This paper considers the Aboriginal population in Canada (composed of First Nations, Métis and Inuit peoples) and explores the hypothesis that the degree to which traditional knowledge concepts, specifically in the area of mental health, is impacted by the extent to which a given population has achieved self-government. Additionally, from a public policy standpoint, this study – using a single case comparison methodology – examines the gap between intentions outlined in policy formulation stage guidance documents, indicating that the Canadian federal government intends to incorporate traditional knowledge to a greater degree, and evidence present at the policy implementation and budgeting stage, where it is clear that the application of the guidance does not always result in the stated outcome. By looking at similarities and differences between the case populations, this study will highlight some successes in the field of mental health policy, assess the challenges that policymakers face in the area of Aboriginal health, and offer suggestions to arrive at a place in the future where fundamental mental health disparities have been reduced for Aboriginal people in Canada.

Thesis (M. Soc. Sc.)--University of Hong Kong, 1987.

Thesis (M.P.A.)--University of Hong Kong, 1994. / Includes bibliographical references.

Thesis (M.P.A.)--University of Hong Kong, 1994. / Includes bibliographical references. Also available in print.

Thesis (M.Soc.Sc.)--University of Hong Kong, 1987. / Also available in print.

This paper considers the Aboriginal population in Canada (composed of First Nations, Métis and Inuit peoples) and explores the hypothesis that the degree to which traditional knowledge concepts, specifically in the area of mental health, is impacted by the extent to which a given population has achieved self-government. Additionally, from a public policy standpoint, this study – using a single case comparison methodology – examines the gap between intentions outlined in policy formulation stage guidance documents, indicating that the Canadian federal government intends to incorporate traditional knowledge to a greater degree, and evidence present at the policy implementation and budgeting stage, where it is clear that the application of the guidance does not always result in the stated outcome. By looking at similarities and differences between the case populations, this study will highlight some successes in the field of mental health policy, assess the challenges that policymakers face in the area of Aboriginal health, and offer suggestions to arrive at a place in the future where fundamental mental health disparities have been reduced for Aboriginal people in Canada.

In many states, outdated rules and regulations restrict nurse practitioners (NPs) from practicing to their full potential, often limiting patients’ access to primary care. Modernizing NP state scope of practice laws and allowing patients greater access to NPs services is a priority. Unlike other professions, nurse practitioners have been unable to consistently influence legislative changes to health policy. This study examined the political efficacy and participation of nurse practitioners in the United States today (N=632). A descriptive cross sectional design, in conjunction with a political efficacy framework, evaluated nurse practitioners’ participation in political activities and their internal and external political efficacy. Increased internal political efficacy was significantly (p < 0.001) associated with NPs who were older, had specific health policy education, and have been mentored in health policy. Our findings show that NPs vote at consistently higher rates (94%) than the general population and almost 50% report contacting legislators via mail/email/phone. As a group however, NPs report limited participation in other political activities, especially grassroots efforts. These findings hold significant implications for the profession as we strive to make policy changes across the country. It is important that educators assess our current methods of educating NPs about politics and health policy. Professional organizations and policy makers must reexamine outreach and strategies to inspire greater grassroots engagement of NPs.

Evidence-based practices and comparative effectiveness research are salient topics in public policy. Empirical validation of agency operating processes provides agencies and policy-makers the opportunity to address uncertainty surrounding effectiveness. While this is an increasingly accepted rational approach to public policy, the exact mechanism for how this operates is less known. In order to evaluate several theoretical assumptions and normative rational expectations inherent in this approach, the implementation of a state legislative mandate stating policy expectations for behavioral health evidence-based practices is assessed. This study sought to assess whether implementation patterns and associated outcomes reflect "rational mechanism" policy expectations. While the premise of this research surrounds a state behavioral health legal mandate, results inform broader health policy efforts. Study results identify some evidence that the policy yielded "rational mechanism" processes and outcomes, but also indicated that other mechanisms may have influenced implementation patterns. In addition, evidence of a link between policy and outcomes is at best inconsistent. Further research on evidence-based policies using definitional and measurement frameworks applied in this study is clearly warranted.

Objectives: The use of interactive public engagement methods to elicit public values is becoming routine practice in health system planning, policy and evaluation; however, little systematic attention has been given to the analysis of how these values are articulated. This process will be examined with the use of deliberative discourse methods in the context of health technologies. Approach: The deliberations of a 14-person Citizens’ Reference Panel on Health Technologies were audiotaped and transcribed. The panel provided input to the Ontario Health Technology Advisory Committee in developing its recommendations. Discussion transcripts were analyzed using Gee’s (2005) ‘building tasks’ framework with a focus on identities, relationships, and politics. In depth language-context analysis was then used to study ‘situated meanings’ of social and ethical citizen values. Both levels of discourse analysis were then used to elicit the meso-level dynamics within the citizen panel deliberations. Results: Panel members used the provided materials, personal experience and other sources of information to express their values toward the technologies under review. In the group, members used their occupational, personal and cultural identities and adopted in-group citizen panel roles that involved summarizing small group discussions, challenging other members, providing information, providing expertise, interpreting information and facilitating. These individual roles were similar across meetings and members began to form relationships with their fellow citizens and make connections between the values involved in similar technologies. Conclusion: Discourse analysis methods can be used to draw in-depth insights from public engagement deliberations which contribute important new knowledge to the field of public deliberation and health policy. Further use and refinement of deliberative discourse methods will allow public values to be better understood and more adequately portrayed in the health technology assessment process. / Master of Science (MSc)

<p>Introduction: Palliative care in Canada is an under-funded service for all Canadians, but for Aboriginal people in Canada, the level of access to such care is significantly lower. This study examined the system of palliative care delivery at Six Nations of the Grand River. The overall aim of the project was to identify ways on how the system of care could be improved.</p> <p>Methods: A qualitative case study approach was used. Interviews were held with Elders and family caregivers to identify the priorities in care delivery from their perspective. Focus groups were held with representatives from palliative care service provider agencies in an effort to identify the strengths and challenges within the system and to determine how palliative care services provided to the members of Six Nations could be improved.</p> <p>Findings: Themes identified in the interviews included: personable, caring care; culturally-competent care; open two-way communication; support for family caregivers; palliative home care should be available; meeting comfort needs of the person; and the need for a hospice in the community. The main theme identified in the focus groups with care providers included: relationship/rapport issues between provider organizations; within-program strengths and challenges; cultural considerations in care; and broader system factors that influence care.</p> <p>Discussion: Relationship/rapport issues were identified as a challenge, and it appeared that the focus groups provided an opportunity for communication between the organizations to improve. Identification of within-program challenges – and ways to address these challenges - may provide opportunities for each organization to improve how palliative care services are delivered at Six Nations. Identification of broader system factors that influence care may also benefit patients in need of palliative care.</p> / Master of Science (MSc)