The issue of preventive health policy has become increasingly important topic. A point worth emphasizing here for the managers, market scholars, or policy makers is that whether the health policy would change the consumer behavior. For considerable efforts to encouraging consumer taking the physical examination, here, marketing signaling and costumers perceived trust might be considered as marketing strategies in this dissertation.

Abstract The global burden of neuropsychiatric disorders is rising worldwide. This burden will be felt most in developing countries which have limited resources to respond. Within the health sector, mental health has traditionally been a low priority in most countries, resources to address the burden are limited and mental illness competes with other serious disease for government attention. Despite high-profile international statements, mental health reform has been slow and mental health has remained a low-level political priority, particularly in developing countries and Newly Independent States. There is growing recognition of the need for mental health development and reform. There is growing consensus that successful delivery of mental health interventions to address the disease burden is constrained not only by resource limitations but also by the absence of policy and planning frameworks to identify and deliver these interventions. This thesis highlights that the preparation and adoption of a policy position and the development of a comprehensive policy document is the outcome of a range of complex interactions between environmental factors and the stakeholders within the policy environment. There is growing recognition within the policy sciences literature that a comprehensive understanding of the overall policy process requires an individual and combined understanding of the content of a policy and the processes involved in achieving policy status and implementing policy. Little is documented regarding the content domains and elements which should be included in a mental health policy and the key variables within the policy environment which impact on the mental health policy development process. As a result there are no universally applicable blue prints or policy formulation tools for mental health policy which recognise the complexity of mental health systems and identify key issues which need to be considered in understanding how to promote mental health onto the policy agenda, how to develop a policy once this has been achieved and how stakeholders can more effectively engage in mental health policy agenda building. This thesis addresses this issue by undertaking three distinct but interlinked tasks. Part 1 contributes new knowledge to the area of mental health policy content. It identifies the key content domains and elements which constitute a comprehensive mental health policy. The domains and elements are validated through an extensive consultative process, undertaken by the author, with key mental health stakeholders in 40 countries in all six WHO regions of the world in 2000 and 2001. Based on this work the thesis develops an innovative conceptual tool for mental health policy makers, The Mental Health Policy Template. Whilst responding most particularly to the needs of developing countries and Independent States, the Template is sufficiently generic to be used in a range of countries, provinces and at district levels. The experience of many mental health reformers in developing countries and Newly Independent States is that raising mental health onto the policy agenda and maintaining it there is an on-going challenge. Conceptual models for understanding mental health policy process are extremely limited. Part 2 of this thesis responds to this situation by drawing on the policy analysis literature, with particular focus on agenda building. It identifies two key variables, Context and Stakeholders and their components. These variables are argued to impact on raising mental health onto the policy agenda. The applicability of these variables and their components is demonstrated through the analysis of two country experiences of mental health policy development and reform. One country, Lithuania is a Newly Independent State and the other, Zambia is a developing country. The information collected for these country studies was developed by a series of country visits and stakeholder consultations by the author between 2000 and 2007. The analysis of the country data suggests that the experiences of two quite disparate countries can be usefully organised using the variables and components identified from the literature and may be applicable across a diverse range of countries. This constitutes new knowledge of the variables which impact on mental health policy process and mental health policy reform. Part 3 of this thesis proposes a conceptual model which synthesises the new knowledge established in Part1 and 2. A Mental Health Policy Development Model is proposed which brings together the policy literature and country experiences. It identifies the key content and process factors which need to be considered in mental health policy development and reform with particular application to developing countries and Newly Independent States. The model can be used by those wishing to more fully understand and undertake mental health policy development and reform. To my knowledge such work has not been undertaken in the area of mental health and constitutes a basis for further development in the field. Finally, the thesis acknowledges the formative nature of the work and makes suggestions for further research to build this knowledge ideally in partnership with other key mental health policy stakeholders throughout the world.

Thesis (M.S.)--University of Wisconsin, 1983. / Typescript. eContent provider-neutral record in process. Description based on print version record. Includes bibliographical references (leaves 85-90).

Background: Malaria has remained a major public health burden in Malawi despite recent global progress in its control. Children under the age of five and pregnant women are among the groups most affected by the disease. Malaria research has been identified to provide vital evidence that contributes to addressing this burden through the development of evidence-based policies. One of the challenges however, is the lack of a systematic mechanism through which malaria research can be fully utilised for policy development. Unless research is commissioned by the government, individual researchers often do not know the pathway through which they can engage with policymakers. While some institutions or elements that promote health research in policy development exist, they remain fragmented and overwhelmed by the totality of health research in the country. This study aimed at developing a framework for promoting the utilisation of malaria research for policy development in Malawi. The framework seeks to encourage the engagement of researchers and policymakers, and to increase visibility and coordination of the existing elements presently promoting research utilisation for policy development. Methods: The study utilised both quantitative and qualitative methods depending on the study objectives. Several specific approaches were employed towards the development of the framework. The first step described the type and amount of malaria research conducted in Malawi, and its related sources of funding from 1984 to 2016. Its approach included an online systematic literature review in the Medline/PubMed database for Malawian publications, and the extraction of approved malaria studies from two Ethical Committees. The second approach assessed the research contribution to malaria policy development and the understanding of policy formulation process in Malawi. This step was done through case studies that adopted systematic literature search, in-depth interviews with key informants and relevant stakeholders, and record review. The third step examined the facilitating factors and barriers to utilisation of malaria research in the policy development process and involved in-depth interview with key informants, and review of records. In addition, the assessment of challenges to the implementation of malaria policies in Malawi was conducted through in-depth interviews with key informants and key stakeholders. The development of the framework was then guided by the lessons from the case studies and findings from the assessment of facilitating factors and barriers while being informed by literature of existing research-to-policy frameworks. In addition, a rigorous iterative approach with stakeholders was conducted for validation and applicability of the framework. Findings: The research revealed that clinical and basic research in the fields of malaria in pregnancy, severe malaria, and vector and/or agent dynamics dominated the publications while morbidity studies, severe malaria, and health policy and systems research dominated the approved studies. The results show that malaria research output increased steadily from 1996 to 2016 and this was attributed to the establishment of the College of Medicine and its research affiliates. However, the major malaria research funding came from external sources. The case studies showed that primary research was instrumental in changing the malaria treatment policies and in some cases Malawi was the first country to adopt these changes. Policy development process was found to follow the established process that involves agenda setting, policy formulation, and policy implementation. Many factors were identified as facilitating the utilisation of malaria research in policy development and these included the government commitment through the ministry of health, by reviving the policy development unit and the establishment of the office for the director of research, the knowledge translation unit, and academic and non-academic research institutions. Specific tools that support these institutions are the national health research agenda, guidelines for policy development and analysis, and guidelines for evidence use in policy-making. Barriers to the utilisation of malaria research included, the lack of knowledge by researchers to involve, collaborate and communicate their research findings to policy makers. Other barriers included lack of platforms for researcher-public engagement, politics, funder driven research, unknown World Health Organization policy position, and the lack of a malaria research repository. Challenges to the implementation of malaria policies included inadequate resources, unavailability of trained staff, poor supervision and mentorship, politics, parallel implementation of policies, lack of a platform for engagement with communities, top-down approach in policy development, lack of understanding of socio-cultural factors affecting policy uptake by communities, and incomplete stakeholder analysis during policy development. Lessons from the case studies and the assessment of facilitating factors and barriers contributed to the development of a contextual knowledge-to-policy framework which proposes an integrated approach to knowledge translation between malaria researchers and the government, through the Ministry of Health (MOH) and the National Malaria Control Programme (NMCP), which is considered as the main user of research knowledge. Conclusion: Malaria research provides the relevant evidence for policy decision-making to address the malaria burden in Malawi. The developed framework offers a basis for the identified factors and their linkages to promote a coordinated approach to malaria research utilisation in policy making. Its applicability and success would, however, hinge on its wider dissemination and ownership by the government through the NMCP. It is important for the government to support health policy and systems research that seeks to explore bottlenecks in the delivery of health services within the health system. This evidence should provide solutions to challenges of policy implementation. / Thesis (PhD)--University of Pretoria, 2017. / University of Pretoria Institute for Sustainable Malaria Control (UP ISMC) and MRC Collaborating Centre for malaria research / School of Health Systems and Public Health (SHSPH) / PhD / Unrestricted

<p>This thesis was successfully defended on January 15, 2014 at McMaster University.</p> / <p>Understanding why policies change is an important pursuit for researchers and policy-makers alike. Research evidence is one of many possible factors that encourage or constrain policy change, as is the role of ‘networks’ of policy actors. Despite extensive empirical literature on each of evidence-informed health policy and policy networks, the two have rarely been studied together, particularly in low-income country policy environments. This thesis explores both of these variables in a broader structural context of institutions, interests and ideas. Concepts and approaches from social network analysis are applied to three distinct research questions and chapters with the objective to: 1) develop and test a conceptual framework for the integration of networks, institutions, interests and ideas as major variables explaining policy change; 2) test the relationship between policy network structure (closure and heterogeneity) on the use of research evidence and innovation across the three cases; and 3) model the factors that influence the formation of an evidence exchange relationship between policy actors, and the effect of those exchanges on actor-level use of research evidence. Taken together, the findings of this dissertation present persuasive support for adopting a network lens to study evidence-informed health policy and policy change.</p> / Doctor of Philosophy (PhD)

The epidemiologic transition has shifted major causes of mortality from infectious disease to chronic disease; however, infectious diseases are again re-emerging as a major global concern (Diamond, 1997; Karlen, 1995; McNeil, 1976). This research aimed to identify potential areas of infectious disease influence that are not health-related in order to help governments and policymakers establish new policies, correct current policies, or further address these issues in order to effectively prevent and combat infectious disease. This study employed a retrospective, cross-sectional, non-experimental design via structural equation modeling (SEM) and examined tuberculosis incidence rates at the country-level. Secondary data from open-source, international databases like World Bank's World Development Indicators, World Governance Indicators, and World Health Organization for the year 2014 was utilized. Results revealed that the latent constructs of political stability, health system indicators, and detection policies directly affected tuberculosis incidence rates; they also exhibited an indirect effect due to covariation. Economic stability did not direct affect tuberculosis incidence, but it indirectly influenced incidence through the covariation of political stability, health system indicators, and detection policies. As a country's political stability increased, tuberculosis incidence decreased. As positive health system indicators increased, tuberculosis incidence decreased. Countries with more Xpert detection policies in place experienced an apparent increase in tuberculosis incidence.

A significant concern in healthcare is that of patient privacy and how organizations protect against unauthorized access to protected health information. The federal government has responded by instituting policies and guidelines on requirements for protection. However, the policy language leaves areas open to interpretation by those following the guidelines. Reporting to the Office for Civil Rights and/or the patient can open an organization to risk of financial and possible criminal penalties. There is a risk of harm to their reputation which could impact patient visits and market share. Therefore, Privacy Officers might view risk in different ways and therefore handle breach reporting differently. Privacy Officers are responsible for determining an individual organization's breach reportability status. Their processes may vary dependent on their knowledge of the policy, the status of previous reported breaches, and their framing of an incident. This research aims to explore the following factors: (1) personal and organizational knowledge, (2) prior breach status, (3) and scenario framing, to explore if Prospect Theory is applicable to the choices a Privacy Officer makes regarding breach determination. The study uses primary data collection through a survey that includes loss and gain scenarios in accordance with Prospect Theory. Individuals listed as Privacy Officers within the American Health Information Management Association (AHIMA) were the target audience for the survey. Univariate, Bivariate, Multivariate, and Post Regression techniques were used to analyze the data collected. The findings of the study supported the theoretical framework and provided industry and public affairs implications. These findings show that there is a gap where Privacy Officers have to make their own decisions and there is a difference in the types of decisions they are making on a day to day basis. Future guidance and policies need to address these gaps and can use the insight provided by this study.

The political focus of equitable health outcomes in the United States have long centered on access to medical care. However, there is compelling evidence that access to medical care is only the bare minimum necessary to achieve health, and the true influence of health insurance on health is still unclear. Widely accepted models of health estimate that less than 20% of health outcomes can be attributed to clinical care, while greater than 50% is related to social and economic determinants of health, with income being the most consistent predictor. As a result, this study investigated whether earned income is related to insurance status on the one hand and self-rated health on the other; whether the association between income and self-rated health is indirectly influenced by the presence of health insurance –namely private health insurance; whether there are differences in self-rated health between the privately insured, the publicly insured, and the uninsured; and if duration of uninsurance was inversely associated with self-rated health. As hypothesized, higher income was associated with having health insurance, and in particular private insurance. Among all included predictor variables, higher income and private insurance are the strongest predictors of higher self-rated health, and lower income and Medicaid were the strongest predictors of lower self-rated health. This study affirms that the health of persons with Medicaid is more similar to persons who are uninsured, and the health of persons with private insurance is more similar to those with Medicare. The association between income and self-rated health is indirectly influenced by health insurance. Age and education exerted the strongest overall influence on self-rated health: older respondents had lower self-rated health, and more educated respondents had higher self-rated health. And as uninsurance duration increased, self-rated health decreased. Additional studies are recommended to improve health insurance policy.

<p>In this age of accountability, responsiveness, and transparency, governments are increasingly pressured to develop ways to demonstrate the value of public involvement in policy decision-making. Yet the extent to which policy decisions actually reflect citizens’ views and input from public involvement processes remains relatively unknown. The main purpose of my dissertation is to examine the internal dynamics of how public involvement is used in the health policy decision-making process. It is guided by two research questions: i) How is public involvement used in the health policy decision-making process; and ii) What factors influence the use of public involvement in the health policy decision-making process? These questions are explored through three independent but complementary studies: i) through a concept analysis, to clarify the concept of public involvement use in health policy decision-making; ii) through a document analysis, to examine the values and assumptions that underpin current and proposed relationships between publics and government, how these have evolved over time, and the meaning of public involvement itself; and iii) through a literature review and key informant interviews, to identify the range of factors influencing the nature of how public involvement is used. The concept of public involvement use, as presented in this thesis, is a complex<strong><em> </em></strong>concept that may be understood, interpreted and operationalized through three interrelated questions: What is the meaning of use in relation to other similar concepts? What is public involvement used for? And, how do we know public involvement was used in health policy decision-making? The results of this dissertation also reveal numerous tensions that characterize the dynamics of how public involvement is used in policy decision-making. Taken together, the three studies provide insights into ways in which public administrators and policy decision-makers could respond to calls for greater accountability and transparency regarding the use of public involvement in policy decision-making.</p> / Doctor of Philosophy (PhD)

The unprecedented scale of health sector reform in the course of radical political transformation in post-apartheid South Africa is well-documented. This thesis examines child health policy reform as a crucial part of this process. The goals of broader health sector reform were to improve the overall health status of citizens, in particular those most vulnerable, and eliminate inequities in health service provision and health status outcomes. Although children were accorded explicit prioritisation during this time, child health indicators remain poor and some have worsened. Amidst the documented explanations for the poor progress with child health indicators, the specific role and contribution of child health policies had not been interrogated. The thesis examines the development, design and implementation of national child health policies, with particular focus on equity. The National School Health Policy serves as a case-study for the analysis. Three complementary policy analysis frameworks guide the enquiry. Findings are based on a documentary analysis of key policies and 81 qualitative interviews with national policy makers and managers, provincial and district managers, and service providers in three socioeconomically different provinces of South Africa. The common assertion by South African health system analysts, that "policies are good, but implementation is poor", is refuted by this research. The findings show that child health policies have many deficiencies in their design and development. These "poor policies" contribute to inadequate child health service provision, which in turn have a bearing on poor child health outcomes. In particular the failure in clearly defining and conceptualising equity in policy development and design contributed to the absence of equity considerations in the implementation phase. The explanations for these policy failures include: lack of strategic direction for child health services; poor policy making capacity; a lack of clear policy translation; and the diverse politics, power and passion of policy actors. Broader health system factors, such as an immature and poorly functioning district health system, compound these policy failures. The thesis deepens the understanding of child health policy reform through a retrospective policy analysis and so contributes to the body of knowledge on policy reform in South Africa and in low- and middle-income countries more generally.