This study, in collaboration with the Montreal Deaf Community, used an anthropological perspective to explore the health care experiences of deaf persons and identify the strategies they use to meet their health needs. Narratives were qualitatively analyzed. Deaf persons see their world as separate from the hearing world of health services. The latter is perceived as lacking understanding of deaf persons, leading to their feeling of exclusion and powerlessness. What is supposed to be a source of support becomes one of anxiety. Nevertheless, deaf people show courage and versatility in coping strategies including affiliation and the notion of culture. The health system focus on 'normalization' contradicts deaf persons' perceptions of deafness as a meaningful human reality. The differing values have implications for health professionals and the organization of services. The McGill Model of Nursing offers an organizational framework for planning accessible health services for deaf persons.

The focus of health care reform is to contribute to better patient health and maintain an equitable access to the system while at the same time achieving a more effective and efficient use of increasingly scarce health care dollars. Due to budgetary and other restraints provincial governments are either spending less on health care or are looking to change the delivery and management of the health industry. / How the Canadian health care system responds to the challenges depends upon the interpretation of a number of factors. Three basic factors which are linked to any health care delivery system are financing, delivery and allocation of resources with the altering of one of these components affecting the others. / Has there developed a right to health care and if so, would this foreclose a curtailment of health care services? If there is no right to health care, can the courts or the Charter of Rights and Freedoms be used to protect the existing system? Is it possible for public interest groups, or others, to utilize judicial intervention to force a government, either at the provincial or federal level, to spend more on health care or change their health care policy? What if a patient is affected by decision affecting health care delivery, does this bring in civil liability? / This thesis will review these areas in an effort to understand, articulate and ascribe values to Canada's health care system and provide a legal and ethical analysis of alternative health care delivery systems.

This thesis will explore the various legal, administrative and ethical issues arising out of the situation in which nurse is HIV-positive or has AIDS. In contrast to the situation of patients suffering from AIDS or HIV, there has been little in the literature, whether legal or medical, on nurses who are infected. The rights and duties of these nurses, testing of nurses for the presence of HIV infection or AIDS and the issue of discrimination are among the matters discussed with reference to relevant legislation and ethical principles.

Background: This thesis is composed of three studies testing the effect of the Colon Cancer Check (CCC) program, the organized screening program for colorectal cancer in Ontario, on screening participation. In the first paper, we described the trends of participation to Fecal Occult Blood Test (FOBT) and endoscopy, and the trend of ‘up-to-date’ consistent with guidelines, overall and stratified by demographic characteristics between 2005 and 2011. In the second paper, we tested the effect of physician’s recommendation on FOBT participation and disparities in participation. In the third paper, we measured the effect of the CCC program on FOBT participation using an interrupted time series. Methods: We identified six annual cohorts of individuals eligible for CRC screening in Ontario between 2005 and 2011 by linking the Registered Persons Database to Ontario Health Insurance Plan and 2006 Census from Statistics Canada. We used descriptive statistics to describe the trends of participation. The effect of physician’s recommendation on screening participation was tested using multiple logistic regression analysis. The effect of the CCC program on FOBT participation was tested using segmented regression analysis. Results: An increasing trend in FOBT participation and ‘up-to-date’ status was observed across all demographic characteristics. The disparity gaps persisted over time by gender, income, recent registrant and age. The rural/urban gap was removed. Physician’s recommendation tripled the likelihood of FOBT participation (prevalence rate ratio=3.23, CI= 3.22-3.24) and mitigated disparities. The CCC led to a temporary increase in level (8.2‰ person-month) in FOBT participation followed by a decline in trend and then a plateau. The increase in level was significant across all population sub-groups. Conclusions: We found that CRC screening has increased in Ontario across all subgroups of the population but remained suboptimal. Disparities in screening participation were identified. Proposed strategies to improve performance include interventions to increase the rate of physician’s recommendation at the practice level, tailored interventions to motivate under-users and public media campaigns.

This action research study explored the supports required to facilitate the successful transition for new graduate paramedics integrating into their role and to provide recommendations to AHS Emergency Medical Services managers to implement a positive change outcome. AHS paramedics who graduated in the last three years participated in a focus group and online survey. The study findings revealed that the transition experience was challenging and caused stress and anxiety for new graduates. Having a support system in place could increase job satisfaction, retention, organizational commitment, and enhance employee skill development. The study concluded that implementing a mentorship program with support of AHS leadership would prove invaluable. The recommendations reflect the importance of providing a healthy and supportive work environment and working collaboratively with key stakeholders to develop and implement support for new graduate paramedics in AHS. This study adhered to all ethical requirements.

Background: This thesis is composed of three studies testing the effect of the Colon Cancer Check (CCC) program, the organized screening program for colorectal cancer in Ontario, on screening participation. In the first paper, we described the trends of participation to Fecal Occult Blood Test (FOBT) and endoscopy, and the trend of ‘up-to-date’ consistent with guidelines, overall and stratified by demographic characteristics between 2005 and 2011. In the second paper, we tested the effect of physician’s recommendation on FOBT participation and disparities in participation. In the third paper, we measured the effect of the CCC program on FOBT participation using an interrupted time series. Methods: We identified six annual cohorts of individuals eligible for CRC screening in Ontario between 2005 and 2011 by linking the Registered Persons Database to Ontario Health Insurance Plan and 2006 Census from Statistics Canada. We used descriptive statistics to describe the trends of participation. The effect of physician’s recommendation on screening participation was tested using multiple logistic regression analysis. The effect of the CCC program on FOBT participation was tested using segmented regression analysis. Results: An increasing trend in FOBT participation and ‘up-to-date’ status was observed across all demographic characteristics. The disparity gaps persisted over time by gender, income, recent registrant and age. The rural/urban gap was removed. Physician’s recommendation tripled the likelihood of FOBT participation (prevalence rate ratio=3.23, CI= 3.22-3.24) and mitigated disparities. The CCC led to a temporary increase in level (8.2‰ person-month) in FOBT participation followed by a decline in trend and then a plateau. The increase in level was significant across all population sub-groups. Conclusions: We found that CRC screening has increased in Ontario across all subgroups of the population but remained suboptimal. Disparities in screening participation were identified. Proposed strategies to improve performance include interventions to increase the rate of physician’s recommendation at the practice level, tailored interventions to motivate under-users and public media campaigns.

<p> While the primary goal of the northwest Alaska Native village maternal transport program is safe deliveries for mothers from remote villages, little has been done to examine the impact of transport on the mothers and communities involved. I explore how present values (Western and I&ntilde;upiat cultural values) can influence the desire of indigenous women of differing eras and northwest Alaska villages to participate in biomedical birth practices, largely as made available by a tribal health-sponsored patient transport system. The work that follows portrays the varying influences on these women and their communities as they determine the level of importance for mothers to get to the hospital to deliver. I have enlisted viewpoints of Alaska Native families and women of different generations from various I&ntilde;upiat villages to help paint a picture of the situation. With this research, I ask, how do generations of mothers, transport situations, and villages compare in terms of experiences during the processes of these I&ntilde;upiat women becoming mothers? What gender, ethnicity, and power interplays exist in this dynamic helix of social and political elements (embodiment) during their periods of liminality? What are influences (biomedical and community) that contribute to a woman's transition to motherhood in this community? Moreover, how do women, families, and community members perceive the maternal transport policy today? I examine how the transport policy figures into stages of liminality, as these mothers and communities produce future generations. With theoretical frameworks provided by medical anthropology and maternal identity work, I track the differences concerning the maternal transport operation for I&ntilde;upiat mothers of the area. I compare the influences of cultural value systems present in each of the communities by birth era and location. Using content analysis to determine common themes, I found connections among presence of I&ntilde;upiat values, community acceptance of maternal transport, and expressed desire for community autonomy in maternal health care.</p>

Some 70,000 people in New Zealand may have undiagnosed diabetes. This study aims to develop ‘systematic opportunistic screening’ for diabetes, testing people attending a general practitioner (GP) for some other reason, and to trial this process with Auckland GPs. The literature on how to change doctor behaviour is reviewed for both theoretical perspectives and empirical evidence. Two of the most promising strategies are computer reminders within a medical consultation and having patients influence doctors. Literature reviews cover GP attitudes to diabetes, guidelines and preventive care and the role of a computer in a GP consultation. The Mail Survey (response rate 154/212, 72.6%) reports GP attitudes to guidelines and preventive care. Factor analysis showed five ‘guidelines’ factors and two ‘preventive care’ factors that might indicate differential motivations to screening for diabetes. The Focus Group Study, of 35 GPs in 5 groups, discussed guidelines, diabetes and computer reminders in a consultation. The analysis suggested that GPs would respond to a patient reminder and may respond to a computer reminder to screen for diabetes. The Screening Reminder Trial involved 107 GPs randomly allocated across four interventions: Computer reminders, Patient reminders, Both and Usual care. The main outcome measures were whether a patient who was eligible for diabetes screening and who visited a GP during the trial had a glucose test done within the trial. The trial ran for two months. Analysis was by intention-to-treat and allowed for clustering by GP. Compared with the Usual care group (screening rate 15.5%), the Odds Ratio of eligible patients being screened were; Computer group OR 2.55 (1.68-3.88), Patient group OR 1.72 (1.21-2.43) and Both group OR 1.69 (1.11-2.59). The Computer reminders were more acceptable to GPs than were the Patient intervention. The findings suggest that a simple computer reminder can implement systematic opportunistic screening for diabetes in New Zealand. If all GPs in New Zealand used the computer reminders for one year, some 8000 patients might benefit from having their diabetes treated for five years longer than they would have under ‘usual care’. / Subscription resource available via Digital Dissertations only.

Some 70,000 people in New Zealand may have undiagnosed diabetes. This study aims to develop ‘systematic opportunistic screening’ for diabetes, testing people attending a general practitioner (GP) for some other reason, and to trial this process with Auckland GPs. The literature on how to change doctor behaviour is reviewed for both theoretical perspectives and empirical evidence. Two of the most promising strategies are computer reminders within a medical consultation and having patients influence doctors. Literature reviews cover GP attitudes to diabetes, guidelines and preventive care and the role of a computer in a GP consultation. The Mail Survey (response rate 154/212, 72.6%) reports GP attitudes to guidelines and preventive care. Factor analysis showed five ‘guidelines’ factors and two ‘preventive care’ factors that might indicate differential motivations to screening for diabetes. The Focus Group Study, of 35 GPs in 5 groups, discussed guidelines, diabetes and computer reminders in a consultation. The analysis suggested that GPs would respond to a patient reminder and may respond to a computer reminder to screen for diabetes. The Screening Reminder Trial involved 107 GPs randomly allocated across four interventions: Computer reminders, Patient reminders, Both and Usual care. The main outcome measures were whether a patient who was eligible for diabetes screening and who visited a GP during the trial had a glucose test done within the trial. The trial ran for two months. Analysis was by intention-to-treat and allowed for clustering by GP. Compared with the Usual care group (screening rate 15.5%), the Odds Ratio of eligible patients being screened were; Computer group OR 2.55 (1.68-3.88), Patient group OR 1.72 (1.21-2.43) and Both group OR 1.69 (1.11-2.59). The Computer reminders were more acceptable to GPs than were the Patient intervention. The findings suggest that a simple computer reminder can implement systematic opportunistic screening for diabetes in New Zealand. If all GPs in New Zealand used the computer reminders for one year, some 8000 patients might benefit from having their diabetes treated for five years longer than they would have under ‘usual care’. / Subscription resource available via Digital Dissertations only.

Some 70,000 people in New Zealand may have undiagnosed diabetes. This study aims to develop ‘systematic opportunistic screening’ for diabetes, testing people attending a general practitioner (GP) for some other reason, and to trial this process with Auckland GPs. The literature on how to change doctor behaviour is reviewed for both theoretical perspectives and empirical evidence. Two of the most promising strategies are computer reminders within a medical consultation and having patients influence doctors. Literature reviews cover GP attitudes to diabetes, guidelines and preventive care and the role of a computer in a GP consultation. The Mail Survey (response rate 154/212, 72.6%) reports GP attitudes to guidelines and preventive care. Factor analysis showed five ‘guidelines’ factors and two ‘preventive care’ factors that might indicate differential motivations to screening for diabetes. The Focus Group Study, of 35 GPs in 5 groups, discussed guidelines, diabetes and computer reminders in a consultation. The analysis suggested that GPs would respond to a patient reminder and may respond to a computer reminder to screen for diabetes. The Screening Reminder Trial involved 107 GPs randomly allocated across four interventions: Computer reminders, Patient reminders, Both and Usual care. The main outcome measures were whether a patient who was eligible for diabetes screening and who visited a GP during the trial had a glucose test done within the trial. The trial ran for two months. Analysis was by intention-to-treat and allowed for clustering by GP. Compared with the Usual care group (screening rate 15.5%), the Odds Ratio of eligible patients being screened were; Computer group OR 2.55 (1.68-3.88), Patient group OR 1.72 (1.21-2.43) and Both group OR 1.69 (1.11-2.59). The Computer reminders were more acceptable to GPs than were the Patient intervention. The findings suggest that a simple computer reminder can implement systematic opportunistic screening for diabetes in New Zealand. If all GPs in New Zealand used the computer reminders for one year, some 8000 patients might benefit from having their diabetes treated for five years longer than they would have under ‘usual care’. / Subscription resource available via Digital Dissertations only.