The profession of law enforcement is an inherently stressful job. Although the physical stress of the job is often discussed, the mental health impact on officers is often ignored, resulting in poor mental health and increased risk for suicide. The purpose of the current study was to investigate factors related to the reluctance of law enforcement officers (LEOs) to seeking treatment, as well as to gain an understanding of the prevalence rates of disorders in a law enforcement population. Convenience sampling was used to recruit participants (N = 306) across a variety of agencies. Correlation, moderated regression analysis, and structural equation modeling (SEM) was used in order to model barriers to care among officers. Findings suggest that the presence of psychological disorders was not predictive of willingness to seek treatment. However, perceived stigma did predict lower willingness to seek treatment. General conclusions suggest that increasing unit cohesion and unit support may make a positive impact in decreasing stigma and increasing officers’ willingness to seek treatment.

Evidence suggests that employment for women can reduce poverty and inequality resulting in improved living standards. The garment industry is an important source of income for Indian women. This thesis tested the effects of garment work as an income source on women’s health-care utilization practices and decision-making in comparison to both agricultural labourers and general women in India. Cross-sectional data collected from India’s National Family Health Survey-3 were used to generate descriptive statistics. Statistical modeling was used to test the effect of garment work on a) barriers to health care services and b) decision-making abilities of Indian women. Results suggest garment workers are younger, more educated, urban, and wealthier, make more cash earnings, and have more access and control over their own money as compared to agricultural labourers. Results indicate female garment workers report facing fewer barriers to accessing health care services. As well, access to cash earnings increases their decision-making abilities.

This thesis explores the barriers to mental health care that new, racialized Canadians may face. Using a case study methodology, this project first reviews the literature on identified barriers to care. Several barriers are highlighted in this process including discrimination and racism, service use, language, awareness of services and knowledge of the Canadian healthcare system, socio-economic barriers, cultural beliefs, and stigma. Interviews were conducted with three new Canadians who identify as racialized to further existing knowledge on this topic. The interviews provided a forum for participants to speak to their experiences prior to immigrating to Canada, their experiences following immigration, and their pathway to mental health care. Participants described significant events which they believed to be factors in developing a mental health problem and as a result of this, their decision-making process in help-seeking. Using the categories from the literature as a framework, themes and sub-themes were developed to understand the experiences of the participants. Additional themes that were added included employment, coping with a mental health problem, and trauma. An in-depth, line by line analysis of the interview transcripts was conducted to provide a detailed depiction of each participant’s experience. Each participant interview was defined as a case and compared with the other interviews. This thesis concludes by summarizing the results and detailing the implications for social work practice. Implications include anti-oppressive practice, cultural competence, and self-awareness. Structural and clinical implications are also discussed. / Graduate

abstract: While women in higher income countries can expect to survive a diagnosis of breast cancer, women in lower- and middle-income countries such as Bangladesh have mortality rates near 50%, suggesting that there are significant barriers to care seeking for breast problems. Given limited literature on barriers to care among native, rural South Asian populations, this study thus sought to understand 1) the impacts of breast problems on women and their families, including the extent of abuse among women with breast problems, and 2) the barriers and facilitators of care for women with breast problems in rural Bangladesh. Sixty-three study participants (43 women and 20 men) were interviewed about their experiences. Interviewers elicited barriers to care, facilitators of care, and questions about the attitudes and behaviors of family and community members were in structured interviews. The study found that breast problems and their treatment put significant resource and emotional strains on the family. Furthermore, over a third of women in this study reported abuse of some kind, with emotional abuse, neglect, and abandonment being the most frequently reported. The study reinforced barriers to care identified in the literature for South Asian populations, but only a quarter of participants reported stigma of any kind. Lack of knowledge about breast cancer and inability to pay for care were the most frequently reported barriers, followed by access to care and fear of treatment. Facilitators of care among women who received a biopsy point to the importance of support by the husband and husband’s family, as well as the ability to identify economic support for and knowledge about care. This study contributes to the understanding of two overarching themes: structural violence and the value of women, as well as how these themes influence poor outcomes for women with breast cancer in rural Bangladesh. Suggestions for future studies and short and long-term interventions to address study findings are offered. / Dissertation/Thesis / Appendix E: Study Approval / Appendix B: Barriers to Care Table / Appendix H: Codebook / Appendix C: Study Instruments 1 / Appendix C: Study Instruments 2 / Doctoral Dissertation Anthropology 2016

No description available.

By examining barriers to care, health professionals can better understand what disparities exist between groups and who may be at greater risk for poor primary care. Researchers have highlighted the need for additional research that focuses on the extent of unmet needs for U.S. children with sickle cell disease (SCD). The purpose of this quantitative study was to compare the differences between parents who are in a SCD support group and those who are not. The theoretical framework of this study is based on the chronic care model and social support theory. A total of 128 parents of children with SCD completed the study survey. The sampling occurred by e-mail, phone, and face-to-face conversations. Selection criteria for potential participants in both groups were based on their children being diagnosed with SCD. Seventy-four participants (57.8%) were members of a SCD support group, and 54 participants (42.4%) were not members of a SCD support group. In this study, the independent variables were parents attending or not a SCD support group. The t test and MANCOVA was used to assessed the association between perceptions of barriers to care and support group status. However, statistical analysis showed no significant results. The null hypothesis was not rejected. Therefore, the positive social change implication is to further explore potential factors that may shape perceptions of barriers to care for those with SCD so that perceived barriers to care can be overcome.

Former United States military members have consistently faced mental health concerns post discharge from the military. Some researchers have argued that the use of mental health services by veterans does not parallel the prevalence and need of such services (Hoge, Castro, Messer, McGurk, Cotting, & Koffman, 2004; Milliken, Auchterlonie, & Hoge, 2007; Vogt, 2011). Reasons why veterans do not access mental health care are varied and broad, however, they tend to be consistent with explanations rooted in the stigma of mental health care, and in the barriers that prevent the use of mental health care. The degree of the impact of factors contributing to stigma and barriers to mental health care is not fully understood. Particularly lacking from previous research is an examination of how the education received while in the military about mental health symptoms and treatment impacts the likelihood that a service member will access care. In the current study, I used theories of stigma and barriers to care outlined by Overton and Medina (2008) to examine the relationships among demographic characteristics, self-reported diagnoses of common mental health disorders that veterans experience, and likelihood of accessing mental health care based on the education received while in the military with self-reported levels of stigma and barriers to care in a sample of 355 former military service members from several branches. Multiple regression analyses were used to examine the relationships among these variables. Results revealed statistically significant relationships among gender, age, self-reported diagnosis of depression, the impact of education, and stigma. Results also revealed statistically significant relationships among employment and barriers to care. In addition, stigma was found to have significant relationships with the positive impact of education, and the likelihood of accessing care. Lastly, results revealed that when in the presence of the mediation variable impact of education, stigma was no longer associated with the likelihood veterans would access care post discharge.

Despite the fact that the United States spends more per capita than any other nation on healthcare for its citizens, the quality of American health outcomes lags well behind every other developed country in the world. This paper proposes that it is no coincidence that the United States is also the only developed nation that does not guarantee the right comprehensive coverage of medical services for its citizens. Instead, we rely on a fee-for-service system which functionally denies quality health care to those without the means to pay for it. In this paper I document the experiences of various clients and staff of the Center, a torture survivor treatment and support agency, the majority of whose clients are or were refugees or political asylees, with the healthcare systems in the United States and elsewhere. I also analyze documented differences in the efficiency, efficacy, and levels of satisfaction with these foreign health care systems to that of the United States. The barriers to good quality health care experienced by the participants in this research are systemic, rather than individualistic, in nature. I therefore argue that the American ideology of health as a commodity to be bought and sold directly contributes to the inferior health outcomes of the United States health care delivery system, as compared to other nations whose ideology of health holds it to be a universal human right.

Unga som varken arbetar eller studerar (UVAS) är en grupp som fått alltmer uppmärksamhet i Sverige och Europa. Att unga vuxna är utan sysselsättning kan få konsekvenser både för samhället med höga kostnader men även för den unga själv i form av psykiskt och socialt lidande. Tidigare forskning visar på att unga som varken arbetar eller studerar är en heterogen grupp med individuella behov, samt att psykisk ohälsa är vanligt förekommande inom målgruppen. Denna studie syftar till att undersöka vad unga vuxna med erfarenhet av att vara UVAS samt professionella som arbetar med UVAS anser är orsak till att bli UVAS, hinder till hjälp för att ta sig ur sin situation och psykiska ohälsa samt förslag på hur fler UVAS kan få hjälp. Studien har utförts genom en kvalitativ metod med semistrukturerade intervjuer. De intervjuade är sju professionella som på något sätt arbetar med UVAS samt tre unga med erfarenhet att vara UVAS. Studien utgår från ett systemteoretiskt perspektiv och Bronfenbrenners ekologiska modell. Resultatet har analyserats genom tematisk analys. Resultaten visar att UVAS-gruppen är heterogen och att orsaker till att bli en UVAS varierar och att flera orsaker kan påverka- och förstärka varandra. Orsaker som framkommer är bland annat svårigheter i skolan, oroliga hemförhållanden samt psykisk ohälsa. Hinder för UVAS att få hjälp finns enligt studiens empiri på både strukturell- och individuell nivå. Exempel på hinder som framkommer är långa väntetider inom psykiatrin, att det inom skolan saknas resurser för individanpassat stöd, stigmatisering av psykisk ohälsa samt en social ångest som gör det svårt för UVAS att ta sig utanför hemmet. Förslag som finns för att fler UVAS ska få hjälp att ta sig ur sin situation och psykiska ohälsa är bland annat förbättrad samverkan mellan myndigheter och verksamheter, individuellt anpassat stöd, alternativa undervisningssätt i skolan samt fler lättillgängliga hälsovårdstjänster. / Young people not in education, employment or training (NEET, which is comparable with UVAS in swedish) is a group which has received more and more attention in Sweden and Europe. Young people who neither work or study is a problem both on society level with high costs for the society as well as on an individual level in form of poor mental health and social suffering. Previous research shows that NEET is a heterogeneous group with individual needs, and that poor mental health is common in the group. This study aims to investigate what young adults with experience of being NEETs as well as professionals who work with NEETs consider to be the reason of becoming NEET, barriers to get help to get out of their situation and poor mental health and suggestions on how more NEETs can get access to help. The study has been conducted through a qualitative method with semi-structured interviews. The respondents are seven professionals who work with NEETs and three young people with experience of being NEET. The study is based on a system theoretical perspective and Bronfenbrenner's ecological model. The results have been analyzed through thematic analysis. The result shows that NEET is a heterogeneous group and that causes of becoming NEET vary and can affect each other. Causes that emerge include difficulties in school, troubled home conditions and poor mental health. Example of barriers that emerge are long queues to get help from the psychiatry, lack of resources in schools for individualized support, stigmatization of poor mental health and social anxiety. Suggestions to help more NEET to get out of their situation and poor mental health includes improved collaboration between authorities and welfare services, individually adapted support, alternative teaching methods in the school and more accessible health care services.

PURPOSE: Sickle cell disease (SCD) is an inherited blood disorder that affects the hemoglobin protein of red blood cells and has a significant impact on morbidity, mortality, and quality of life. Hydroxyurea has been FDA approved since 1998 as a disease-modifying therapy for SCD. However, hydroxyurea has not been optimally utilized for those with SCD. The purpose of this study was to evaluate reasons for hydroxyurea use, from the perspectives of providers, adults with SCD, and parents/caregivers of children with SCD, as well as perceived barriers to its use. We examined indications and reasons for being “on hydroxyurea,” defined by patients as currently taking hydroxyurea, and reported on pain frequency, perceptions of barriers, hydroxyurea adherence, and health care access for patients with SCD who were either on and not on hydroxyurea. METHODS: We conducted a cross sectional analysis of data collected within the Pacific Sickle Cell Regional Collaborative (PSCRC), a consortium of nine western U.S. states. Individuals were eligible for this study if they 1) had a confirmed diagnosis of SCD, 2) were followed at one of the PSCRC sites, and 3) were eligible for hydroxyurea therapy. Parents/caregivers of children with SCD less than 18 years and adults with SCD 18 years and older completed a brief survey about hydroxyurea use, indications, side effects, pain frequency, number of hospital and emergency department (ED) admissions per year, and individual and family perceptions of barriers to hydroxyurea use. Participants completed a follow-up survey annually, but we reported only on baseline data. Data collection occurred between February 2016 and May 2018. RESULTS: Individuals with SCD (n = 413) included 1) children (n=178; 6.7 ± 3.4 years), 2) adolescents (n=66; 15.0 ± 1.4 years), 3) young adults (n=57; 21.4 ± 2.6 years), and 4) adults (n=112; 39.2 ± 10.6 years). The majority were predominantly female (51.6%), African American (93.2%), and had HgbSS (74.1%) genotype. The majority of children (65.2%), adolescents (62.1%), and young adults (54.4%) were on hydroxyurea; fewer adults (39.3%) were on hydroxyurea. The majority with HgbSS (65.5%) were adherent to hydroxyurea. There was no significant difference in hospitalizations for pain, ED visits, and pain severity in the previous 12 months between individuals who were and were not on hydroxyurea, and between individuals who were and were not adherent to hydroxyurea. For those with a current prescription for hydroxyurea, the majority (66.5%) were receiving hydroxyurea for recurrent pain episodes or acute chest syndrome (19.9%). Hydroxyurea was discontinued because of patient/family preference (34.5%), chronic transfusions (31.1%), and side effects (24.1%). Patients prescribed hydroxyurea for empiric use (n=21) had fewer hospitalizations for pain, ED visits, and severe pain interfering with daily activities. The major barriers to hydroxyurea use, from the perspective of individuals with SCD or their caregivers, were 1) forgetting to take the medicine (19.4%), 2) worried about side effects (16.4%), and 3) lack of knowledge about hydroxyurea (13.6%). Fewer young adults (49.1%) and adults (50.0%) had primary care providers than children (78.1%) and adolescents (65.2%). CONCLUSIONS: Barriers to hydroxyurea use persist with emerging solutions to alleviate these barriers. For this sample, while hydroxyurea prescription rates by sickle cell specialists were similar to what has been seen in some other studies, neither hydroxyurea use nor adherence were associated with decreased frequency of hospitalizations for pain, ED visits, and severe acute pain episodes in the previous 12 months. Future studies need to evaluate hydroxyurea prescription patterns, duration on hydroxyurea, and adherence to hydroxyurea. Healthcare providers are recommended to prescribe hydroxyurea for eligible individuals who may benefit from it, such as those HgbSS or HgbS-β0 thalassemia genotype, and prescribe for empiric use to minimize complications. Provider and patient education about hydroxyurea could reduce common barriers experienced by individuals with SCD. It is important to customize educational resources to specific concerns for different age groups. Individuals 18 years and older with SCD have been documented with more ED visits and hospitalizations due to pain, most likely because they did not have a primary care provider and an adult hematologist with expertise in SCD. Future studies need to evaluate whether primary care providers who receive SCD education may promote hydroxyurea use and adherence. Dedicating time and resources for shared decision making between providers and patients/families can address concerns about hydroxyurea and increase patient/family confidence when deciding about hydroxyurea. As more disease-modifying therapies become available for individuals with SCD, strategies for shared decision making facilitate standardization and optimize the use of hydroxyurea and emerging therapies.