganda". Thesis, University of the Western Cape, 2005. http://etd.uwc.ac.za/index.php?module=etd&amp.

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Decentralization of health services in Uganda, driven by the structural adjustment programme of the World Bank, was embraced by government as a means to change the health institutional structure and process delivery of health services in the country. Arising from the decentralization process, the transfer of power concerning functions from the top administrative hierachy in health service provision to lower levels, constitutes a major shift in management, philosophy, infrastructure development, communication as well as other functional roles by actors at various levels of health care. This study focused its investigation on ways and levels to which the process of decentralization of health service delivery has attained efficient and effective provision of health services. The study also examined the extent to which the shift of health service provision has influenced the role of local jurisdictions and communities. Challenges faced by local government leaders in planning and raising funds in response to decentralized health serdelivery were examined.

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Kildea, Sue. "Birthing business in the bush : it's time to listen /". Electronic version, 2005. http://adt.lib.uts.edu.au/public/adt-NTSM20051006.180714/index.html.

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41

Temmers, Lynette. "Factors influencing the collaboration between community health workers and the public primary health care facilities in delivering primary health care services". University of Western Cape, 2019. http://hdl.handle.net/11394/7655.

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Master of Public Health - MPH
Community health workers (CHWs) are integral to improve Primary health care (PHC) coverage, utilising their unique skills within the community to make services accessible and equitable. PHC is the cornerstone of the National Health Insurance (NHI) Bill for the provision of Universal Health Care (UHC). The Department of Health (DOH) in the Western Cape, South Africa, has set priorities and requirements for the provision of funding to Non-profit organisations (NPOs) for forming coalitions with the Health Department to deliver various aspects of health care. The post-2015 agenda of the Sustainable Development Goals (SDGs) are underscored by a strong sense of intersectoral collaboration to work together to attain sufficient and sustainable progress. Collaboration between CHWs and PHC facilities is important in aligning goals and activities to ensure a comprehensive and sustainable approach to ensuring UHC

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42

Veenstra, Gerry. "Social capital and regional health governance in Saskatchewan, Canada /". *McMaster only, 1998.

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43

Bennett, Cudjoe A. "Urban Health Systems Strengthening| The Community Defined Health System for HIV/AIDS and Diabetes Services in Korogocho, Kenya". Thesis, The George Washington University, 2016. http://pqdtopen.proquest.com/#viewpdf?dispub=10146927.

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Background: Low- and middle-income countries have been experiencing unprecedented rates of urbanization. Rapid urbanization has attributed to an upsurge in non-communicable diseases, such as diabetes, cardiovascular diseases, and cancers in these countries. Most low- and middle-income countries are also still struggling to control communicable diseases such as HIV/AIDS, tuberculosis, and malaria. This phenomenon, described as the double burden of disease, places greater strains on urban health systems and vulnerable urban populations, such as slum dwellers, who are likely to bear the brunt of any negative health outcomes. Given the potential impacts of urbanization and quality of health services on poverty and disease in the urban poor, there is urgent need to study urban health systems and the ways in which services can be made more available, accessible, and acceptable to socioeconomically disadvantaged and culturally/ethnically diverse populations.

Objectives: This dissertation is a case study that investigated the community-defined health system for Korogocho slum residents in Nairobi, Kenya. Specifically, the purpose of the research study was to (1) determine the readiness of health workers to provide HIV- and diabetes-related services, (2) define the components of the health system as perceived by Korogocho residents; that is, determine the community-defined health system, (3) assess the factors that affect health service utilization with respect to HIV/AIDS and diabetes prevention, care, and treatment, and (4) make recommendations for improving the availability, accessibility, and acceptability of health services for Korogocho residents.

Methods: The case study research employed both quantitative and qualitative methods. Three complementary peer-review quality manuscripts were developed. Manuscript 1 presents results from one of the first assessments of health provider readiness to provide HIV/AIDS- and diabetes-related services using data from the Demographic and Health Survey’s Kenya Service Provision Assessment. A cross-sectional quantitative study was conducted. Readiness was defined as health workers having the training to provide the minimum HIV/AIDS services as prescribed by key government policies. Data analysis was conducted using STATA version 13 to assess the readiness of health workers in terms of a weighted proportion of providers from facility levels 2-4 who were trained in essential HIV/AIDS- and diabetes-related services according to Kenya’s national guidelines. Manuscript 2 details the results of a qualitative inquiry to understand the community-defined health system and identify factors that influence Korogocho residents’ health utilization behavior, especially in relation to HIV/AIDS and diabetes services. Manuscript 3 utilized a qualitative assessment to determine the role of informal health providers (those who have not received a Western biomedical model of medical training) in health service delivery to the Korogocho community. In both Manuscripts 2 and 3, semi-structured interviews were conducted with community members and informal health providers, respectively. Qualitative sampling was conducted with the purpose of generating a conceptual model of the urban health system for slum residents. Analysis of semi-structured qualitative interviews with community members and informal health providers in Manuscripts 2 and 3 was completed through an iterative process using NVivo 11 for Mac.

Results: The results of this research demonstrate the complexity of urban health systems. Korogocho residents utilize health services from a variety of facilities and providers from both the formal and informal sectors. Their health utilization behavior is primarily influenced by the availability, accessibility, and acceptability of health services, health facilities, and health providers. Informal health providers play a critical role in terms of expanding the availability and accessibility of health services to Korogocho residents. The results of this case study also reveal that training levels of health providers in Nairobi for the delivery of HIV- and diabetes-related services are low. On average, 12% of health workers interviewed in the 2010 Kenya service provision assessment reported having training in the previous 2 years in the full complement of essential HIV-related services as prescribed by Kenyan Government policies. There were similar low proportions of training for the provision of diabetes-related services among the three health worker cadres included in this analysis of the 2010 Kenya service provision assessment. Moreover, the community’s perceptions of the availability and accessibility of diabetes services lagged behind HIV services.

Conclusions: The results of this research reveal key information that can impact the health systems strengthening agenda, particularly for improving the availability and accessibility of health services to the urban poor. It is also clear from this research that there is an urgent need to scale up the training of health providers to handle the current double burden of disease. Further, among socioeconomically disadvantaged populations, such as urban slums, the intentional incorporation of informal providers into the health system is a key step towards ensuring that much needed health services reach the urban poor.

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Holbrook, Hannah Mead. "Referral Patterns and Service Provision in Child Protective Services: Child, Caregiver, and Case Predictors". ScholarWorks @ UVM, 2019. https://scholarworks.uvm.edu/graddis/921.

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Child maltreatment, and recurrent maltreatment in particular, occurs at an alarmingly high rate. Frequency of reports to Child Protective Services (CPS) is associated with negative psychological outcomes, and children whose reports are unsubstantiated experience similar risk of behavioral, emotional, and substance use disorders as those whose reports are substantiated. Prior research has demonstrated that children with no CPS reports and children with one CPS report showed no significant differences in rates of maltreatment perpetration or substance use in adulthood, suggesting that prevention efforts after one report may have strong merit in reducing negative outcomes in adulthood. However, patterns and risk factors of unsubstantiated reports have been only minimally explored thus far, despite having been found to predict subsequent maltreatment. The current study extends upon previous research by (a) examining both substantiated and unsubstantiated reports to identify longitudinal patterns of timing and recurrence and (b) assessing the extent to which service provision mediates long-term recurrence after each type of report. Analyses were conducted using subsamples of a longitudinal national dataset from 2011-2015 containing data from CPS reports for 3,655,951 children. Measures included child, caregiver, and CPS case characteristics obtained at the time of first report in 2011. Latent class analysis of referral patterns indicated four classes of recurrence patterns: (1) 2011 unsubstantiation followed by moderate recurrence, (2) 2011 unsubstantiation followed by low recurrence, (3) 2011 substantiation followed by moderate recurrence, and (4) 2011 substantiation followed by low recurrence. Multinomial logistic regression with most likely class membership as the outcome variable indicated that domestic violence, caregiver substance abuse, and poverty were better predictors of initial substantiation status than of long-term recurrence. Prior victimization was predictive of initial substantiation status as well as long-term recurrence. Asian American race predicted low rates of recurrence. Latent class analysis of service provision revealed only two classes: a class of children who received services and a class of children who did not. Service provision partially mediated associations between initial substantiation status and five-year maltreatment recurrence, as measured by number of subsequent reports, number of subsequent substantiated reports, and number of subsequent years in foster care. Limitations are considered and implications of using predictive modeling to drive service prioritization are discussed.

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Kim, Uriel. "Health Services Access and Cancer Disparities Among Low-Income Ohioans". Case Western Reserve University School of Graduate Studies / OhioLINK, 2020. http://rave.ohiolink.edu/etdc/view?acc_num=case1586799590015602.

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Tran, Duong T. "Queensland Health multicultural and language services policy statements and public oral health care for Vietnamese community in the Brisbane South Health Region /". [St. Lucia, Qld.], 2006. http://www.library.uq.edu.au/pdfserve.php?image=thesisabs/absthe19497.pdf.

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Beatty, Kate, Michael Meit, Tyler Carpenter, Amal Khoury e Paula Masters. "Clinical Service Delivery Disparities along the Urban/Rural Continuum". Digital Commons @ East Tennessee State University, 2015. https://dc.etsu.edu/etsu-works/6847.

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background: Rural communities face numerous health disparities related to health behaviors, health outcomes, and access to medical care. LHDs serving rural communities have fewer resources to meet their community needs. The number and types of community organizations (hospitals, health clinics, not-for-profits), available to partner with may be limited geographically. These factors may affect availability of clinical services in rural communities. This study will assess LHD clinical service delivery levels based on rurality. data sets and sources: Data were obtained from the NACCHO 2013 National Profile of Local Health Departments Study. LHDs were coded as “urban”, “micropolitan”, or “rural” based on Rural/Urban Commuting Area (RUCA) Both “micropolitan” and “rural” categories are considered rural by the Federal Office of Rural Health Policy. analysis: Bivariate analysis for 25 clinical services offered by rurality . For each service, we compared the proportions of LHDs that: 1) directly performed, 2) contracted with organizations, and 3) reported that the service was provided independently by organizations in the community. principal findings: Analyses show significant differences in patterns of clinical services offered, contracted or provided by third parties based on rurality. LHDs in micropolitan areas provided more services directly than urban and rural LHDs (p≤0.001). Urban LHDs were more likely to contract with other organizations (p≤0.001). conclusions: Rural LHDs are less likely to offer, contract, or have services provided by another organization in the community, whereas larger rural (i.e., micropolitan) jurisdictions are more likely to directly provide these services. implications for public health practice and policy: Lower levels of clinical service delivery by rural LHDs may contribute to the access issues facing rural communities. Health care reform brings threats and opportunities for LHD clinical service delivery. Further analyses to assess impacts on rural LHDs and identify strategies to ensure access to clinical services is encouraged.

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Severance, Jennifer Jurado Eve Susan Brown. "A survey of collaborative efforts between public health and aging services networks in community health centers in Texas". [Denton, Tex.] : University of North Texas, 2009. http://digital.library.unt.edu/permalink/meta-dc-10984.

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Bruce, Rebecca. "Barren River District Health Department Health Education/Risk Reduction Demonstration Projects". TopSCHOLAR®, 1989. https://digitalcommons.wku.edu/theses/2172.

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In July 1980, the Barren River District Health Department (BRDHD), serving eight counties (combined population approximately 204,000) in Southcentral Kentucky, was selected as a demonstration site under the auspices of the federal Health Education Risk Reduction (HERR) Program. With continued HERR funding for eight years, the BRDHD developed several successful health promotion projects. Major components of these projects include: 1) community health promotion, which serves to identify high -risk groups in the community and provide them with health education-health promotion services, 2) school health education which included the development of a preschool health education curriculum, 3) teacher education workshop, which instructs primary and secondary public school teachers in health education methods, 4) smoking cessation. and 5) a large industrial wellness program. This study reports on an eight year program evaluation of the HERR demonstration. Overall, the program evaluation suggests an increase in health knowledge and some attitude and behavior change for many of the participants ii BRDHD programs.

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Smark, Ciorstan. "Pound foolish accounting's role in deinstitutionalisation /". Access electronically, 2002. http://www.library.uow.edu.au/adt-NWU/public/adt-NWU20060404.123052/index.html.

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