Registered nurses (RNs) are essential to providing care in the healthcare system. To date, research on the relationship between healthcare provider supply and population health has focused on physician supply. This study explored the effect of RN supply on population health outcomes in the U.S. This is a retrospective, cross-sectional study of U.S. counties and county equivalents using national data. Seven population health outcomes (total and disease specific mortalities and low infant birth weight rate) were the response variables. The predictor variable, RN supply, and some control variables were anticipated to have an asynchronous effect on the seven outcome variables in the hypothesized relationship. Therefore, these variables were examined using three different models: contemporaneous; a three-year lagged; and a distributed lag (both contemporaneous and lagged variables). Quadratic terms for RN and physician supply variables were included. Because the Area Health Resource File (AHRF) outcome variables were skewed toward zero and left censored, Tobit regression analyses were used. Data were obtained from 19 states using historical RN Supply data for 1,472 counties, representing 47% of the total target population of 3,108 U.S. counties and county equivalents. Regions with rural populations—the Midwest and Southeast—were overrepresented. Higher RN supply is positively related to higher mortality rates from ischemic heart disease, other cardiovascular disease, and chronic lower respiratory disease in the distributed lag models. Higher RN supply is not significantly related to rates of low infant birth weight, infant mortality, or mortality from cerebrovascular disease in any model. Higher RN supply is positively related to total deaths in the contemporaneous and lagged model. The results suggest a counter-intuitive, but non-linear relationship between RN supply and health outcomes. More research is needed to understand these relationships and policies must be devised to reduce the current and growing future RN shortage.

published_or_final_version / Public Administration / Master / Master of Public Administration

published_or_final_version / Public Administration / Master / Master of Social Sciences

<p>Sub-Saharan Africa (SSA) continues to be disproportionately burdened by the HIV/AIDS epidemic. In 2011, the region saw 1.8 million new infections, contributing to a prevalence of 4.9% among adults, or 23.5 million people living with HIV/AIDS. This thesis uses data collected by the Demographic and Health Surveys (DHS) to answer questions about risk factors and behaviours associated with HIV acquisition. I use logistic regression models to assess the impact of purported risk factors on sexual behaviours and HIV status. In Chapter One, I evaluate the association between respondents' condom use and their awareness of their own \local" epidemic. In Chapter Two, the association between hormonal contraceptives and risk of HIV infection is examined. The purpose of these analyses is to contribute to the body of literature that identifes factors that mitigate or contribute to risk for HIV infection, and help to inform public health policy.</p> / Master of Science (MSc)

This thesis explores two distinct yet inter-related issues within the twin fields of disability and developments tudies. First, the evolution of Community-BasedR ehabilitation( CBR) as the "received orthodoxy" for disability service provision throughout the developing world. Second, the developmenot f two theoretical" models"o r perspectiveso f disability: the medicala nds ocial perspectivesT. he assumptionws hichu nderpinC BR haven ot generallyb eens ubjectedto critical examinationn or hasc onsiderationb eeng iven ast o how CBR andt he theoreticalu nderstandings of disabilityi nter-relate. This thesisc ritically analysesth is inter-relationship. The thesisd escribesa ndc ritiquest he theoreticalu nderstandingosf disability,a ndt he philosophy ando perationapl racticeo f CBR, beforec onsideringh ow eacho f thesec anm utuallye nhancea nd developt he other.T his analysiss uggestws aysf orwardt o developinga na lternativeu nderstanding of disability, which is pertinent to the experience of disabled people in a developing country context. It is argued that neither perspective provides an intellectually satisfying analysis. CBR has invariably been perceived by planners and policy makers in a somewhat utopian manner. A field study of four NGO-managed CBR programmes in South India provides an empirical exploration of these issues. The case studies enlighten and contextualise the issues this thesis addresses. It is concludedt hat a universal" model" of disabilityi s inadequateb ut that insightsc an be drawn from both the medical and social perspectives. Importantly, an "improved" understandingo f disabilitym ust take into accountt he way in which the experienceo f disabilitya nd impairmenti s shapedb y economic,s ociala ndc ultural factors.T he thesisa lsoc oncludesth at althought here are problems inherent in the principles and practice of CBR, it has the potential to create an unprecedented opportunity for disabled people to improve their well-being. Given that "empowerment"i s becomein creasinglyim portantw ithin CBR. there is potential in considering the implications of Paulo Freire's philosophy of social transformation for operational practice.

Translation of national public health policy into local action is poorly understood. This thesis explores this issue using: (a) independent evaluation data of the government-funded Well Men’s Services Pilots Programme (WMS); and (b) an analytical framework derived from ‘rational’ health planning models; particularly the PRECEDE PROCEED (PP) model. A mixed-methods study was conducted, comprising: (i) a review of the health planning literature; (ii) an interpretative documentary analysis of policy documentation and local intervention plans; and (iii) a secondary analysis of 42 semi-structured interviews with local managers and professionals responsible for developing interventions in response to the policy. The research findings (ii&amp;iii) were considered in light of this review. This thesis concluded that rationalist health planning approaches and frameworks are not sufficient to guide the implementation of public health policy to an effective conclusion, and has argued that there is a need to develop new ways of thinking about public health issues that have become ‘policy problems’ deemed in need of intervention and resolution. This new thinking needs to acknowledge the complex and contested nature of health problems. This include accepting: (1) that a range of different perspectives and interpretations of public health policy problems and associated notions of their solutions will reside amongst those individuals and organisations tasked with transforming policy into practice; (2) the inevitability of imperfect and contested evidence; (3) future uncertainties, and; (4) the existence of bureaucratic barriers that will constrain direct engagement of the intended beneficiaries, by policy implementers, in the process of developing interventions.

MPH, Faculty of Health Sciences, University of the Witwatersrand / School-going children have unique health challenges that deserve a focused attention from policy makers, commonly done through the provision of school health programmes. The education system provides the most comprehensive existing infrastructure for reaching school-going children and school health programmes enable health problems to be addressed at relatively low cost. The 2003 South African National School Health Policy (NSHP) aims to deliver equitable and focused health services to school-going children in order to safeguard their right to optimal health and development. There is currently limited information on the process of implementation of the NSHP, implementation context at different schools, as well as facilitating and constraining factors that impact on the implementation of this policy. Aim: The main aim of this study was to evaluate the implementation of the 2003 National School Health Policy in two primary schools in Cape Town. Methods: This was a process evaluation that used qualitative methods primarily. Two schools located in different education districts were selected via convenient sampling for an in-depth study. Within each school, participants were purposively selected based on their potential to provide relevant information. The final sample consisted of seven individuals; five educators and two school health nurses. Data collection tools included an in-depth semi structured interview schedule, selfadministered questionnaire and document review. Interviews were recorded, transcribed and later analysed to obtain key themes. v Results: The evaluation found that the NSHP has been implemented in a phased manner, disadvantaged areas were prioritized, different staff-mix with regards to the composition of the school health team was used and the minimum requirements in terms of health assessment for Grades R and 1 learners (Phase 1 services) were met. Educators and school health nurses did not have the same level of knowledge and understanding of the NSHP, and educators were less informed about this policy than nurses. The policy context influenced working relationships between different actors or stakeholders. Challenges or constraints to policy implementation included broad systemic problems such as poverty and staff shortages, lack of dedicated budget for school health services and insufficient prioritisation of school health services by senior departmental managers, all which constrained effective policy implementation. Although findings of this study cannot be generalized to other schools, they give important insights into the current implementation process of the NSHP. It is one of the few studies focusing on the process of policy implementation in recent years and the in-depth qualitative methods allowed the researcher to explore the complexities and contradictions of policy implementation in post-apartheid South Africa. Conclusion: This policy has for the most part been implemented according to specified policy implementation guidelines and minimum requirements for implementing phase 1 services were met. It is recommended that a dedicated budget should be allocated to school health services and existing structures within the school system such as School Governing Bodies be utilized effectively to encourage parental involvement in school health. Nurses should advocate for increased support for these services among all stakeholders, including managers in the Department of Health.

Introduction Occupational Epidemiology (OE) has played a vital role in producing improvements in the working population’s health. Nonetheless, anecdotal evidence indicates that OE in the UK is facing many challenges and the research workforce, funding, and output in this area are declining. This study aims to: investigate the nature and evolution of these key contributors to success; identify the external social, political, economic and any other factors which frame and contextualise these challenges and the facilitators; use this contextualisation to explain and evaluate how and why the identified challenges and facilitators influenced the OE field development compared to other similar fields; and explore how far they may explain the ebb and flow of research activity in OE in comparison with other health disciplines. Methods A sequential, mixed-method approach was undertaken in four phases. These included interviews with key UK-based OE researchers; a survey of UK-based OE researchers to test out themes that emerged from the first phase; a bibliometric analysis comparing trends and characteristics of UK-based OE published studies with those in public health epidemiology (PHE); and a documentary review of annual reports of three health research funding bodies including: the Medical Research Council, the Cancer Research Campaign, and the Health and Safety Commission. Results The lack of human and financial resources was found to be of utmost concern to the OE community, which increased over time and negatively affected researchers’ abilities to conduct further and higher quality studies. The bibliometric study revealed that the number of PHE publications and researchers increased substantially while the numbers for OE remained fairly constant. Furthermore, it was found that in PHE much higher levels of collaboration and adoption of newer methods such as the use of molecular and genetic techniques were applied. Widening research collaboration and the adoption of newer methods were encouraged by funding bodies because both are perceived to contribute to research efficiency and commercialisation of research ideas. These have been adopted more widely by other fields, thus helping them to develop and improve their status, which was not the case for OE. Furthermore, fewer influential representatives from the field of OE were found within funding bodies, which had played a major role in directing resources to research within health fields and hence influencing their development. Conclusions Social, economic, and political factors such as the exclusion of occupational health (OH) from the National Health Service, deindustrialisation, and neoliberal government policies within public and higher education institutions particularly that focus on economic contribution of science, and research auditing and efficiency, most likely, have the greatest influence on funding decisions of research in OH and other health disciplines. These issues have significantly instigated obscurity of OH and hence OE within the agendas of both the government and the funding bodies. Henceforward, the development of the OE field has become adversely affected compared to other health research fields. Finally, this thesis confirms that the rise and fall of a particular health research field is heavily influenced by specific past and contemporary social, economic and political factors. Engaging in social, economic and political matters, being open to new advances in research, and optimising networking opportunities with other disciplines, key researchers, policy-makers and other pertinent stakeholders and institutions may potentially facilitate progress in OE and other health research fields.

Objective: Significant efforts have been made to address childhood obesity. Overtime we have realized obesity requires strong political leadership and population level interventions, considering there are many environmental factors contributing to obesity. Stakeholders in Manitoba have created a policy that in combination with other initiatives is attempting to increase physical activity and in turn combat the obesity epidemic. Therefore the objective of this study was to understand the complexities involved with developing an innovative policy. Results from this study would refine our understanding on how policy is enacted, provide information on the support for and resistance of policies for decision makers in the future, and contribute an historical record to Manitoba stakeholders. Mobilizing these context-specific findings will inform other Canadian provinces or jurisdictions on how to develop, integrate and implement a similar policy. Methods: This study employed a retrospective single case study design. Twelve participants were purposively selected from provincial and local-levels and invited to participate in a 45 minute semi-structured telephone interview examining the developmental processes involved in the Physical Education/Health Education policy. The data consisted of two sources. The primary sources consisted of 9 interview transcripts and the secondary sources consisted of several important documents that assisted filling in gaps pertaining to the policy. Qualitative analyses were separated into two parts. The first part identified common themes from the interview transcripts, and the second part organized the data into stages from an existing model for analysis. Results: The analysis identified several influential factors that facilitated moving the policy process forward. More specifically, the factors existing between the Policy Formulation and Implementation stages were critically analyzed revealing collaboration and on-going communication as important features for developing and implementing policies. The Stages Model proved to be relatively uninformative yielding minimal information to understanding the policy process. Therefore researchers should seek out additional theories or models in future research. Conclusions: The findings from this research project have contributed valuable knowledge and insights. Lessons learned from this project will assist future decision makers on how to develop and implement a similar policy in another province or jurisdiction.

Objective: Significant efforts have been made to address childhood obesity. Overtime we have realized obesity requires strong political leadership and population level interventions, considering there are many environmental factors contributing to obesity. Stakeholders in Manitoba have created a policy that in combination with other initiatives is attempting to increase physical activity and in turn combat the obesity epidemic. Therefore the objective of this study was to understand the complexities involved with developing an innovative policy. Results from this study would refine our understanding on how policy is enacted, provide information on the support for and resistance of policies for decision makers in the future, and contribute an historical record to Manitoba stakeholders. Mobilizing these context-specific findings will inform other Canadian provinces or jurisdictions on how to develop, integrate and implement a similar policy. Methods: This study employed a retrospective single case study design. Twelve participants were purposively selected from provincial and local-levels and invited to participate in a 45 minute semi-structured telephone interview examining the developmental processes involved in the Physical Education/Health Education policy. The data consisted of two sources. The primary sources consisted of 9 interview transcripts and the secondary sources consisted of several important documents that assisted filling in gaps pertaining to the policy. Qualitative analyses were separated into two parts. The first part identified common themes from the interview transcripts, and the second part organized the data into stages from an existing model for analysis. Results: The analysis identified several influential factors that facilitated moving the policy process forward. More specifically, the factors existing between the Policy Formulation and Implementation stages were critically analyzed revealing collaboration and on-going communication as important features for developing and implementing policies. The Stages Model proved to be relatively uninformative yielding minimal information to understanding the policy process. Therefore researchers should seek out additional theories or models in future research. Conclusions: The findings from this research project have contributed valuable knowledge and insights. Lessons learned from this project will assist future decision makers on how to develop and implement a similar policy in another province or jurisdiction.