Thesis (Ph.D.)--University of Central Florida, 2008. / Adviser: Aaron Liberman. Includes bibliographical references (p. 148-163).

Thesis (Ph. D.)--University of Texas at Austin, 2000. / Vita. Includes bibliographical references (leaves 195-208). Available also in a digital version from Dissertation Abstracts.

Master of Public Health - MPH / Introduction: Despite the progress that Zambia has made in reducing its maternal mortality ratio from 649 to 398 per 100,000 live births between 1996 and 2013/14, the country did not meet the Millennium Development Goal 5a target, of reducing the maternal mortality ratio by 75% (i.e. to a ratio of 162 per 100,000 live births) by the end of 2015. Thus, as is the case with many other countries, considerable challenges still remain in relation to reducing maternal mortality in Zambia. According to Zambia's Roadmap for Accelerating Reduction of Maternal, Newborn and Child Mortality (2013-2016), the continuum of care for reproductive and maternal, newborn, and child health includes integrated service delivery for mothers and children across these various time periods, and also across place: within the home, the community, and in health facilities. In this regard, a referral system plays a key role in linking the various levels at which care is provided, and the different types of services offered at these levels. In the urban district of Lusaka, Zambia, all complicated pregnancy-related cases received by health centres or clinics are referred to either Levy Mwanawasa General Hospital, or the University Teaching Hospital. However, it appears that at present those working at the primary level of care, who make such referrals up to these higher levels of care, receive no feedback on the outcome of their referrals; there are also few counter-referrals to the respective clinics in the district. With limited communication to the primary level of care, and with no formal handover of patients back to the clinics by the tertiary level institutions, it is difficult to ensure that the required continuum of care for the referred mothers and their children, post-delivery, has been established within the district. This explorative study aimed therefore to identify the strengths and weaknesses of the maternity-related referral system currently operating between primary and tertiary levels of health care in the district, and to consider how the system might be strengthened so as to support a stronger continuum of care with respect to maternal and neonatal health. Methods: Using a descriptive qualitative research approach, stakeholders involved in the planning, delivery and/or oversight of maternal and neonatal health services in the district were purposively sampled and asked to voluntarily participate in the study. Prior to all the interviews, after being informed about the study, and receiving information sheets to read through, participants were required to give informed consent. Their experiences and opinions regarding referrals and counter-referrals were collected through a series of 23 individual, semi-structured interviews. A Thematic Analysis approach was used to analyse data in this study. Ethics approval was first obtained from the Senate Research Committee, University of the Western Cape and thereafter from the Excellence in Research Ethics and Science Converge Ethical Review Board in Zambia, before proceeding with the study. Clearance was also obtained from the Ministry of Health, the Lusaka District Health Management Team and the University Teaching Hospital to facilitate entry into the health facilities. Findings: The study found that, in practice, the referral system for maternity and neonatal health does exist and is generally – but not optimally - functional in the Lusaka District. However, challenges were noted that included the fact that the district’s maternity referral system has not been revised since it was first developed in the 1980s and is not available in a comprehensive set of guidelines or standard operational procedures which explicitly outline the reasons for referral and the related referral steps and mechanisms. In addition, the referral forms currently in use in the district have not been standardised and appear to be inconsistently used by the different facilities. Interviewees reported that there were limitations in terms of the number of, and availability of ambulances, and that there was also an inadequate number of trained midwives. Limitations on the health service's infrastructure, namely, the physical space that is available, the number of delivery beds, and the limited supply of equipment place an additional burden on the staff working at both the primary and tertiary level. Conclusion: Overall, the study recommends that further research – possibly in the form of a baseline audit – be conducted so as to develop a more detailed and/or operational assessment of the actual rather than the reported level of functionality of the district's maternity referral system. Specific recommendations are also proposed for the various stakeholders who are critical role players in the referral system, namely, the clinics, the University Teaching Hospital, the Lusaka District Health Management Team, the Provincial Health Office, the Ministry of Health and Cooperating Partners.

The aim of this study is to determine the effect of two approaches of social work intervention, a continuity approach, and a team approach, upon the three dependent variables of subject satisfaction, control, and mood. In order to determine differences in outcome, subjects were administered psychological tests to determine changes in their reported sense of control and mood (hopelessness) in relation to their response to the diagnosis and treatment of cancer. At follow-up, subjects also completed a questionnaire designed to determine their satisfaction with social work services received. The amount of time spent in contact with social workers was also assessed at this time. The analysis of the relationship between these variables revealed that there were no statistically significant differences between the study groups; subjects were equally satisfied with the two approaches in social work intervention, and there were no major differences between the reported changes in mood and control by the subjects in the study groups. / Medicine, Faculty of / Population and Public Health (SPPH), School of / Graduate

Philosophiae Doctor - PhD / The continuum of care is a public health framework for improving maternal health outcomes by providing comprehensive health services, at different levels of the health system and across the lifecycle. The framework emphasizes the importance of interventions to address the social determinants of health as well, alongside healthcare services. Although the framework is useful for visualizing service organization, it has not been adequately integrated into policy and practice in South Africa. In addition, there is currently no comprehensive approach to monitor and evaluate service provision along the continuum of care. The current approach is fragmented across programs and sectors and focuses on only a handful of indicators. This research explores an approach for measurement and monitoring of a comprehensive continuum of care for maternal health in South Africa, with implications for application in other low- and middle-income countries (LMICs).

Using the methodology and criteria put forth by the Juvenile Justice Evaluation Center (part of the Justice Research and Statistics Association, Washington D.C.), an assessment for evaluation of the Metropolitan Ministries "Uplift UTM" Program was conducted using review of data previously collected by Metropolitan Ministries, examination of documents provided by the organization, participant observation, and interviews with Metropolitan Ministry staff. This assessment reveals that there are significant problems in several areas that must be addressed before their program can be formally evaluated; including data collection and organization, outcomes measures, client selection standards, and how the program is portrayed as opposed to how it is actually run. Preliminary analysis of the collected data suggests that there are no relationships between demographic information such as education, employability, or other factors, and successfully completing their program. Further analysis suggests that other factors related to rules, guidelines, and unpopular restrictions are related to the low success rate they have experienced. Based upon a literature review of successful programs, suggestions for improving the outcomes of Uplift UTM are provided.

This study investigated clients' perceptions of two approaches to ending homelessness in the United States: the Continuum of Care approach and a Housing First approach. Data were collected about perceived differences between the Continuum of Care and Housing First models of resolving homelessness. The study was conducted at an award-winning Housing First program in Los Angeles County, California. Successful completion of the Housing First approach was examined. This research employed a descriptive case study design, using multiple sources of evidence to investigate a contemporary phenomenon within its real-life context. Nine clients were interviewed who had experienced both the Continuum of Care and Housing First approaches. The clients comprised a convenience sample that was selected in collaboration with the Housing First staff. Clients' perceptions of the two approaches were obtained primarily via the use of standardized open-ended interviews and informal conversational interviews. Clients' perceptions of the two approaches suggested that clients considered the Housing First approach to ending homelessness to be more effective than the Continuum of Care approach. The Housing First approach uses engagement of the clients by staff, teaching the clients to use tools of empowerment, and finally supporting the clients into a life of self-reliance.

Our main aim with this study is to shed a light over the social workers opinions about what they believe will be the consequences of introducing Housing First in the city of Stockholm. We wanted to examine the social workers perceptions about how Housing First could change their client’s autonomy and justice. Therefor we accomplished five qualitative interviews with social workers. We analyzed our empirical material with the theoretical terms; justice, autonomy and intern role-conflict. The results and analysis showed that the social workers considered that their client’s autonomy and justice increases by the Housing First model. We also found that Housing First seems to reduce the social workers intern role-conflict. We found that the reason might be that they do not have to choose between different expectations in the same extent as when they work with the continuum of care model. The result also showed that the social workers believed that the more independent the clients are towards the social services and the social workers demands, the more dependent the clients become towards the social workers, by the means of motivation work.

Background: Viral hepatitis C (HCV) represents a major public health problem worldwide and also in the Czech Republic. There are as many as 80,000 people have been living with chronic HCV in Czechia since 2015, most of them are/were drug addicts who have been infected by contaminated syringes. Global and national efforts to eliminate HCV are currently underway, focusing primarily on improving the quality of treatment continuity (sustainability, uninterrupted treatment) which involves ensuring the availability of testing for all patients, patients' involvement in their own treatment, sustaining treatment, achieving a response rate and the necessary follow-up care. Objective: To describe the HCV continuum of care in people who inject drugs (mapping testing rate, treatment uptake and treatment completion), and to describe the factors that affect this process. Based on the collected data, to formulate recommendations for addiction care professionals in order to improve HCV continuum of care. Methodology: A questionnaire survey among clients of low-threshold centres in Prague was carried out. The convenient sample consisted of a total of 60 respondents, 20 from each of the three centres. Data were analyzed using descriptive statistics. Data collection was realised in August 2019. Results: Out of the 60...

The dissertation investigates the form of network governance in the context of U.S. homeless service networks (namely continuum of care programs; CoCs). This research examines CoC homeless service networks by applying the institutional collective action (ICA) perspectives to understand the forms of network governance as a reflection of network context. The ICA perspective has been applied to understand the rational behavior of network members for the network governance form to mitigate the collective action problems. The ICA perspective helps understand why network members accept specific governance structures with their expectation to maximize the benefits and minimize the costs and uncertainty in their process of collaboration. This dissertation uses the data of CoC networks and point in time data from the U.S. Department of Housing and Urban Development in 2019 and Census. The data developed for this study offers the homeless incidences, geographical characteristics, and governance structure based on the contact information. For an in-depth understanding, interview by CoC leaders was integrated. This dissertation consists of four essays about 1) Literature review on network governance and the theoretical argument in the ICA framework, 2) Background and network governance of the U.S. homeless service networks, 3) Factors affecting the choice of network administrative organization (NAO) form, and 4) Interviews by the representatives of CoC networks. The findings inform us of the governance structure for the effective service provisions and coordination of actions of network members and about why and how network organizations choose a form of network governance.