Thesis (M.S.)--University of Missouri--Columbia, 2000. / Typescript. Includes bibliographical references (leaves [32]-35). Also available on the Internet.

Background: To curb the transmission of HIV/AIDS and other infectious diseases several studies indicate the need for improved access to medical care for injection drug users (IDUs) including those already linked to syringe exchange programs (SEPs). However, availability and access to services remains a problem for many IDUs. This study seeks to examine perceptions of medical care access among a pharmacy-based sample of IDUs, utilization of medical services among IDUs and, identify barriers to accessing health care services to help ensure that IDUs receive appropriate care when needed and reduce the transmission of diseases. Methods: Data was obtained from the Pharmacists As Resources Making Links to Community Services (PHARM-Link) study. Dependent variables: health care access to the same provider and receiving care a usual source, health care utilization of services including the emergency room, clinic, medical office, medical mobile unit and hospital; and health care barriers categorized as personal or structural. Independent variables were insurance status, homelessness in the prior six months, case management, drug treatment and socio-demographic characteristics such as age, sex, income, education and employment status. Descriptive statistics analysis and logistic regression were performed using SAS version 9.4 (2013) with significance set at p<0.05. Results: Our sample included 615 IDUs participating in the PHARM-Link study. Overall, IDUs accessed health services and having the same provider remained statistically higher among those with legal income above $5,000 OR: 1.60 (95% CI: 1.03- 2.48), the insured OR: 4.11 (95% CI: 2.48-6.79), and those with positive HIV status OR: 7.64 (95% CI: 3.18 – 18.36), while those who were homeless reported lower access to the same provider OR: 0.63 (95% CI: 0.43 – 0.92). Only the older age group OR: 2.85 (95% CI: 1.42-5.73) and the insured OR: 3.42 (95% CI: 1.81-6.46) remained significantly associated with more access to receiving health needs at the same location. Those with some college education had less frequent visits to the clinic OR: 0.59 (95% CI: 0.38-0.92) and medical office OR: 0.64 (95% CI: 0.41-0.99), while the homeless were more likely to visit the emergency room OR: 1.49 (95% CI: 1.06-2.11). Females were less likely to go to a mobile unit OR; 0.52 (95% CI: 0.33-0.83) and married people were more likely OR: 1.95 (95% CI: 0.28-0.91). Visit to the hospital were less likely among females OR: 0.54 (95% CI: 0.36-0.81) and among those with some college education OR: 0.63 (95% CI: 0.41-0.96). Those with legal income above $5,000 were less likely to have any personal barriers OR: 0.64 (95% CI: 0.45 – 0.92). Structural barriers remained more likely among those who were homeless OR: 1.62 (95% CI: 1.13-2.39), but less likely among those 44 years and older OR: 0.58 (95% CI: 0.40-0.85), the insured OR: 0.60 (95% CI: 0.38-0.94), those with positive HIV status OR: 0.53 (95% CI: 0.28-0.99), as well as Non-Hispanic Blacks OR: 0.47 (95% CI: 0.14-0.83) and Latinos OR: 0.47 (95% CI: 0.25-0.86). Conclusion: Our results suggest that most IDUs linked to care through pharmacy-based SEP programs established to expand health services and improve health, did access available health services. However, some continue to experience difficulties such as structural barriers among the homeless as well as few reported visits to the clinic, medical office and the hospital among the employed believed to have resources to pay for such services. These services may have been underutilized because the participants were unsatisfied with the services provided. Therefore, interventions should target structural barriers such as homelessness among IDUs as well as health insurance coverage to help increase access to and utilization of health services.

Thesis (MEd)--University of South Australia, 1994

Thesis (Ph.D.)--McMaster University, 2005. / Supervisor: William D. Coleman. Includes bibliographical references (p. [165]-190) Also available online.

Senior Honors thesis--Regis University, Denver, Colo., 2009. / Title from PDF title page (viewed on May 11, 2009). Includes bibliographical references.

Thesis (Ph. D.)--University of Washington, 1999. / Vita. Includes bibliographical references (leaves 170-182).

Thesis (Ph.D.)--Virginia Commonwealth University, 2010. / Prepared for: Dept. of Health Administration. Title from title-page of electronic thesis. Bibliography: leaves 158-177.

A dissertation submitted to the Faculty of Arts in fulfilment of the requirements for the Degree of Doctor of Philosophy (Community Psychology) in the Department of Psychology at the University Of Zululand, 2017 / Health is a human need and considered to be a human right across all societies. Access to health care services is not a problem for those who can afford it, but, for those who cannot provide for themselves, legislation needs to protect their rights. Although there is legislation in place to protect these vulnerable populations, it is ultimately the health care practitioners’ job to protect and improve the health of their communities. It is these health care practitioners who were the inspiration for and focus of the present study. The present study emerged as a separate, but expanded version of the researcher’s limited 2011 study, which specifically focused on medical practitioners’ experiences of the current health care delivery system. Results from this 2011 study suggested that a broader spectrum of health care practitioners may be similarly affected by the current health care system and that their experiences may ultimately contribute towards a better understanding of the dynamics within which health care practitioners work and function. Therefore, the present phenomenologically-oriented study aimed to describe, explicate, interpret and analyse the experiences of a broad sample of health care practitioners through their lived, day-to-day realities in both the public and private health care sectors. Data were collected from a non-probability, purposive, convenience sample of 30 adult registered health care practitioners in public and private hospitals, clinics and private practices in the uThungulu District of Kwa-Zulu Natal, South Africa. There were 15 participants from the public and 15 from the private sector. An open-ended questionnaire was used to ascertain and understand their experiences, knowledge and exposure to the relatively new national health insurance (NHI) system, what they perceived as key objectives for effective transformation of the South African health care system, possible reasons for considering emigration in light of the current staff shortages and their views on the new NHI policy, in order to find solutions to problems. The overall data analysis consisted of three levels of subsidiary data analysis, descriptive, social constructionist and interpretive paradigms, each contributing to the whole, both “vertically and horizontally”, where participants’ experiences were described, explicated and interpreted. Research findings indicated persisting large divisions and fragmentation in and between the public and private health care sectors. Yet there was unity in responses concerning the poor and disadvantaged members of society and the challenges of their access to health care services. Sensitivity to human rights standards, past socio-political influences and awareness of health as a human right and need were evident in all participant responses. Valuable solutions to improve the health care delivery system were offered by health care practitioners as key stakeholders in the future of health care delivery in South Africa. Public health care practitioners’ experiences were dominated by overall expressions of unhappiness, anger and frustration related to poor service delivery, lack of resources, inadequate management structures, wages, inadequate consultation, fear for personal (and family) safety and the future of health care. Concern for the poor, vulnerable and the majority of citizens who use health care services, coupled with the burgeoning burden of disease, were perceived as a major stressor and source of anger towards the government and bureaucracy in general. Chronic stress and anxiety, suggestive of burnout and other negative psychological states, were also apparent. The inability to service long patient queues, inadequate communication structures/channels and lack of cohesive team practices, ethics and standards created a sense of emotional overburden and other negative affective states. These, and the uncertain future of health care under the new NHI, exerted extra stress on already overworked health care personnel. Education and effective consultation about the NHI were expressed as being inadequate and incomplete. Despite these factors, health care practitioners offered various valuable solutions and suggestions for the improvement of health care service delivery. Despite also being stressed, participants who work in the private sector were generally happier and they evinced less negative psychological states. Although a stressful environment with its own problems, within the private sector the NHI was considered to be a good concept in principle, although many participants doubted its feasibility and felt that regulatory changes often took place without adequate consultation. Given the nature and transparency of the present study, across multidisciplinary teams of health care practitioners, the researcher is of the opinion that the present study created a platform for discussion and debate around the context of a changing health care system within South Africa’s culturally diverse society. In conclusion, a critical review of the present study and recommendations for management structures, health care practitioners themselves and future research is provided.

A thesis submitted in partial fulfillment for the requirement for the degree of Doctor of Philosophy in the Department of Psychology at the University of Zululand, South Africa, 2010. / This research project was undertaken to investigate workplace bullying and its effect on health service delivery. Research participants were drawn from Prince Mshiyeni Memorial and Mosvold Hospitals; the aim was to compare the experiences of public health employees in rural and urban areas of KwaZulu- Natal. The employees have a right to be treated with respect and dignity and, most importantly, to work in a harmonious and supportive environment. Bullying behaviour breaches the employer’s duty under common law to provide a safe and a secure work environment both physically and psychologically. What makes it difficult for managers to manage bullying is that it has no tangible results but it leaves the victim with psychological and emotional problems which lead to anxiety, stress and depression if not properly attended to. The results of this research project further reveal that the majority of bullied employees are reluctant to speak out or end up not reporting the incidences because when they do report problems they believe that they will not be taken seriously. The results also prove that bullying is not a once-off event but a continuous cycle aimed at humiliating and belittling the XVII victim and that it is present in both health institutions. Though many factors were indicated as contributing to bullying, the low–self-esteem and personality factors of the bully were mentioned as the main factors, followed by inadequate training for the managers. If managers are serious about combating bullying in their workplaces they need to be in touch with what their employees go through when they execute their daily duties and they need to devise some means of ensuring that the grievance procedure is adequate and that it caters for bullying problems.

No description available.