Achieving the right of access to healthcare for persons with disabilities is a challenge in Eswatini as a result of various barriers, such as availability of services, acceptability in healthcare facilities, financial and geographical accessibility. As a means of facilitating access to healthcare for persons with disabilities, Eswatini ratified the United Nations Convention of the Rights of Persons with Disabilities and subsequently developed the National Disability Policy Reform documents. The study therefore employed a case study research design utilising multiple data sources to establish the extent to which the National Disability Policy Reforms had addressed access to healthcare for persons with disabilities. The study aimed to establish how the manner in which these reforms were developed and implemented influenced access to healthcare for persons with disabilities in Eswatini. Data Source 1 encompassed a review of the National Disability Policy Reform documents. Data Source 2 included in-depth interviews with key informants (n=7) who were involved in the development and implementation of the National Disability Reform documents. Data Source 3 included focus groups with persons with disabilities (n=5), caregivers of persons with disabilities (n=6) and healthcare professionals (n=7). Additional electronic questionnaires were conducted with healthcare professionals (n=7) as part of Data Source 3. All data were analysed using a framework approach, specifically the Integrated Disability Policy Analysis Framework. Findings of the study indicated that the National Disability Policy Reform documents had adequately addressed the availability of services and acceptability of persons with disabilities within healthcare facilities. The National Disability Policy Reform documents however neglected to consider the significant role of financial and geographical accessibility on influencing access to healthcare. Findings also revealed that while the development of the National Disability Policy Reform documents was a collaborative effort between different stakeholders, the processes of implementation of these documents was not entirely clear. As a result, the promises of the National Disability Policy Reform documents were not translating into actions as persons with disabilities lacked knowledge on the existence of the National Disability Policy Reform documents. Persons with disabilities were also not aware of their rights to healthcare, and they still experienced challenges when they had to access healthcare. A policy brief was developed to communicate the findings of the study to policy makers. Access to healthcare guidelines with pictorial support were developed to conscientise persons with disabilities, caregivers of persons with disabilities and healthcare professionals about the rights to access for persons with disabilities. Keywords: access to healthcare, disability policy, human rights, Integrated Disability Policy Analysis Framework; persons with disabilities; policy analysis / Thesis (PhD)--University of Pretoria, 2020, / University of Pretoria, Faculty of Humanities Postgraduate Funding; University of Witwatersrand Transformation Funding / Centre for Augmentative and Alternative Communication (CAAC) / PhD (AAC) / Restricted

Unhoused Individuals and Access to Healthcare Introduction & Background: The unhoused, identified as those in shelters, transitional housing, and those who sleep in unhabitable places are prone to exposure to issues such as diabetes complications, tuberculosis, and lack of insurance. This U.S. population of over 560,000 may not prioritize health due to their focus on survival. Purpose Statement & Research Question: The purpose of researching homelessness is to determine if the unhoused population who use community health resources has a better quality of life than the unhoused who do not utilize resources. Literature Review: The literature review included search terms such as unhoused, hospital admissions, homeless programs, and scientific nursing research. A broad inclusion criterion with a focus on the use of local resources within the population was utilized. The CINAHL database was searched. Each source is peer reviewed, less than 5 years old, and authored by at least one registered nurse. Findings: Findings indicate that current systems and tools for the unhoused within healthcare facilities are deficient regarding patient-centered care. Over 50% of unhoused people are male, and 60% of the unhoused seek shelter in some capacity. Trends include region, climate, and available resources. Interviews yield that the unhoused have issues seeking proper care due to a lack of understanding of healthcare systems or referral pathways. Difficulties with transportation, insurance, or perceived negative authority from providers affect this population. Conclusions & Nursing Implications: Professional hypotheses and methodology are portrayed in the viewed research. Different identification strategies and accessible health programs are necessary for this population to improve the well-being of the unhoused and the efficiency of health facilities.

A global rise in humanitarian emergencies, driven by conflict, poses significant health challenges, especially for children under five years old. While the source of such crises and the challenges affected healthcare systems face may be confined to man-made borders, the resulting spread of health problems such as antimicrobial resistant (AMR) infections and diarrheal diseases are not bound geographically. To address concerns in such dynamic environments, healthcare workers utilize simple, fast acting solutions to save as many children as possible. For diarrheal diseases, this entails initially treating with zinc supplements and oral rehydration solutions (ORS), saving antibiotics for the cases that do not respond to this treatment. Determining who needs this care is often assessed through proxy data tracked via routine vaccination records, such as “zero dose communities”. However, both protocols are not without their shortcomings. The goal of this thesis is to examine their risks. We first examine how zinc might impact resistance development in Escherichia coli in vitro. We further demonstrate by computational modeling that slight changes in fitness have disproportionate changes on the rate of resistance onset. After discovering that the use of zinc for diarrhea treatment may be contributing to the AMR crisis, we next focus on ensuring that children suffering from diarrheal diseases can access treatment. We find that using zero dose communities as a means of determining which children could access care, while suitable for other services, is ultimately insufficient for diarrheal diseases in crisis settings such as Democratic Republic of Congo, Afghanistan and Bangladesh. Finally, we look at developing a tool that could be used to better understand access to care patterns for diarrheal disease and show the impacts that conflict, weather and travel infrastructure have on altering access to care in Yemen, which has been in the midst of the world’s worst humanitarian crisis. Overall, this body of work demonstrates how both current treatment practices and access to care assessments for diarrheal diseases have previously overlooked risks which can contribute to poor health outcomes especially for children under five years old living in areas affected by humanitarian crises.

Sociological theory and literature in the study of disparities in health and access to care in old age has, with few exceptions, not considered important political contexts for the aging AI/AN community. Political histories have unique implications for this population, and particularly those in old age. Native Peoples are affected by federal old age and health policies as well as AI/AN specific policies, which creates a unique intersection of inequality for this group. This project engages with three distinct areas of sociological scholarship in this area and works to highlight the strengths and gaps of existing frameworks to work towards more inclusive scholarship for Native Peoples in sociological scholarship. The first article uses a quantitative analysis using secondary data from the National Health Interview survey to explore how helpful sociological frameworks are in explaining health disparities in old age for the AI/AN population. The second article, using the same dataset, engages with Andersen's behavioral model of care utilization and its developments and couples it with important scholarship emerging about policy, AI/AN healthcare organization, and funding. The third article offers a qualitative analysis of reports and policy recommendations from Native organizations focused on increasing well-being for Native elders to further understand how healthcare, old age, and AI/AN specific polices work to create intersections of inequality for this group. This analysis further informs future directions for sociological theory and application to promote a more inclusive field in the sociology of aging and inequality. / Doctor of Philosophy / How policy impacts aging American Indian and Alaskan Native (AI/AN) has been largely overlooked in the field of sociology. Through three distinct studies, this dissertation project seeks to connect policy to disparities in health outcomes, issues in access to care, and the provisioning of health resources for this group. Native Peoples, through treaty agreements, have a right to healthcare, which has been poorly fulfilled by the US government. Because of this, Native Tribes and organizations have increasingly relied on other healthcare policies and social welfare programs to meet the needs of AI/AN elders. Policies like Medicare, Medicaid, and the Older Americans Act are all important policies in generating health resources for Native elders, but they also overlap in ways that can also create barriers to health equity. This project, in three articles, explores 1.) how policy-based resources affect health outcomes in old age across racial groups, 2.) how equitable healthcare access for the aging AI/AN population, and 3.) how organizations understand and navigate policy landscapes in order to promote health and well-being for Native elders. These three studies work together to inform theories of aging and health disparities in order to work towards scholarship that is more inclusive of Native Peoples.

The purpose of this study was to examine community health services and HIV/AIDS awareness in rural communities in Abia State Nigeria in respect to the sociodemographic factors of level of community health services, level of education, and community leaders' influence. Two questions guided the research process: To what extent are sociodemographic factors associated with HIV/AIDS awareness, and what is the relationship between level of community health services and extent of HIV/AIDS, as perceived by residents of these communities. A mixed method paradigm was used. A sample of 131 participants, who were HIV/AIDS patients, were purposively drawn from a population of 107,488 individuals from 2 selected rural communities in Aba South, Abia State, Nigeria. The Kolmogorov-Smirnov for normality distribution at p=0.1 for all variables indicated that normality rule was not violated. Descriptive and inferential tests (Spearman's rank order correlation, analysis of variance[ANOVA], chi-square tests of independence, Fisher's exact tests, and independent sample t-tests) were carried out with SPSS V.2 software and the confident level set at 95% (α=0.05). Findings revealed no significant association between level of education, level of community health services, and influence of community leaders and extent of HIV/AIDS awareness, as perceived by residents of these communities (p>0.05). Results also indicated significant relationship between the level of community health services and the extent of risk of HIV/AIDS, as perceived by residents of these communities. A well-planned method of information dissemination on HIV/AIDS can also be used to educate rural residents in Nigeria.

There are three to five million migrant and seasonal farmworkers in the United States that work in one of the most hazardous industries. They are exposed to numerous occupational and non-occupational injuries and illnesses daily, including but not limited to, pesticide and chemical-related health conditions, heat-related health conditions, muscle and joint pain, eye injuries, diabetes, high blood pressure, obesity, and depression. Furthermore, these farmworkers also experience multiple vulnerabilities including cultural and language barriers and low socioeconomic status. A survey was administered in interview setting to characterize farmworkers’ occupational and non-occupational health conditions, their healthcare-seeking behavior, and their use of preventive measures and health education. Muscle and/or joint pain and eye injuries were the most commonly reported occupational health outcomes, and diabetes and high blood pressure were the most commonly reported non-occupational health outcomes. Farmworker participants requested more information covering prevention, management, and care for these health outcomes. There were low reports of receiving health education regarding common occupational and non-occupational health conditions. Future research efforts and next steps should focus on creating networks between healthcare providers, employers, and other organizations that serve farmworkers as well as continue to host programs that directly involve farmworkers to understand their perceptions of their health and access to healthcare.

No description available.

Background: Bariatric surgery is the most effective treatment for severe obesity, resulting in much larger and longer-lasting weight loss compared with those seen with other treatment options. It also results in significant improvements in several weight-related comorbidities. Despite these favorable outcomes, bariatric surgery remains underused in the United States. Objective: The goal of this dissertation was to investigate the impact of insurance-related factors on the access and utilization of bariatric procedures. The goal was achieved via three studies. The first study examined temporal changes in patient characteristics and insurer type mix among adult bariatric surgery patients in Southeastern Pennsylvania, as well as the associations between payer type, insurance plan type, cost-sharing arrangements (among traditional Medicare beneficiaries), and bariatric surgery utilization. The second study investigated whether there is an association between precertification criteria, such as 3-6 months preoperative supervised medical weight management (MWM), and documented 2-year weight history and the likelihood of undergoing bariatric surgery. The third study examined whether there is an association between insurance-mandated MWM requirement, as well as cardiology and pulmonology evaluations and short-term inpatient healthcare utilization. Data Source: Pennsylvania Health Care Cost Containment Council’s (PHC4) databases in Southeastern Pennsylvania during 2014-2018. Study Population: In Study 1, all adult patients in the PHC4 dataset who underwent the most common types of bariatric surgery during 2014-2018 (N = 14,348) and a 1:1 matched sample of surgery patients and those who were eligible for surgery but did not undergo surgery were identified. In Study 2, privately insured patients within the PHC4 dataset who underwent bariatric surgery in 2016 and individuals who met the eligibility criteria but did not undergo surgery were identified and 1:1 matched (N = 1,054). The population of Study 3 consisted of all adult patients within the PHC4 dataset with a diagnosis of severe obesity who underwent the most common bariatric surgical procedures in 2016 and for whom the insurance-mandated precertification requirements were known (N = 2,717). Results: Over the five years, there was an increase in the proportion of Black individuals (37.1% in 2014 vs 43.0% in 2018), Hispanics (5.4% vs 8.0%), and Medicaid beneficiaries (18.5% in 2014 vs 26.9% in 2018) who underwent surgery. The odds of undergoing bariatric surgery based on payer type were statistically different (22% smaller odds) only between Medicare beneficiaries compared to privately insured individuals. There were significantly different odds of undergoing surgery based on insurance plan type within Medicare and private insurance payer categories. Individuals with traditional Medicare plans with no supplementary insurance and those with dual eligibility had smaller odds of undergoing surgery (42% and 32%, respectively) compared to those with private secondary insurance. The insurance requirement for 3-6 months MWM was associated with smaller odds of undergoing surgery (odds ratio [OR] = 0.459, 95% confidence interval [CI] 0.253 to 0.832, P = 0.010), after controlling for insurance plan type and the requirement for documented weight history. The documented weight history requirement was not a significant predictor of the odds of undergoing surgery (P = 0.132). The requirement for MWM, as well as pulmonology and cardiology examinations, were not associated with the patient length of stay, the number of all-cause rehospitalizations, and the number of all-cause rehospitalization days, after adjusting for patient age, sex, race, ethnicity, the Elixhauser Comorbidity Score, type of the surgery, facility where the surgery was performed, primary payer type, and the estimated median household income. The absence of the precertification requirement for pulmonology and cardiology evaluations was associated with smaller odds of rehospitalizations with common cardiac and pulmonary conditions during the study period, (OR = 0.43, 95% CI 0.23 to 0.80, P = 0.008), after controlling for patient age, sex, race, ethnicity, estimated median household income, and the Elixhauser Comorbidity Score. Conclusions and Significance: Medicaid expansion in Pennsylvania appears to have improved access to bariatric surgery among Black and Hispanic individuals. Nevertheless, insurance plan type, cost-sharing arrangements, and precertification requirements, such as insurance-mandated 3-6 months of MWM requirement, remain key determinants for the access and utilization of bariatric surgery. Additionally, the MWM requirement, as well as the preoperative cardiology and pulmonology evaluations, were not associated with a reduction in inpatient healthcare utilization during the first postoperative year. Careful examination of the bariatric surgery benefit design and application of value-based insurance design to bariatric surgery may improve the access to this potentially life-saving surgery for many Americans. / Public Health

No description available.

Background: Currently, there is limited research on the importance and need for access to healthcare amongst refugee and immigrant populations in Canada. Amongst such populations are the Sri Lankan Tamils in Canada, who arrived in Canada as either refugees or immigrants due to the ongoing war in Sri Lanka in the late 1980s. Although Canada is home to the majority of Sri Lankan Tamils, there is minimal research showcasing the need and access to better healthcare for such individuals who have fled from a crisis, the civil war in Sri Lanka. As such, this study aims to assess and understand the experiences of the Canadian Sri Lankan Tamils in accessing healthcare upon their initial arrival to Canada and how these experiences have changed overtime. Methods: An Interpretative Phenomenological Analysis approach was used to conduct semi-structured interviews in English and Tamil with 8 Sri Lankan Tamil Canadians who arrived in Canada during the late 1980s and are currently between the ages of 55-75 years, residing in the Greater Toronto Areas. Interviews were transcribed and analyzed using the IPA to elicit themes. Results: The interviews revealed facilitators and challenges to access care within the past and present experiences of Sri Lankan Tamil Canadians. Past experiences revealed facilitators to access care, such as the influences of personal factors, the significance of social support systems and structural facilitators. The impacts of immigration status and acculturation in Canada were identified as barriers to access to care in the past. As for present experiences in accessing care, the degradation of the Canadian healthcare system revealed itself as a barrier to care, whereas settling down as a gradual process came up as a facilitator to accessing healthcare services. Conclusion: While Sri Lankan Tamil Canadian’s perspectives suggested facilitators in accessing care, their experiences still reveal many areas for improvement in the healthcare system for future newcomer populations in Canada. As such, these findings may have implications for policymakers who focus on refugee and immigrant health and service providers working with these populations. / Thesis / Master of Science (MSc)