Orientadores: Debora Isane Ratner Kirschbaum, Claudinei Jose Gomes Campos / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-12T04:07:58Z (GMT). No. of bitstreams: 1 Dos-Santos_EdirleiMachado_M.pdf: 2381971 bytes, checksum: b0e79c9b0ffafa4cd6f143208f095dc1 (MD5) Previous issue date: 2008 / Resumo: Este estudo apresentou como objeto de investigação a visão dos usuários do Sistema Único de Saúde acerca da visita domiciliária como instrumento de trabalho dos membros da equipe de saúde da Estratégia Saúde da Família (ESF). Seu objetivo foi analisar o significado da visita domiciliária para o usuário que recebe os trabalhadores da ESF no seu domicílio. Trata-se de uma pesquisa descritiva e exploratória de abordagem qualitativa. A investigação foi desenvolvida no município de Fernandópolis, localizado no noroeste do Estado de São Paulo, pertencente ao Departamento Regional de Saúde - DRS XV de São José do Rio Preto. O município apresentava em 2007, uma população de 61.392 habitantes, contando com nove Unidades de Saúde da Família, das quais duas foram escolhidas como campo de pesquisa. Os sujeitos selecionados são membros de famílias da área adscrita que recebem a visita domiciliária dos trabalhadores da ESF e os indivíduos que estabelecem o primeiro contato com os últimos, quando estes realizam a visita domiciliária. Para a coleta de dados foi utilizada a técnica de entrevista aberta. Na análise dos dados foi empregada a Análise de Conteúdo na Modalidade Temática. Duas unidades temáticas foram construídas a partir dos núcleos de sentido: 1ª) A visita domiciliária e o trabalho da equipe da Estratégia Saúde da Família sob a ótica do usuário e 2ª) A visão dos usuários sobre a Estratégia Saúde da Família como possibilidade de acesso aos serviços de saúde. A análise dos dados demonstrou que os usuários dos serviços da ESF acreditam ser a visita domiciliária uma garantia de acesso aos serviços públicos de saúde e apontam a sua satisfação com relação à presença dos trabalhadores no seu domicílio e das ações executadas por estes neste cenário. / Abstract: This study aims to investigate the view of the Brazilian Public Health System (SUS) users about domiciliary visiting, as a working instrument for the Family Health Strategy (FHS) team members. Its objective is to analyze the domiciliary visits significance for the individuals who receive the FHS workers in their homes. The descriptive and inquiring research herein has been developed within a qualitative approach. This investigation was carried out in Fernandópolis, a small city localized in Northwest of the São Paulo State, liable to the Regional Health Department (DRS XV) of the São José do Rio Preto County. In 2007, the population of this small city was of 61.392 inhabitants counting on nine Family Health units. Among those, two were chosen as research field. The selected subjects are family members from the related area, who receive domiciliary visits of the FHS workers and the individuals that establish their first contact with the last. The data collection was made by means of open interviews, and for the data assessment the content was analyzed within a Thematic Mode. Two thematic units were structured on core sense. 1st: The domiciliary visit and the Family Health Strategy team work in the user's view and 2nd: The user's vision about the Family Health Strategy as a possible access to health services. The data assessment evinced, that FHS service users believe the domiciliary visit to be an access guarantee to public health services and express their satisfaction about the presence of the workers in their homes and the actions taken by them within this scenario. / Mestrado / Enfermagem e Trabalho / Mestre em Enfermagem

Quality of health care delivered in the public sector remains a major challenge with diminishing resources to meet the increasing health care demands. Improvements in quality health care are identified in the Department of Health’s strategic framework as a key challenge. In order to improve quality, one needs to measure it. The patients’ views are important in identifying what is important to them. Inexpensive, easy to collect metrics need to be developed to measure quality of care. The study investigated perceptions of patients as a reflection of quality of care provided. The study also determined the key success factors in quality care in emergency departments and priorities of quality of care for improvement. A prospective study was conducted using one of Gauteng hospitals’ emergency departments as a case study. A structured questionnaire based on an overall care index focusing on specific dimensions of patients’ experience with health care was used to collect the data. Quantitative analysis was done using the Epi Info statistical package and the results summarised in frequency diagrams and tables. The findings indicate that waiting time is a major factor in perception of quality of health care. Although other hospitality issues in health care are important to patients, the degree to which they affect perception of quality of health care is difficult to determine because of the overwhelming influence of waiting time. It is recommended that priorities in addressing what users really want from health care should concentrate on strategies to shorten the waiting time. It is further recommended that a similar study be carried out in future once the waiting times have been improved considerably thus eliminating its excessive influence. This may highlight other variables important to the patients that may need to be improved in order to improve quality of care. / Dr. Susan Jennifer Armstrong

Abstract The purpose of the present study was to analyse and describe the health behaviour among the male population in the Kainuu region in Finland, to chart the men's attitudes towards health services and find out how they talked about their health behaviour. The objective was to produce new, cultural information about how to develope health services, and in addition to shed light into the health behaviour among the men living in the Kainuu region. The research material consisted of 20 thematic biographical interviews. The interviewees were 36–56-year-old men who were born, and currently living in the Kainuu region. In the study, the biographical method was applied, and the interviewees were asked to tell their life story from a health perspective. The research material was approached both from a factist perspective and a specimen perspective. The material was analysed in three stages by using material-based content analysis, thematic content analysis, and rhetorical analysis. The framework of the study consisted of a cultural perspective. Thus, when doing the analysis, it was essential to find the different meanings the men had given to health in their life. According to the results, the value of health did not guide the health behaviour of the interviewed men until adulthood, and health services were not used willingly. There were matters in the course of the lives of these men as well as in their growth environment that made it easier to understand their health behaviour and attitudes towards health services. Attitudes passed on from generation to generation and increased morbidity in the immediate environment were among the things that contributed to the men's behaviour and attitudes. The men also used rhetorical ways to justify their own health behaviour. The most used rhetorical strategies were the absence of agency and the use of extreme expressions. It is possible to obtain in-depth information about health behaviour with the help of biographical study that takes cultural issues into consideration. The information gathered in the present study can be used when developing and directing health services in the Kainuu region as well as when developing the national health service system in Finland. The methodological solutions used in the present study can also be applied to other studies in the field of health sciences. / Tiivistelmä Tutkimuksen tarkoituksena oli analysoida ja kuvata kainuulaisten miesten terveyskäyttäytymistä, terveyspalveluihin suhtautumista ja terveyskäyttäytymiseen liittyvää puhetta. Tavoitteena oli tuottaa uutta, kulttuurista tietoa terveyspalvelujen kehittämiseen ja lisäksi tehdä ymmärrettäväksi kainuulaisten miesten terveyskäyttäytymistä. Tutkimusaineisto muodostui 20 temaattisesta elämäkertahaastattelusta. Haastateltavat olivat syntyperäisiä kainuulaisia ja Kainuussa asuvia 36–56-vuotiaita miehiä. Tutkimuksessa sovellettiin elämäkertametodia siten, että haastateltavat kertoivat elämäntarinansa terveyden teemasta lähtien. Tutkimusaineistoa lähestyttiin sekä faktanäkökulmasta että näytenäkökulmasta. Aineisto analysoitiin kolmivaiheisesti: aineistolähtöisellä analyysillä, teemoihin pohjautuvalla analyysillä ja retorisella analyysillä. Tutkimuksen viitekehys muodostui kulttuurisuudesta. Näin ollen, aineiston analyysissä oli olennaista löytää kainuulaisten miesten terveyskäyttäytymiseen liittämiään kulttuurisia merkityksiä. Tulosten mukaan terveyden arvo ohjaa kainuulaisten miesten terveyskäyttäytymistä vasta aikuisiässä eikä terveyspalveluja käytetä mielellään. Kainuulaisten miesten elämänkulusta ja kasvuympäristöstä löytyi asioita, joiden avulla miesten terveyskäyttäytymistä ja terveyspalveluihin suhtautumista voidaan ymmärtää. Näitä ovat esimerkiksi sukupolvelta toiselle periytyneet asenteet ja lähiympäristön runsas sairastavuus. Miesten puheesta oli myös löydettävissä retorisia keinoja, joilla he argumentoivat omaa terveyskäyttäytymistään. Retorisista keinoista yleisimmin käytettyjä olivat toimijuuden kadottaminen ja ääri-ilmaisujen käyttäminen. Kulttuurisuuden huomioivan elämäkertatutkimuksen avulla on mahdollista saada syvällistä tietoa terveyskäyttäytymisestä. Tutkimuksessa tuotettua tietoa voidaan hyödyntää terveyspalvelujen laadun kehittämisessä ja yksilöllisessä suuntaamisessa sekä Kainuussa että laajemmin suomalaista terveyspalvelujärjestelmää kehitettäessä. Tutkimuksen metodologisia ratkaisuja voidaan soveltaa myös muissa terveystieteellisissä tutkimuksissa.

Orientadores: Enidio Ilario, Marta Fuentes Rojas / Dissertação (mestrado profissional) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-26T18:28:27Z (GMT). No. of bitstreams: 1 Hirashima_HelenRodriguesdaConceicao_M.pdf: 1839392 bytes, checksum: 1f017649eedde7866192dd912ef8a72f (MD5) Previous issue date: 2015 / Resumo: Este estudo pretendeu identificar e compreender as demandas da pessoa com deficiência física em seu processo de reabilitação no Centro de Referência em Reabilitação, um serviço do SUS Campinas, a partir do modelo assistencial oferecido. Inicialmente foi realizada uma revisão da história da deficiência e suas representações sociais, do processo histórico do desenvolvimento da reabilitação enquanto especialidade médica e organização desses serviços no mundo, contextualizando com a realidade do município de Campinas. Para tanto, partiu-se de uma revisão bibliográfica e análise documental com os temas afins, em livros, periódicos e documentos da Secretaria Municipal de Saúde de Campinas e Ministério da Saúde. Considerando o tema deste projeto como de difícil captação por verificáveis quantitativamente, foi escolhida a abordagem qualitativa. O recurso metodológico utilizado para levantamento de dados primários ocorreu através da realização de entrevistas semiestruturadas com os usuários deste serviço, onde foram questionados sobre seu processo de reabilitação: conceitos, demandas, expectativas e percepção da própria assistência. O tamanho da amostra foi definido pelo método de amostragem por saturação, caracterizando 17 entrevistas. Foi adotada para o tratamento dos dados, a análise de conteúdo, o que resultou em cinco principais eixos-temas relacionados às demandas dessas pessoas em seu processo de reabilitação. Na sequência, as discussões e as considerações foram respaldadas pelos conceitos referenciais da Saúde Coletiva. Foram encontrados: (1) concepção da reabilitação que reforça o modelo biomédico original e caráter médico da deficiência; (2) apontamentos de demandas delimitadas a técnicas e tecnologias; (3) limites do modelo assistencial quanto à frequência/quantidade e continuidade dessa assistência; (4) desejos e anseios marcados pela busca da normalização do corpo "desviante"; (5a) a percepção do modelo oferecido ressaltando a interdisciplinaridade da atenção e relações interpessoais afetivas; e (5b) aspectos relacionados à acessibilidade prejudicados, especialmente pela oferta de atendimentos, distância (localização) e transporte público limitado / Abstract: This study aimed at identifying and understanding the demands of people with disabilities in their rehabilitation in the Reference Center for Rehabilitation, a service of SUS Campinas, based on the model of assistance that is offered. Initially, a review of the history of disability and its social representations has been carried out, as well as of the process of development of rehabilitation as a medical specialty, and of the organization of such services in the world, making the necessary adaptations to the context of the city of Campinas. For this purpose, it has been performed a literature review and documentary analysis about related topics in books, periodicals and documents of Campinas Municipal Health Department and the Health Ministry. Since the theme of this project is relatively difficult to be assessed by quantitative measures, a qualitative approach was chosen. The methodological approach used for collecting the primary data consisted of semi-structured interviews with the users of this service, in which they were asked about their rehabilitation process, concepts, demands, expectations and perceptions concerning their own care. The sample size, which was defined according to the method of sampling saturation, corresponded to 17 interviews. For the data processing, the content analysis was adopted, which resulted in five main themes related to the needs of these people in their rehabilitation process. Then, the discussions and considerations were supported by the concepts of the Public Health references. It has been verified: (1) a rehabilitation conception that reinforces the original biomedical model and the medical character of the disability; (2) indications of specific demands concerning techniques and technologies; (3) potential limits of the assistance model with respect to the frequency/quantity and continuity of this assistance; (4) wishes and aspirations characterized by the search for normalizing the different body; (5a) a perception of the offered assistance model that emphasizes the interdisciplinary character of attention and personal affective relations; and (5b) relevant aspects concerning accessibility, which are impaired by the availability, distance (location) and limited public transportation / Mestrado / Política, Planejamento e Gestão em Saúde / Mestra em Saúde Coletiva

Thesis (MSD)--Boston University, Henry M. Goldman School of Dental Medicine, 2008 (Dept. of Health Policy and Health Services Research). / Includes bibliography: leaves 44-48. / 0bjective: The objective of this study is to detemine if there are differences by race or ethnicity in dental care provided at community health center clinics resulting in oral health disparities. This study also provides detailed information about the types of dental procedures received by patients at community health center clinics. Methods: This was a retrospective observational study design, consisting of a convenience sample of patients seen and care provided by senior dental students during their ten-week externship at twenty one Boston University Goldman School of Dental Medicine affiliated community health center clinics. The data collected was analyzed SAS version 9.1. Frequencies for categorical variables, means for continuous variable, bivariate analyses and generalized models of logistic regression analysis were performed with the main dependent variable of interest being patient’s race/ethnicity. Results: The total sample was 62,112 observations, of which 56% were females. Regression analysis found that Blacks were 1.23 times and Asians and others were 1.09 times more likely to get diagnostic procedures than Whites. Hispanics were just as likely to receive diagnostic procedures as Whites. Blacks, Hispanics, Asians and others were more likely to get preventive procedures when compared to Whites (p[less than or equal to]0.0001 ). Blacks were less likely to get restorative procedures than Whites (p[less than or equal to]0.0001) whereas Hispanics were as likely to get restorative procedures as Whites. Further generalized logistic regression models to predict specific procedures were performed which indicates that Blacks were 1.99 times, Hispanics were 1.72 times, Asians and others were 1.21 times more likely to get amalgam restorations compared to composite restorations than Whites. However, Blacks were as likely to get root canal therapy compared to extractions as Whites whereas Hispanics were 27% and Asians and others were 37% more likely to get root canal therapy versus extractions than Whites (p[less than or equal to]0.0001). Blacks were 0.55 times, Asians and others were 0.37 times less likely to receive fixed partial dentures compared to removable partial dentures than Whites (p[less than or equal to]0.0001) whereas Hispanics were just as likely to receive fixed Partial dentures as Whites. Conclusion: Disparities were seen in the receipt of dental services provided such as diagnostic, preventive, and restorative procedures based on race at community health center clinics. This surprising finding related to community health center clinics indicate the need for future research focused on reasons for these disparities as community health center clinics are primary care providers for underserved populations.

Includes bibliographical references / BACKGROUND: People with disabilities encounter major barriers that prevent them realising their right to health in South Africa. Health committees are legislated structures for community participation in health at a local level. This study investigated how health committee members understand and practise their role in community participation and how this advances the right to health for persons with disability. METHODS: A qualitative study was conducted with three health committees in the Cape Town Metropole in the Western Cape province of South Africa purposively selected for the study. Three facility managers and eight health committee members took part in focus group discussions and semi-structured interviews, supplemented by participant observations of committee meetings. Additionally, semi-structured interviews were conducted with 2 disability activists. These methods were used to gain a rich understanding of health committees’ roles and practises in relation to persons with disabilities. Thematic analysis was used to analyse the data. RESULTS: The main research findings were: (i) health committees did not prioritise disability on their respective agendas; (ii) persons with disabilities were not adequately represented on health committees; (iii) health committees exhibited poor understanding of disability barriers relating to health; (iv) lack of egalitarian values led to persons with disabilities not trusting the health committee, and distrust amongst health committee members; lastly (v) health committees augment health facility operations instead of fulfilling their governance and oversight function. These factors may have contributed to health committees not helping to advance the right to health for persons with disabilities. CONCLUSIONS: Health committees should include mandated representation of persons with disabilities, whilst addressing marginalisation directed toward persons with disabilities on committees. Training of health committees, as well as networking with disabled organisations, could help improve their limited understanding of disability. Health committees should consider addressing disability a human rights issue, which critically involves community mobilisation, raising awareness around issues of disability and promoting agency amongst persons with disabilities to claim their rights.

There is emerging evidence that addressing health-related social needs through enhanced clinical-community linkages can improve health outcomes and reduce costs. Unmet health-related social needs, such as food insecurity, inadequate or unstable housing, and lack of access to transportation may increase the risk of developing chronic conditions, reduce an individual's ability to manage these conditions, increase health care costs, and lead to avoidable health care utilization. In response, work on social needs is happening across large health systems in the United States, but the pace of progress is slow and accountability is diffuse. The goal of this applied research project is to examine Kaiser Permanente Northwest's patient navigator program as a case study for how health systems can transform into organizations that bridge clinical, social and behavioral health and redefine what it means to be a prevention-oriented delivery system. Kaiser Permanente Northwest (KPNW) provides high quality, patient-centered care to over 550,000 medical members and 240,000 dental members in Oregon and Southwest Washington. In conjunction with the Care Management Institute, KPNW created a patient navigator administered, social needs screening tool called "Your Current Life Situation" (YCLS). This thesis focuses on the data collected from this screening tool with an emphasis on operations management, workflows, and the technical tools that have been supported to do this work. The analysis also uses semi-structured qualitative interviews from patient navigators, physicians, social workers, community organizations and members to better understand the experience of social needs screening in clinical practice and its impact on members and community partners as they receive referrals for services outside the health care delivery system. Through using anthropological theory and methods, I seek to help health systems think and act differently by elevating the voice and experience of the community and translating vulnerable populations' needs into a language that can be integrated into multiple systems of care.

In 2013, a bunch of us ran around collecting paper surveys off chairs after a plenary address at the Collaborative Family Healthcare Association's (CFHA) annual conference. From 150 responses, we found that less than a quarter would take the time to attend a workshop about research and evaluation. Fast forward 5 years: The organization showed robust attendance at research and evaluation training sessions, and interest in a preconference had risen to 77%. What prompted this shift? In response to survey findings, the Research and Evaluation Committee (REC), supported by the CFHA, engaged a data-informed and stakeholder-responsive approach to cultivating empiricism within the CFHA. The activities led by the REC demonstrate the need for creativity and leadership in this area and the CFHA's strong. organizational values around such efforts. As past and present leaders in the CFHA's REC initiatives, we write this editorial to make explicit the value of research to the organization and the value of the organization to the evidence base. In addition, we document some key institutional history in this area and, with input from the CFHA's current chief executive officer, Neftali Serrano, and REC chair, Will Lusenhop, forecast a vision for the future. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

The maternal mortality ratio (MMR) and neonatal mortality rate (NMR) have been persistently high in South Africa, with black, poor, rural women and neonates mostly affected. The MMR and the NMR are indicative of the health of the population and reflect deeper issues such as inequitable distribution of the country’s resources, social exclusion, deprivation, and lack of access to quality public services. The purpose of the study was to develop a model to meet the overall health needs of the socially excluded, the deprived and the vulnerable women by listing those factors that influence maternal and child health outcomes. From the point of view that individual reproduction and health decision-making takes place in a milieu comprising multiple socio-economic and cultural factors, this study attempts to add to the body of knowledge on maternal and child health in order to influence policies and interventions. Data was collected through a multi-staged, qualitative research design. The results show how structural factors result in high risk for poor maternal and child health outcomes, suggesting that the high rates of poor health outcomes are evidence of deprivation of women’s needs due to poverty leading to an inability to cope with pregnancy and childbirth. The results are used to develop a model that proposes pathways for policy action to confront both the structural and intermediary determinants of maternal and child ill health and mortality. These pathways operate through integrative and inter-sectorial mechanisms intended at empowering women and enhancing female reproductive health care activities. / Sociology / D.Litt. et Phil. (Sociology)

Background: This study is located within a complex network of paradigmatical methodological, and institutional relationships, and draws concepts from a range of scholastic traditions. The hermeneutical tradition within Sociology, particularly as exemplified in the work of Jurgen Habermas, provides a starting point for exploring and interpreting the experiences of chronic illness and healthcare access. The concept of the lifeworld/ healthworld as a description of the complex of health beliefs and behaviours of individuals in relation to the ailing body is used to describe chronic illness and healthcare access, both as lived experience and as fields for public health intervention. Aim: To understand how women living with chronic illness experience their illness and access healthcare in an urban and rural context. Methods: This study is a mixed-methods comparative case study of the healthcare access experiences of women with chronic illness in an urban and rural area in South Africa. The core of the study methodology is a comparative qualitative case study, with quantitative methods serving to contextualise the findings. The urban component of the study was conducted in Birth to Twenty (Bt20), a birth cohort study located in Johannesburg-Soweto. The rural component of the study was conducted in Agincourt, a sub-district of the Bushbuckridge district in Mpumalanga Province. The quantitative context for the Soweto case study uses secondary data collected by Bt20 to construct a historical overview of the use of formal and informal healthcare services in Soweto. It also uses the findings of a large scale cross sectional survey of the primary caregivers of the Bt20 cohort, conducted between November 2008 and June 2010. The rural case study is contextualised by a detailed review of research conducted in the Agincourt sub-district. For the qualitative case studies I employed a qualitative methodology incorporating serial narrative interviews to present an experience-based overview of concepts of disease causation, self treatment and coping. Results: The cross-sectional survey describes a low resource population with a high prevalence of chronic noncommunicable disease (NCDs). Over one third (37.3%) of the population in Soweto could be categorised as having a low socio-economic status, defined as access to only one or less of 5 socio-economic items. Slightly over half the respondents in Soweto (50.7%) reported having at least one chronic illness. Only around a third (33.3%) of the survey participants with chronic illnesses reported accessing formal healthcare services in the last 6 months. Similar trends were found in the review of research carried out in Agincourt. The qualitative case study in Soweto is characterised by a preoccupation with how the medicine from the clinic interacts with the body. The search for alternative remedies took place not as an attempt to cure disease, but to reach a deeper understanding of the diseased state of the body. The Agincourt qualitative case study highlights the importance of church membership, particularly of African Christian Churches, as the strongest factor motivating against the open use of traditional medicine. In both study sites there is evidence that traditional healers were consulted for social purposes rather than health-related purposes. Discussion: Soweto and Agincourt share similar patterns of healthcare utilisation and healthcare belief. Both study sites were characterised by increasing trends in formalisation. At the same time, only a small portion of individuals in both study sites with chronic illness utilised formal healthcare services. A consideration of the findings suggests five broad themes for further research: (1) Processes of constructing body narratives; (2) Encounters with purposive-rational systems; (3) Encounters with traditional medicine; (4) Encounters with contemporary informal medicine; and (5) Religion and healthcare. These five themes constitute the beginning of a comprehensive map of the lifeworld/ healthworld schema. Such a schema has implications for healthcare policy and practice, particularly with regard to the development of integrative paradigms in South Africa as exemplified by Community Oriented Primary Care (COPC). Conclusion: The aims and objectives of the study were met through the development of an initial lifeworld/ healthworld schema, which suggests that the coexistence of diverse public healthcare concerns of high NCD prevalence and low formal healthcare utilisation is best addressed through the adoption of integrated healthcare approaches based on lifeworld/ healthworld rationalistion.