Thesis (M.P.H.)--University of Michigan, 1947.

Thesis (M.P.H.)--University of Michigan, 1944.

Thesis (M.P.H.)--University of Michigan, 1947.

Thesis (M.P.H.)--University of Michigan, 1944.

Thesis (Ph. D.)--University of Chicago, School of Social Service Administration, June 2000. / Includes bibliographical references. Also available on the Internet.

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Background: Numerous studies demonstrate benefits of using advance care planning (ACP) in the general practice setting. Despite this, providers do not regularly initiate ACP and only one third of Americans have completed an advance directive (AD). This number is even lower among ethnic and minority groups. Community health center (CHC) providers have the opportunity to improve the quality of end-of-life (EOL) care and reduce healthcare disparities affecting medically underserved populations, yet no research has been conducted to identify CHC providers' practices, knowledge and attitudes towards ACP. Addressing this query may assist researchers in identifying optimal strategies for improving ACP delivery in this setting, ultimately leading to improved quality of EOL care for the populations served. Purpose: The study purpose was to assess Arizona CHC providers' practices, knowledge and attitudes towards ACP. Setting: The study setting was federally qualified community health centers located in urban and rural sites throughout Arizona. Participants: Study participants (N = 38) were predominantly middle-aged females practicing for an average of 13 years. 60% of providers were Master's or Doctor of Nursing Practice (DNP) prepared providers while 40% were Doctor of Medicine (MD) or Doctor of Osteopathy (MD). Methods: This study used a descriptive correlational quantitative research design. The "EOL Decision Making Survey" instrument was adapted into an electronic survey and distributed to 514 physician and non-physician CHC providers. Data analysis was performed using PASS and SPSS statistical software. Results: This sample of Arizona CHC providers was reasonably knowledgeable about Arizona state law and clinical application of ACP. Physician providers had greater knowledge and greater confidence in their answers related to Arizona state law compared to non-physician providers. Participants were largely comfortable with counseling patients in ACP and exhibited mostly positive attitudes toward ACP. Older respondents with greater years' experience tended to have greater knowledge of the clinical application of ACP as well as greater positive attitudes towards ACP. Providers with greater years' experience tended to have greater comfort in counseling patients in ACP. Despite these positive findings, routine initiation of ACP in this setting was low (44%). Conclusions: Though Arizona CHC providers have reasonable knowledge related to ACP, are comfortable with counseling patients in ACP and have positive attitudes towards ACP, less than half routinely initiate ACP conversations with their patients. Though more research is needed to validate these findings, targeted educational interventions and process changes may help improve ACP delivery rates in this setting.

Thesis advisor: Rocío Calvo / Hispanics are less likely than non-Hispanic whites to use mental health service, even after controlling for various social, environmental, and health factors. Mental health services disparities between Hispanics and non-Hispanic whites have been well-documented and consistent over time. However, very little is known about the impact mental health care organizations have on Hispanics’ access to mental health care, especially since the implementation of the Patient Protection and Affordable Care Act (ACA). The three papers in this dissertation utilize the 2010, 2014, and 2016 waves of the National Mental Services Survey (N-MHSS) to assess the impact of the ACA on Hispanics’ access to mental health care and mental health care organizations’ provision of integrated services. The N-MHSS is a national repository of data on the mental health organizations in the United States. This dataset was created to report the characteristics and client enrollment at mental health care organizations. Paper 1 uses the 2014 N-MHSS to describe the structural characteristics of mental health care organizations according to the proportion of Hispanics they serve and the organizations’ structural characteristics in Medicaid expansion and non-expansion states. Paper 2 uses the 2010, 2014, and 2016 N-MHSS waves to examines the impact of the ACA and the health safety net on Hispanic admissions at mental health care organizations. These three waves were merged together using a repeated cross-sectional design to assess whether Hispanic admissions increased after the implementation of the ACA. The final paper uses the 2014 and 2016 N-MHSS waves to assesses whether integrated care has increased at Hispanic-serving organizations compared with mainstream organizations two years after the implementation of the ACA. This paper also assessed whether the increased funding for integrated services under the ACA has disproportionately affected mainstream organizations compared with Hispanic-serving organizations. / Thesis (PhD) — Boston College, 2018. / Submitted to: Boston College. Graduate School of Social Work. / Discipline: Social Work.

Introdução. A Iniciativa Hospital Amigo da Criança (IHAC) foi idealizada pela OMS e pelo UNICEF para promover, proteger e apoiar o aleitamento materno no âmbito hospitalar. Já a Rede Amamenta Brasil foi criada pelo Ministério da Saúde com o mesmo objetivo; porém, no âmbito da atenção básica. Objetivo. Avaliar a influência do apoio propiciado pelas maternidades e pelos locais de seguimento ambulatorial sobre o padrão de aleitamento materno de crianças menores de seis meses do Município de Ribeirão Preto SP. Métodos. Foram coletados dados referentes à caracterização das maternidades e à implementação dos Dez Passos para o Sucesso do Aleitamento Materno da IHAC mediante entrevista com o chefe do serviço de neonatologia de cada local. Informação sobre a Rede realização da Oficina de Trabalho em Aleitamento Materno foi fornecida pela Secretaria de Saúde do município. Características das crianças, suas mães, hospital de nascimento e local de seguimento ambulatorial foram obtidas com base no Projeto Amamentação e Municípios 2011. O efeito do fator de estudo sobre a amamentação exclusiva (AME) e predominante (AMP) foi avaliado mediante análise de regressão múltipla de Poisson com variância robusta. No modelo múltiplo foram incluídas como ajuste as variáveis que apresentaram p<0,20 na análise bruta e modificaram em mais de 10 por cento a razão de prevalência do fator de estudo. Resultados. Foram estudadas 916 crianças. A maioria (58,9 por cento ) nasceu de parto cesárea. A prevalência de AME foi de 33,2 por cento e de AMP, 16,3 por cento . Das sete maternidades do município, três são públicas e estão credenciadas na IHAC. Das 40 unidades de saúde, 15 realizaram a Oficina da Rede. O total de passos cumpridos por cada maternidade variou de 1 a 10, e somente um local cumpriu todos os passos. A prevalência de AME foi maior quando o passo relacionado ao não uso de bicos artificiais foi cumprido. A de AMP tendeu a aumentar quanto maior foi o número de passos cumpridos, e o passo referente a grupos de apoio à amamentação aumentou essa prevalência. O AME foi mais prevalente em locais que realizaram a Oficina da Rede. Conclusões. Cumprir maior número de passos mostrou tendência ascendente no aumento da prevalência de AMP. O passo 10 também aumentou essa prevalência, e o passo 9 aumentou a de AME. Este desfecho foi mais prevalente em locais que participaram da Oficina da Rede. Os achados deste estudo podem servir como subsídios para outras localidades incentivarem o aleitamento materno. / Introduction. The Baby Friendly Hospital Initiative (BFHI) was idealized by WHO and UNICEF to promote, protect and support breastfeeding in the hospital sphere. The Rede Amamenta Brasil was created by Ministry of Health with the same objective; however, in the primary health care sphere. Objective. To evaluate the influence of support offered by maternity hospitals and ambulatory attendance places on breastfeeding pattern in children less than six months in the city of Ribeirão Preto, SP, Brazil. Methods. Dates related to maternity hospitals characterization and implementation of IHACs Ten Steps to Successful Breastfeeding were collected during an interview with responsible doctor by the neonatology service of each place. Information about Rede Amamenta Brasil participation on Oficina de Trabalho em Aleitamento Materno was given by Citys Secretary of Health. Characteristics of children, their mothers, birth hospital and ambulatory attendance place were obtained by Projeto Amamentação e Municípios 2011. The effect of factor study on exclusive (EB) and predominant (PB) breastfeeding was evaluated by Poisson multiple regression analysis with robust variance. Variables with p<0,20 and that modified in more than 10 per cent prevalence ratio of factor study were included in the multiple model. Resultados. The number of studied children was 916. The most part (58.9 per cent ) was born by Cesarean delivery. The prevalence of EB was 33.2 per cent , and PB, 16.3 per cent . Among seven maternity hospitals of the studied city, three are public and accredited by BFHI. Among 40 primary care units, 15 made the Oficina da Rede. Total number of met steps for each maternity hospital range from 1 to 10, and only one place met all steps. The prevalence of EB was higher when step referred to no offer artificial teats or pacifiers was met. The prevalence of PB tended to increase when the number of met steps raised, and the step related to breastfeeding support groups increased this prevalence. The EB was more prevalent in places that realized the Oficina da Rede. Conclusions. Meeting higher number of steps showed ascendant trend on increasing prevalence of PB in children less than six months. The step 10 also increase this prevalence, and the step 9 increase the prevalence of EB. This outcome was more prevalent in places that participated of the Oficina da Rede. The findings of this study can be useful to other places encourage breastfeeding.

Com o objetivo de quantificar o evento psico-social \"Atitude em relação a Centros de Saúde\", uma escala Thurstone dos \"Intervalos equi-aparenciais\" foi construida e apresentada. Inicialmente montou-se um quadro teórico, onde foi inserido o conceito a ser mensurado e a partir do qual construiram-se duzentos e sete estímulos- afirmações. Quatro áreas de conteúdo foram abrangidas: atitude em relação aos médicos, atitude em relação a serviços oferecidos, atitude em relação a funcionários e atitude em relação ao ambiente psico-social dos Centros de Saúde. As afirmações foram submetidas a quatro grupos de juízes compostos de médicos, enfermeiros, educadores de saúde pública e sociólogos que trabalham na área da saúde. Os valores escalares e índices de ambiguidade foram calculados para cada grupo profissional e para o grupo como um todo. As afirmações definitivas foram selecionadas através dos seguintes critérios: valor escalar, índice de ambiguidade e área de conteúdo. Foram escolhidas cinquenta e sete afirmações: dezenove na primeira área de conteúdo, treze na segunda área de conteúdo, quinze na terceira área e dez na quarta. Esta pesquisa foi somente uma primeira abordagem ao problema de mensuração de atitudes. Um pré-teste será necessário para testar validade e fidedignidade do instrumento construido para que depois seja empregado em pesquisas ligadas à educação em saúde pública. / With the purpose of gaining quantitative knowledge about the social psychological phenomena \"Atitude toward Health Centers\", A Thurstone \"Equal Appearing Interval\" scale was developed and presented. In the begining a theoritical referal system was built ineluding the concept to be measured, and 207 statements were devised. Four content areas were included: attitude toward physicians, attitude toward health services offered, attitude toward social-psychological environment of the Health Centers. The statements were presented to four groups of judges composed of psysicians, public health educators, nurses and sociologists working in public health. Scale values and a Q value were calculated separately for each statement for each group of Judges and for de whole group. A final scale was selected by three criterion: scale values, Q value and content areas. From the 207 scored statements a scale containing 57 items was developed: 19 in the first content area, 13 in the second, 15 in the third, 10 in the fourth. This research was only a first approach to measure atitudes. A pretest will be necessary to test validity and reliability of the instrument developed, to make it useful to research applied to public health education.