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Federally qualified health centers (FQHCs) provide essential contraceptive services to low-income individuals; yet, access to all method options, notably intrauterine devices (IUDs) and implants, may be limited at non-Title X FQHCs. The South Carolina (SC) Choose Well initiative is a statewide contraceptive access initiative that was launched in 2017 and extends into 2022. Choose Well established a collaborative network between training and clinical partners and is aimed at facilitating implementation of contraceptive care best practices through capacity-building and training of clinical and administrative staff in partner organizations. The initiative provided funding for workforce expansion and contraceptive methods. We examined perceptions of staff from Choose Well-participating FQHCs regarding contraceptive access during the first 2 years of the initiative, including factors that facilitated or posed access challenges as well as sustaining factors. This study informs the process evaluation of Choose Well while providing data critical for uncovering and scaling up contraceptive access initiatives. Interviews were conducted with FQHC staff ( = 34) in 2018 and 2019 to assess Choose Well implementation and were recorded, transcribed, and double-coded at least 80% interrater reliability or consensus coding. Data were analyzed according to clinical and administrative factors influencing contraceptive access. Increased capacity for contraceptive counseling and provision through training and external funding for IUDs and implants were the most noted clinical factors facilitating access. Streamlining workflow processes was also a facilitator. Buy-in and engagement among staff and leadership emerged as a facilitator at some clinics and as a barrier at others. Policy/structural factors related to costs of devices and insurance coverage were identified as threats to sustainability. The Choose Well initiative contributed to the perception of an increase in contraceptive access at participating FQHCs in SC. Statewide contraceptive access initiatives have the potential to support FQHCs in meeting their clients' contraceptive needs. Organizational buy-in, sustainability of funding, and training are key to realizing the full potential of these initiatives.

The purpose of this dissertation research was to explore indications of disparities within the east Central Florida child and adolescent healthcare services market. Structured as a follow-up study to work completed in 2005 under the direction of the Health Council of East Central Florida assessing parental perceptions of community child and adolescent healthcare services, this research extended that evaluation by aggregating participant responses at the county and small area zip code group levels, contextually testing the uniformity of responses in understanding parent perceptions of access to, and satisfaction with, community healthcare service offerings available for children and adolescents. Under a variety of methodologies significance in the responses concerning access to healthcare services were demonstrated between the counties studied. Statistical modeling, however, could not demonstrate the core demographic differences among these data. Data representing perceptions of satisfaction with the services received by children and adolescents were demonstrated at the small area zip code group level within Orange county. Primary effect assessment of the demographic variables representing these respondents yielded findings generally consistent with theoretical expectations of disparity but, notably, the correlation effects between a number of key independent variables demonstrated a mediation of the primary effects on overall perception of satisfaction. Specifically, it was demonstrated that the interaction of white race with possession of private healthcare insurance, and the iv interaction of greater levels of educational attainment with black race, caused a proportional reduction in the predicted satisfaction score of these survey respondent cohorts. Further research specific to these phenomenon encompassing a clearer understanding of the type of care received and the individual’s specific experiences with their healthcare providers was recommended, with ensuing research to better identify commonalities of interactions with specific area providers, local restrictions imposed by area insurance carriers, influences caused by language and/or cultural barriers, and the like as drivers in understanding the individual dynamics of satisfaction.

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Yes / The frequency of visits to Emergency Departments (ED) varies greatly between populations. This may reflect variation in patient behaviour, need, accessibility, and service configuration as well as the complex interactions between these factors. This study investigates the relationship between distance, socio-economic deprivation, and proximity to an alternative care setting (a Minor Injuries Unit (MIU)), with particular attention to the interaction between distance and deprivation. It is set in a population of approximately 5.4 million living in central England, which is highly heterogeneous in terms of ethnicity, socio-economics, and distance to hospital. The study data set captured 1,413,363 ED visits made by residents of the region to National Health Service (NHS) hospitals during the financial year 2007/8. Our units of analysis were small units of census geography having an average population of 1,545. Separate regression models were made for children and adults. For each additional kilometre of distance from a hospital, predicted child attendances fell by 2.2% (1.7%-2.6% p<0.001) and predicted adult attendances fell by 1.5% (1.2% -1.8%, p<0.001). Compared to the least deprived quintile, attendances in the most deprived quintile more than doubled for children (incident rate ratio (IRR) = 2.19, (1.90-2.54, p<0.001)) and adults (IRR 2.26, (2.01-2.55, p<0.001)). Proximity of an MIU was significant and both adult and child attendances were greater in populations who lived further away from them, suggesting that MIUs may reduce ED demand. The interaction between distance and deprivation was significant. Attendance in deprived neighbourhoods reduces with distance to a greater degree than in less deprived ones for both adults and children. In conclusion, ED use is related to both deprivation and distance, but the effect of distance is modified by deprivation.

Human beings have two apparently conflicting fundamental rights. On the one hand, individuals have a right to health care as the United Nations declared in 1948. On the other hand, individuals have a right to liberty; that is, the freedom to make one's own health related choices, even poor ones. One goal of this essay is to show how to reconcile these two apparently conflicting core American values. This reconciliation is important, because a universal health care system that is fair and just must account for individual rights in tandem with attempts to address matters of social justice. In order for this reconciliation to occur, matters of individual responsibility, social responsibility, and social justice must be central to health care reform. / by Jennifer Lynn Mantoni. / Vita. / Thesis (M.A.)--Florida Atlantic University, 2011. / Includes bibliography. / Electronic reproduction. Boca Raton, Fla., 2011. Mode of access: World Wide Web.

The purpose of this study was to examine the effect of perceived discrimination on Samoan health. This study employed purposive data collection and was conducted quantitatively using a questionnaire format, which measured everyday perceived discrimination, depression, and physical health.

This study explored how the well-being of the gays, lesbians and bisexuals (GLBs} in Botswana could be promoted. The health and human rights approach that places dignity before rights was selected as a framework for investigation. The respondents' (n=47) levels of well-being were assessed through a questionnaire with 76 items that included the General Well-Being Schedule. The findings indicated that varying degrees of distress were experienced by 64 % of the GLBs in this study. The GLBs identified a need for HIV/AIDS education and had concerns about their general health, discrimination and vulnerability for violence including sexual attacks. Their levels of well-being were influenced by both positive internal acceptance of their sexual orientation and negative external acceptance by society. Levels of involvement of health professionals was poor, and linkage between health and human rights was proposed to reduce dignity violations and improve the quality of life of the GLBs in Botswana. / Health Studies / M.A. (Nursing Science)

Inequalities in levels of health between regions within a country are frequently regarded as a problem. Zimbabwe is characterised by poor and unequal conditions of health (both the state of people’s health and health services). The health system of the country shows severe spatial inequalities that are manifested at provincial, district and even local levels. This research therefore examines and analyses the spatial inequalities and temporal variation of health conditions in Zimbabwe. Composite indices were used to determine the people’s state of health in Zimbabwe. Administrative districts were ranked according to the level of people’s state of health. Cluster analysis was also performed to demarcate administrative districts according the level of health service provision. Districts with minimum difference were demarcated in a single cluster. Clusters were delineated using data on patterns of diseases and health and such clusters were used to demarcate the country’s spatial health system according to the Adapted Epidemiological Transition Model. This was used to evaluate the applicability of the model to Zimbabwe. It emerged from the research that generally the country’s health conditions are poor and the health system is characterised by severe spatial inequalities. Some districts are experiencing poor health service provision and serious health challenges and are still in the age of pestilence and famine but others have good health service provision as well as highly developed health conditions and are in the age degenerative diseases of the epidemiological transition model. It further emerged that the country’s health has been evolving with signs of improvement since the 1990s. Recommendations were made regarding possible adjustment to previous strategies and policies used in Zimbabwe, for the development of the health system of the country. New strategies were also recommended for the improvement of the health system of the country. Some proposals are made for further research on the spatial development of health in the country. / Geography / D. Litt et. Phil. (Geography)

The purpose of this study was to explore the views of adults with disabilities and their care providers with regard to extent to which health promotion implementation was facilitated within Protective Workshops across several service areas in South Africa. Quantitative and Qualitative Data was collected via a combination of data collection approaches that included the use of a descriptive survey, a self-administered questionnaire and a semi-structured interview. Structured questionnaires and an interview schedule were used to generate data from both the patient and care provider participants in each of the selected facilities. Participants with disabilities and care providers working in the Protective Workshops were identified and sampled through a multi-stage sampling procedure. Participants from 48 facilities participated in the study. The findings revealed that health promotion in Protective Workshops was cursory and informal. Even though health education was provided whenever the need arose, it was neither individualized nor customized in accordance with reasonable accommodation of people with disabilities. There were provincial differences in terms of the levels of participation and organizational support for people with disabilities. In certain cases bureaucratic obstacles were identified during field work. Results show inconsistency regarding access to equal opportunities for people with disabilities, albeit some agreed to a lesser extent (30.5%), others moderately (21.5%) compared to only 22.6% who agreed, were exceeded by 25% of respondents who completely disagreed to the notion that equal opportunities existed for people with disabilities. The latter was confirmed by care providers. The study recommended an urgent need for the development of inclusive health promotion, the enforcement of the requirements for reasonable accommodation and adherence to policy and legal imperatives. / Health Studies / D. Litt. et Phil. (Health Studies)