Community-based participatory research (CBPR) positions community members on an equal footing with their academic colleagues and makes them responsible for the decisions which shape the direction and substance of research. The approach is founded on ideals of empowerment and the raising of critical awareness amongst stakeholders while contributing to social and community change. This thesis examines the practice of CBPR; specifically, the inconsistencies between its ideals and the achievement of meaningful outcomes, and its relative absence within health geography. While the thesis relies most heavily on theories of social capital for its conceptual framing, it also draws on three key concepts stigma, and critical and oppositional consciousness. Three CBPR case studies were initiated to uncover the challenges, benefits, and shortcomings of the approach involving people living with HIV/AIDS, persons with disabilities, and residents of social housing. The projects were evaluated using a range of strategies including participant observation, interviews with key stakeholders, questionnaires, and focus group discussions. The implementation of these projects ranged in success from being sidelined by managerial difficulties, community mobilization efforts proving unsuccessful, to a fully realized CBPR case study. ii The case studies illustrate the tenuous position of a researcher engaged in grassroots community mobilization and the need for core levels of social capital to precede the researcher’s intervention. Interviews with CBPR stakeholders exposed the sense of purpose and value of being united against a given cause and even the social benefits of connecting with others. The interviews brought into question the imposition of stringent research expectations upon community members who may face multiple barriers to carrying out research and gain little benefit from the practice. I conclude by suggesting that CBPR is a long way from being the perfect marriage of academia and community, failing adequately to meet the needs of both parties. In particular, the third case study demonstrates that stakeholders are critically aware of issues that affect their lives, their capabilities to carry out research and the roles that the researcher might play. Ultimately, this raises questions about what role CBPR might play in community mobilization, especially when the resources of groups are limited socially, economically and politically. / Thesis (Ph.D, Geography) -- Queen's University, 2007-09-28 16:24:40.67

This thesis is a study of the residential care for elderly people in Beijing, China. First, a set of statistical indicators are developed for mapping the spatial distribution of the elderly population and residential care facilities (RCFs). Secondly, in-depth, semi-structured interviews are used to understand the socio-cultural meanings of access, the decision making process in relocation, the well-being of elderly residents, as well as the challenges of residential care and social welfare reform. In total, 27 elderly residents, 16 family members, and five RCF managers were interviewed in six RCFs in Beijing. The constant comparative method is used to analyze all the transcribed interview materials. There are several major findings resulting from the research: the distribution of the elderly population and residential care resources is geographically uneven across the districts of Beijing and the supply of resources does not match the potential need. Elderly people and their family members choose residential care because of the shortage of community and home care resources and/or the advantages of residential care. The decision making process is a process of balancing geographical factors, quality of services, and financial affordability. Access to residential care is an interactive process influenced by geographical, economic, and social-cultural factors. The physical and socio-cultural environments of RCFs and individual’s sense of place play important roles in their adaptation and well-being after the relocation from the home to a RCF. Building up the active aging model with joint efforts from governments, society, RCFs, and individuals is helpful and effective for promoting the well-being of elderly residents in RCFs. At the end, the study also provides suggestions for the government, organizations, and RCFs on aspects such as administration, policy making, planning, volunteering, and management of RCFs to meet the challenges of residential care in China. The study confirms the importance of healthy living environments to the well-being of elderly residents. It also provides knowledge for understanding the reconfiguration of filial piety in decision making processes and utilization of residential care in current Chinese society. From a health geography perspective, this thesis is one of the first studies on residential care in China. / Thesis (Ph.D, Geography) -- Queen's University, 2010-04-30 12:15:57.972

Made available in DSpace on 2014-06-11T19:33:34Z (GMT). No. of bitstreams: 0 Previous issue date: 2008-12-18Bitstream added on 2014-06-13T21:06:31Z : No. of bitstreams: 1 pereira_mpb_dr_prud.pdf: 5209874 bytes, checksum: fc46280e51a574d9999471c82b27bd32 (MD5) / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) / A Estratégia de Saúde da Família e o Programa de Saúde Ambiental, políticas públicas implantadas na cidade do Recife – PE, implicam em práticas sociais, e que tanto produzem quanto resultam em espaços educativos, como são resultados desses espaços. Enquanto práticas sociais, são desenvolvidas competências e habilidades sociais capazes de fazer com que os integrantes dessas políticas, em especial os agentes de saúde, desenvolvam um conhecimento geográfico capaz de promover a materialização dessas políticas na medida em que percebem elementos na paisagem e apropriam-se do território. Neste contexto, esta pesquisa analisa o conhecimento geográfico dos agentes envolvidos nesses programas implantados na cidade do Recife a partir das competências e habilidades desenvolvidas no processo de trabalho na política de saúde local. Para viabilizar a pesquisa optou-se pelo método qualitativo cujos procedimentos possibilitaram o uso de uma diversidade de metodologias e instrumentos de coleta de informação, assim como o uso da triangulação de métodos para analisar o conteúdo obtido. De acordo com as análises procedidas, percebeu-se que os agentes de saúde desenvolvem competências e habilidades sociais e quanto mais complexo o nível de desenvolvimento, melhor se expressa o conhecimento geográfico do ACS e do ASA. / The Health Family Strategy and enviromental Health Program, Public Politics implanted in Recife City - PE, imply in social practices and product as a result of educative spaces, as a result of these places. As social practices, competences and social habilities are developed in order to make the participants of these politics, specially the Health Agents, grow in geographical knowledge, turning them able to promote the materialization of these politics, observing the scenery elements and taking the territory as their own. In this context, this research analyses the geographical knowledge of the agents involved in these programs implanted in Recife City, from the competences and habilities developed in the work process and local health politic. To make this research viable a qualitative method was used, whose procedures made possible the use of several methodologies and instruments of information collect, as well as, the use of triangulation of methods to analyse the obtained contents. According to the proceeded analysis, it was realized that the Agents develop competences and social habilities and the more complex the level of development, better is the geographical knowledge by the ACS and ASA.

Therapeutic landscapes are places that contribute positively to a healing experience or to the maintenance of an individual's health and wellbeing. The literature on therapeutic landscapes has been growing steadily since the early 1990s, but researchers have yet to sufficiently explore both non-Western and gendered perspectives. The research presented in this thesis addresses these two gaps by examining how Kaqchikel men and women in the municipality of San Lucas Tolimán, Guatemala, differ in their construction and use of the therapeutic landscapes that surround them in their daily lives. <br /><br /> This research is broadly informed by feminist thought and methodologies, and the specific strategy of reflexivity was employed throughout the research process. In terms of gathering data, the two specific methods used were photovoice and structured interviews. Photovoice, it is argued, is an ideal method for studying therapeutic landscapes (particularly in a cross-cultural setting) because it gives participants the opportunity to reflect on their therapeutic landscapes before explaining them. The photographs also act as a visual cue that enhances interviews and can also bridge different experiences of reality. In total, 28 key informants were recruited through snowball sampling, with an equal number of male and female participants. Issues of foreign language research and translation are also addressed and some strategies for dealing with working in a foreign language are suggested. <br /><br /> Four main themes emerged from the data, and these themes revealed that Kaqchikel therapeutic landscapes are heavily driven by the poverty and violence experienced by the majority of participants. These four themes were: daily survival, community development, 'escape', and negative landscapes. Through these themes it was shown that the therapeutic landscapes of the Kaqchikel differ greatly between men and women due to traditional gender roles and relationships as well as the disproportional effect of violence on women, which restricts their mobility and ability to access their therapeutic landscapes. Finally, these themes reveal that Kaqchikel therapeutic landscapes span multiple generations and are multilayered, highly dynamic, and contingent on the social, political, and economic climates of the day.

Therapeutic landscapes are places that contribute positively to a healing experience or to the maintenance of an individual's health and wellbeing. The literature on therapeutic landscapes has been growing steadily since the early 1990s, but researchers have yet to sufficiently explore both non-Western and gendered perspectives. The research presented in this thesis addresses these two gaps by examining how Kaqchikel men and women in the municipality of San Lucas Tolimán, Guatemala, differ in their construction and use of the therapeutic landscapes that surround them in their daily lives. <br /><br /> This research is broadly informed by feminist thought and methodologies, and the specific strategy of reflexivity was employed throughout the research process. In terms of gathering data, the two specific methods used were photovoice and structured interviews. Photovoice, it is argued, is an ideal method for studying therapeutic landscapes (particularly in a cross-cultural setting) because it gives participants the opportunity to reflect on their therapeutic landscapes before explaining them. The photographs also act as a visual cue that enhances interviews and can also bridge different experiences of reality. In total, 28 key informants were recruited through snowball sampling, with an equal number of male and female participants. Issues of foreign language research and translation are also addressed and some strategies for dealing with working in a foreign language are suggested. <br /><br /> Four main themes emerged from the data, and these themes revealed that Kaqchikel therapeutic landscapes are heavily driven by the poverty and violence experienced by the majority of participants. These four themes were: daily survival, community development, 'escape', and negative landscapes. Through these themes it was shown that the therapeutic landscapes of the Kaqchikel differ greatly between men and women due to traditional gender roles and relationships as well as the disproportional effect of violence on women, which restricts their mobility and ability to access their therapeutic landscapes. Finally, these themes reveal that Kaqchikel therapeutic landscapes span multiple generations and are multilayered, highly dynamic, and contingent on the social, political, and economic climates of the day.

Orientador: Raul Borges Guimarães / Banca: Jayro Gonçalves Melo / Banca: Samuel do Carmo Lima / Banca: Christovam Barcellos / Resumo: A Estratégia de Saúde da Família e o Programa de Saúde Ambiental, políticas públicas implantadas na cidade do Recife - PE, implicam em práticas sociais, e que tanto produzem quanto resultam em espaços educativos, como são resultados desses espaços. Enquanto práticas sociais, são desenvolvidas competências e habilidades sociais capazes de fazer com que os integrantes dessas políticas, em especial os agentes de saúde, desenvolvam um conhecimento geográfico capaz de promover a materialização dessas políticas na medida em que percebem elementos na paisagem e apropriam-se do território. Neste contexto, esta pesquisa analisa o conhecimento geográfico dos agentes envolvidos nesses programas implantados na cidade do Recife a partir das competências e habilidades desenvolvidas no processo de trabalho na política de saúde local. Para viabilizar a pesquisa optou-se pelo método qualitativo cujos procedimentos possibilitaram o uso de uma diversidade de metodologias e instrumentos de coleta de informação, assim como o uso da triangulação de métodos para analisar o conteúdo obtido. De acordo com as análises procedidas, percebeu-se que os agentes de saúde desenvolvem competências e habilidades sociais e quanto mais complexo o nível de desenvolvimento, melhor se expressa o conhecimento geográfico do ACS e do ASA. / Abstract: The Health Family Strategy and enviromental Health Program, Public Politics implanted in Recife City - PE, imply in social practices and product as a result of educative spaces, as a result of these places. As social practices, competences and social habilities are developed in order to make the participants of these politics, specially the Health Agents, grow in geographical knowledge, turning them able to promote the materialization of these politics, observing the scenery elements and taking the territory as their own. In this context, this research analyses the geographical knowledge of the agents involved in these programs implanted in Recife City, from the competences and habilities developed in the work process and local health politic. To make this research viable a qualitative method was used, whose procedures made possible the use of several methodologies and instruments of information collect, as well as, the use of triangulation of methods to analyse the obtained contents. According to the proceeded analysis, it was realized that the Agents develop competences and social habilities and the more complex the level of development, better is the geographical knowledge by the ACS and ASA. / Doutor

In 1997, the Virginia Refugee Health Program coordinated a protocol and reimbursement structure to encourage health departments to perform initial health screenings on refugees settling in the Commonwealth by establishing four recommended levels of assessment. This thesis is concerned with these initial health-related services provided to refugees by Virginia's health departments, the quality of these services, and how they vary from one district to another. For this study, I interviewed health department staff representing 13 of Virginia's 19 districts that rendered health screenings in 2000. Information such as the level of assessment provided, and the types of procedures and services offered were the main foci of the interviews. I found that of the 13 districts, three (the cities of Alexandria and Virginia Beach, and Prince William County) offer only the required minimum to refugees. The variations I discovered in the services that health districts provide suggest, conceptually, the workings of both "structure" and "agency." Each health department is formally and informally structured in terms of staffing, services, and resources in accordance with its individual needs and initiatives. The structure of current funding at both the state and local level acts to inhibit some health districts from providing all four levels of assessment. In addition, human agency in the form of personal interest in meeting refugee's health needs as well as district collaboration with local resettlement agencies, also plays an important role in the extent of refugee services rendered. / Master of Science

The prevalence rate of the Human Immunodeficiency Virus (HIV) in Brazil has stabilized since the year 2000 at approximately 0.35 percent of the total population (600,000 people). Most researchers and political actors agree that the success in HIV management has been highly correlated with some of the policies that the Brazilian government has implemented concerning the HIV/ AIDS positive population (Levi et al 2002; Dourado 2006; Parker 2009). With worldwide recognition of this accomplishment, one must wonder why it is that the North and Northeast regions of Brazil have been experiencing trends of increasing HIV/ AIDS incidence in the past decade (Nunn et al 2009). This study concentrates on the spatial distribution of HIV incidence in the year 2000, as it uncovers how HIV distribution can be related to aspects of marginalization in the second-most populous Northeastern municipality; Fortaleza, Brazil. The central hypothesis of this research states that HIV incidence is positively correlated with rate of marginalization. Marginalization is considered as the sector of population without access to basic social services, such as education, running water, and appropriate housing. Spatial patterns of HIV and marginalization are examined and interpreted in the context of the Brazilian Model. This research suggests that although marginalization has a strong spatial pattern, HIV is not demographically or geographically discriminatory. / text

In recent years there has been a renewed focus on reducing the harms of addictive substances such as alcohol while at the same time restraining or reducing health care costs. To address these issues, and many of the existing limitations in the literature, the purpose of this dissertation was to improve our understanding of the geography of alcohol-related harm, and use of primary health care services for alcohol-attributed diseases in British Columbia (BC). To achieve this purpose, there were three research objectives that guided the research that comprises this dissertation: Objective 1: Measure regional variations and trends in primary health care utilization in BC for alcohol-attributed diseases across time (2001-2011) and space (Health Service Delivery Areas) (Studies A & D); Objective 2: Describe primary health care physician experiences treating persons with alcohol-attributed diseases in rural communities that are isolated and sparsely populated with minimal access to secondary or tertiary level services (Study B), and Objective 3: Develop a methodology to describe the geography of alcohol-related harm in BC to identify regions that have populations who may have elevated risk for the development of alcohol-attributed diseases (Study C). Administrative health data were used in Studies A and D to examine trends in health care utilization by persons with alcohol-attributed diseases from 2001-2011 based on disease type and geography (Health Services Delivery Areas). Building on these results, Study B examines family physician experiences treating persons with alcohol-related issues in rural places. To further understand regional variations in alcohol-related issues, an index of alcohol-related harm (Study C) was created using a variety of data that are correlated to alcohol-related problems at the population level, including morbidity, mortality, and alcohol consumption data. The results of this dissertation research highlight regional variations in alcohol-related harm and primary health care use for alcohol-related illnesses – as well as significant growth in alcohol-attributed disease cases in BC since 2001. These findings demonstrate the importance of where we live to risk of developing alcohol-attributed diseases and access to treatment. The results of this dissertation suggest that less populated areas of BC are disproportionately affected by alcohol-related problems and there are additional barriers to care for persons from rural areas. Based on the increasing number of alcohol-attributed disease cases, and the large regional variations in alcohol-related harm found in this project, alcohol-related health problems are an emerging and significant population health challenge for BC. / Graduate

Aim: The aim of this study was to: 1) investigate the geographic distribution of six pregnancy complications associated with future maternal cardiovascular disease risk in the province of Ontario and 2) to identify regions where women are likely to benefit from post-partum cardiovascular disease screening, based on the development of complications during pregnancy. Rationale: Cardiovascular disease is the leading cause of death in Canadian women. Pregnancy has been likened to a cardiovascular stress test and provides an early opportunity to assess a female’s lifetime risk of cardiovascular disease. Methods: This study was a retrospective analysis of data collected for the Niday Perinatal Database, provided by the Better Outcomes Registry & Network. Crude and age-standardized cumulative incidences of six pregnancy complications, and one or more pregnancy complications, were calculated for each Public Health Unit area in Ontario. The cumulative incidence of one or more pregnancy complications for women with no previous history of cardiovascular disease or traditional cardiovascular risk factors was calculated at the Public Health Unit and census subdivision area levels. Spatial statistics were applied to locate statistically significant clusters of high cumulative incidence. Results: Crude and age-standardized cumulative incidences of each pregnancy complication and one or more pregnancy complications varied across Public Health Unit areas in Ontario. The crude cumulative incidence of one or more complications ranged from 74 to 224 cases per 1000 pregnancies. The spatial analysis identified one statistically significant cluster of high cumulative incidence at the Public Health Unit area level, spanning the Lambton, Chatham-Kent, and Windsor-Essex Health Unit areas. Seven statistically significant clusters of high cumulative incidence census subdivisions were located within the following Public Health Unit areas: Chatham-Kent, Lambton, Middlesex-London, Ottawa, Leeds, Grenville and Lanark, Renfrew County, Simcoe Muskoka, Grey Bruce, and Eastern Ontario. Conclusion: Regional variation in the cumulative incidence of six pregnancy complications associated with cardiovascular disease risk was observed in Ontario. Statistically significant clusters of high cumulative incidence of one or more of these pregnancy complications were identified. These regions in particular may benefit from post-partum screening clinics and increased awareness regarding the association between pregnancy complications and cardiovascular disease. / Thesis (Master, Community Health & Epidemiology) -- Queen's University, 2012-07-27 13:56:51.945