Dissertation (Ph. D.)--University of Akron, Dept. of Sociology, 2009. / "August, 2009." Title from electronic dissertation title page (viewed 9/2/2009) Advisor, C. André Christie-Mizell; Committee members, Cheryl Elman, Dena Hanley, Patricia S. Hill, Robert Peralta, Richard T. Serpe; Department Chair, John F. Zipp; Dean of the College, Chand Midha; Dean of the Graduate School, George R. Newkome. Includes bibliographical references.

Busy families of Nova Scotia and similar populations find it challenging to make healthy nutrition and exercise choices due to time constraints (Chircop et al, under review; Jabs et al, 2007; Devine et al, 2006). Smartphone application technology can provide health behavior change interventions in a mobile and fast format (Breton, Bernard, Fuemmeler, Lorien & Abroms, 2011). Using focus groups, this research addressed parent’s perceptions on how smartphone application technology can support nutrition and physical activity habits within their family and what, if any, barriers exist in adopting this form of health behavior intervention. Findings revealed this population believes smartphone health applications can improve family nutrition and physical activity as long as barriers are minimized and requirements for adoption are met. Diffusion of Innovations theory was used to understand the adoption rate within the target population. Thoughts on future work efforts for related health behaviour interventions is discussed.

<p> Research has shown that child abuse is a serious public health issue that may warrant child welfare agency intervention and removal of children from their homes. Placement with kin caregivers is considered the least restrictive placement option by social workers. It has been recognized that kin caregivers require some type of formal parental training to prepare them to care for relative children. A large city implemented the Caring for Our Own training program as prelicensing training to prepare relatives for roles as kin caregivers. Prior to this study, no research had assessed whether this training program adequately addressed caregivers&rsquo; ability to adopt effective discipline practices in response to perceived child misbehavior. The purpose of the study was to examine how the Caring for Our Own prelicense training impacted kin caregivers&rsquo; use of ineffective discipline practices, as measured by change in scores on the 3 subscales of the Parenting Scale. The theoretical framework for this study was based on Ajzen&rsquo;s theory of planned behavior. One-way repeated measures ANOVA revealed no statistically significant difference in kin caregivers&rsquo; (<i>n</i> = 27) use of ineffective discipline practices as measured by the 3 subscales of the Parenting Scale over time. In light of this finding, the child welfare agency may create an evidence-based curriculum to assist in the development of competent kin caregivers. Social change to improve training and thus foster more effective responses from kin caregivers may occur within educational departments of child welfare agencies, through assessing and developing prelicensing kin caregiver training that allows for effective child behavior discipline management.</p><p>

Students identified by the special education classification Other Health Impairment (OHI) represent the third largest group of students receiving special education services in the United States. The special education services offered these students include both academic and health related supports. The delivery of these services is enhanced when a partnership exits between the primary stakeholders; the student, parents, the school personnel, and the medical personnel. The use of Family Centered Care principles in the delivery of these services supports and maintains the partnership. Following the qualitative analysis of a series of interviews of parents whose children were classified as OHI, descriptive and inferential themes were derived from the interview data. These themes are discussed relative to the parents’ belief that the classification provided; access to appropriate special education and school-based health care allowing their children to achieve their maximum potential, parental satisfaction with the special education and school-based health care services provided, and the use of Family-Centered Care principles. Key Words: special education, health impairment, OHI, family

<p> With the goal of eliminating mother-to-child transmission by 2015, a wide range of governmental and other efforts within low- and middle-income countries have sought to provide services for the prevention of mother-to-child transmission of HIV (PMTCT) to the estimated 1.2 million pregnant women in need. In support of this goal, the World Health Organization (WHO), as the leading normative international body in the area of evidence-based clinical guidelines, issued policy recommendations on the use of antiretroviral drugs for PMTCT. Through various mechanisms, including guidance notes and dissemination workshops, WHO supports countries to adopt and adapt the guidelines within their national policy frameworks. Through three analyses, this dissertation examines the diffusion of WHO PMTCT guidelines in five Eastern and Southern African countries over a 16-year period (1998-2013) and estimates the effect of PMTCT policy adoption on delivery of key services. </p><p> <b>The first analysis</b> of the adoption of specific PMTCT guideline updates between 1998 and 2013 seeks to ascertain which internal factors may explain why and when countries decided to adopt new technical guidance. The policy analysis shows that the five countries adopted a majority of the key international PMTCT technical guidance updates. It can be concluded that international to national policy diffusion was taking place and that national policies converged to be more similar and more in line with international guidelines over the time period studied. Variation in adoption and in the internal determinants at play in each country was minimal, making it difficult to assess the influence of determinants qualitatively. The three internal determinants that appeared to most influence adoption of key PMTCT updates were: 1) the severity of the MTCT problem 2) governance effectiveness, and 3) prior PMTCT policy adoption. The lag between adoption and implementation in these countries is discussed. The findings indicate that in the countries studied, policies promoted by WHO and other international bodies can play a critical role in supporting national policy adoption for program advancement in the area of PMTCT. </p><p> <b>The second and third analyses</b> investigate whether the completeness of a country&rsquo;s body of PMTCT-supporting policies was associated with the delivery of two key PMTCT services &ndash; the offer of an HIV test and the receipt of HIV counseling as a part of antenatal care (ANC) &ndash; in four of the five countries included in the first analysis. Two nationally representative surveys per country were used to conduct a quasi-experimental fixed-effects analysis of the role of policy in predicting a woman&rsquo;s probability of being offered an HIV test or receiving HIV counseling in ANC, controlling for other key individual- and country-level covariates. </p><p> According to the &lsquo;testing&rsquo; model, a one-unit increase in policy score was associated with a 0.042 (p&lt;0.000) increase in the probability that a woman was offered an HIV test as a part of antenatal care. According to the &lsquo;counseling&rsquo; model, a one-unit increase in policy score was associated with a 0.014 (p&lt;0.001) increase in the probability that a woman received HIV counseling as a part of antenatal care. In both the testing and counseling models, the policy/education interaction was statistically significant in the final model, with a greater policy effect estimated at among those with higher education levels. Time statistically significantly influenced the probability of the outcome, as did government health spending, governance effectiveness, and donor health spending. Further study is needed to identify the policy elements that have the most impact on improving service delivery. </p><p> <b>The three analyses</b> presented here support the premise that international health policies influence national-level policy adoption, and that national-level policy adoption in turn influences national service outputs. As countries and their development partners mobilize for the Sustainable Development Goal era, policy adoption at the international level will continue to be an important influence in national policy adoption in the area of PMTCT. This research has described a number of potential internal and external determinants that will influence national adoption in this next round of global health policy advocacy. Looking forward, this study shows that countries and their development partners should continue to invest in the work of policy adoption to complement other efforts to reach health goals, including increased government health spending.</p>

A proposta de Reforma Psiquiátrica vem modificando a assistência ao portador de transtorno mental nas últimas décadas. Com a desinstitucionalização do doente mental, emergem novos paradigmas com grandes desafios a todos os atores sociais envolvidos na construção da cidadania e na busca da reabilitação psicossocial. Surgem novos conceitos do processo saúde-doença, novas redes de assistência, alocação de recursos como também a implantação de Centros de Atenção Psicossocial CAPS e ainda diretrizes do Ministério da Saúde determinando que as ações, no campo da saúde mental, sejam realizadas na atenção básica, ou seja, nas Unidades Básicas de Saúde (UBS) e por meio da Estratégia Saúde da Família (ESF). A ESF passa a ser uma importante ferramenta no processo saúde-doença no que diz respeito ao cuidado integral do ser humano visando à promoção, prevenção, proteção e recuperação tanto das doenças físicas, sociais quanto mentais. Assim, o objetivo deste trabalho é compreender as necessidades da ESF para desenvolver as ações de saúde mental na comunidade e identificar as ações desenvolvidas pelas equipes da ESF frente aos portadores de transtornos mentais e seus familiares. Trata-se de uma pesquisa qualitativa, que foi desenvolvida por meio de entrevista semiestruturada realizada com os membros das equipes da ESF, as entrevistas foram gravadas e transcritas na íntegra para análise. O material foi analisado por meio da Análise Discurso sob a ótica do referencial teórico do materialismo histórico e dialético. Emergiram das entrevistas três categorias: Processo Saúde Doença-Mental; Família; Processo de Trabalho. Os discursos dos informantes revelaram que os profissionais ESF mantêm a prática da psiquiatria tradicional centrado nas consultas, na medicação e nos exames, sendo esse o principal instrumento para a produção de saúde, e exercício das práticas destes profissionais está baseado no diagnóstico psiquiátrico; é incipiente o numero de profissionais que se mobiliza a desenvolver ações voltas ao acolhimento e a escuta; realizam atividades grupais e relatam que existe a necessidade de ampliar seus conhecimentos na área de saúde mental. / The proposed Psychiatric Reform has changed how mental health patients have been assisted in recent decades. With the deinstitutionalization of mental health patients, new paradigms have emerged offering great challenges to all social actors involved in constructing citizenship and to the search for psychosocial rehabilitation. New concepts of the health-disease process have appeared, along with new assistance networks, allocation of resources, as well as the creation of Psychosocial Care Centers CAPS, and Health Ministry guidelines stipulating that actions in the mental health field be undertaken at the basic care level at Basic Health Units (UBS) and through the Family Health Strategy (ESF). ESF has become an important tool in the health-disease process with regard to integral care aiming for the promotion, prevention, protection and recovery of physical, social and mental illness. Thus, the objective of this work is to comprehend the needs of ESF to develop mental health actions in the community and identify the actions developed by ESF teams with regard to mental health patients and their relatives. It is a qualitative research, to be developed through semi-structured interviews with members of the ESF teams; the interviews were recorded and fully transcribed for analysis. O material foi analisado por meio da Análise Discurso sob a ótica do referencial teórico do materialismo histórico e dialético. The material was analyzed through discourse analysis under the theoretical framework of historical and dialectical materialism. Three categories emerged from the interviews: Health-Mental Illness process; Family; Work Process. The discourses of the informants revealed that ESF professionals keep traditional psychiatric practice centered on consultations, medication and exams, making it the main tool for health production, with the exercise of these professionals practice based on psychiatric diagnosis; the number of professionals who mobilize to develop actions focusing on welcoming and listening is still incipient; they perform group activities and report the need to broaden their knowledge on the field of mental health.

O presente estudo teve como objetivos caracterizar o perfil dos profissionais médicos que atuam nas ESFs dos municípios da área de abrangência da DIR XVIII, Ribeirão Preto, SP e a utilização do Sistema de Informação da Atenção Básica por este profissional, no seu trabalho na Equipe de Saúde da Família. Utilizou-se um estudo tipo Survey, no qual a coleta de dados foi realizada por meio de questionários auto-administrados compostos por perguntas de respostas fechadas, do tipo múltipla escolha, perguntas de respostas tipo abertas e perguntas que utilizavam a Escala de Avaliação Gráfica. A análise dos resultados possibilitou a caracterização do perfil dos profissionais, na maioria do sexo masculino (60%), em média com 38 anos de idade, possuidor de pós-graduação (85%), predominantemente do tipo lato sensu, concentrada em residência e especialização nas áreas de clínica médica, pediatria e ginecologia. Os profissionais tinham em média 11 anos de profissão, encontrando-se na fase de afirmação profissional e atuando há cerca de 03 anos em PSF. A maioria possuindo vínculos empregatícios precários sem estabilidade (61%), trabalhando em outros locais além do PSF (65%). Os profissionais referiram conhecer o SIAB (85%), com um grau de conhecimento, em média, de 53% e possuírem uma visão positiva sobre ele, atribuindo-lhe muita importância para o desenvolvimento do seu trabalho na Equipe de Saúde da Família, em média 64,89%, e para a caracterização da população atendida, em média 62,78%, merecendo ressalvas de vários profissionais quanto à limitação do sistema em relação aos dados coletados a nível local. A necessidade de treinamento foi relevada como possibilidade de capacitação na busca por um maior conhecimento no uso do sistema. Do total de respondentes, apenas 29,4% referiram ter feito treinamento. Outro ponto importante referia-se à readequação da agenda de atividades da ESF, com o objetivo de proporcionar a efetivação de um espaço de discussão acerca do sistema e às informações por ele geradas. O autor acredita que com a implementação de propostas emergidas de um estudo entre os diversos atores envolvidos no processo saúde-doença, em que sejam contemplados não somente os profissionais de linha de frente, mas também coordenadores e gestores e principalmente os usuários, será possível atingir níveis de qualidade melhores em relação às informações geradas pelo sistema e assim se poderão propor e efetivar ações que busquem o alcance do objetivo maior, que é o de atender a população com mais qualidade e, conseqüentemente, proporcionar uma melhor qualidade de vida para o cidadão. / The present study has as objective to characterize the profile of the medical professionals who act in the ESFs of the cities of the geographic area of DIR XVIII, Ribeirão Preto, SP and the use of the System of Information of the Basic Attention for this professional, in its work in the Team of Health of the Family. It was used a type of study Survey, in which the collection of data was carried through by means of auto-managed questionnaires composites for questions of closed answers, of the multiple type choice, questions of open answers type and questions that used Graphical Evaluation Scale. The analysis of the results made possible the characterization of the profile of the professionals, in the majority of the masculine sex (60%), on average with 38 years of age, and of after-graduation (85%), predominantly of the type lato sensu, intent in residence and specialization in the areas of medical clinic, pediatrics and gynecology. The professionals had on average 11 years of profession, meeting in the phase of professional affirmation and acting about 3 years in PSF. The majority possessing precarious employment bonds without stability (61%), working in other places beyond the PSF (65%). The professionals had related to know the SIAB (85%), with a knowledge degree, on average, of 53% and to possess a positive vision on it, attributing much importance to it for the development of its work in the Team of Health of Family, on average 64.89%, and for the characterization of the taken care of population, on average 62.78%, deserving exceptions of some professionals how much the limitation of the system in relation to the collected data locally. The training necessity was raised as possibility of qualification in the search for a bigger knowledge in the use of the system. Of the total of respondents, only 29.4% had related to have done training. Another important point mentioned referred to needs adjusting the agenda of activities of the ESF, with the objective to provide time to discuss about the system and the information it generated. The author believes that with the implementation of emerged proposals of a study he enters the diverse involved actors in the process health-illness, where is contemplated not only the professionals of front line, but coordinating and also managing and mainly the users, the information generated for the system will be possible to reach better levels of quality in relation and thus if it will be able to consider and to accomplish action that they consequently search the reach of the main objective, that is to take care of the population with more quality, and, to provide a better quality of life for the citizen.

O presente estudo teve como objetivos caracterizar o perfil dos profissionais médicos que atuam nas ESFs dos municípios da área de abrangência da DIR XVIII, Ribeirão Preto, SP e a utilização do Sistema de Informação da Atenção Básica por este profissional, no seu trabalho na Equipe de Saúde da Família. Utilizou-se um estudo tipo Survey, no qual a coleta de dados foi realizada por meio de questionários auto-administrados compostos por perguntas de respostas fechadas, do tipo múltipla escolha, perguntas de respostas tipo abertas e perguntas que utilizavam a Escala de Avaliação Gráfica. A análise dos resultados possibilitou a caracterização do perfil dos profissionais, na maioria do sexo masculino (60%), em média com 38 anos de idade, possuidor de pós-graduação (85%), predominantemente do tipo lato sensu, concentrada em residência e especialização nas áreas de clínica médica, pediatria e ginecologia. Os profissionais tinham em média 11 anos de profissão, encontrando-se na fase de afirmação profissional e atuando há cerca de 03 anos em PSF. A maioria possuindo vínculos empregatícios precários sem estabilidade (61%), trabalhando em outros locais além do PSF (65%). Os profissionais referiram conhecer o SIAB (85%), com um grau de conhecimento, em média, de 53% e possuírem uma visão positiva sobre ele, atribuindo-lhe muita importância para o desenvolvimento do seu trabalho na Equipe de Saúde da Família, em média 64,89%, e para a caracterização da população atendida, em média 62,78%, merecendo ressalvas de vários profissionais quanto à limitação do sistema em relação aos dados coletados a nível local. A necessidade de treinamento foi relevada como possibilidade de capacitação na busca por um maior conhecimento no uso do sistema. Do total de respondentes, apenas 29,4% referiram ter feito treinamento. Outro ponto importante referia-se à readequação da agenda de atividades da ESF, com o objetivo de proporcionar a efetivação de um espaço de discussão acerca do sistema e às informações por ele geradas. O autor acredita que com a implementação de propostas emergidas de um estudo entre os diversos atores envolvidos no processo saúde-doença, em que sejam contemplados não somente os profissionais de linha de frente, mas também coordenadores e gestores e principalmente os usuários, será possível atingir níveis de qualidade melhores em relação às informações geradas pelo sistema e assim se poderão propor e efetivar ações que busquem o alcance do objetivo maior, que é o de atender a população com mais qualidade e, conseqüentemente, proporcionar uma melhor qualidade de vida para o cidadão. / The present study has as objective to characterize the profile of the medical professionals who act in the ESFs of the cities of the geographic area of DIR XVIII, Ribeirão Preto, SP and the use of the System of Information of the Basic Attention for this professional, in its work in the Team of Health of the Family. It was used a type of study Survey, in which the collection of data was carried through by means of auto-managed questionnaires composites for questions of closed answers, of the multiple type choice, questions of open answers type and questions that used Graphical Evaluation Scale. The analysis of the results made possible the characterization of the profile of the professionals, in the majority of the masculine sex (60%), on average with 38 years of age, and of after-graduation (85%), predominantly of the type lato sensu, intent in residence and specialization in the areas of medical clinic, pediatrics and gynecology. The professionals had on average 11 years of profession, meeting in the phase of professional affirmation and acting about 3 years in PSF. The majority possessing precarious employment bonds without stability (61%), working in other places beyond the PSF (65%). The professionals had related to know the SIAB (85%), with a knowledge degree, on average, of 53% and to possess a positive vision on it, attributing much importance to it for the development of its work in the Team of Health of Family, on average 64.89%, and for the characterization of the taken care of population, on average 62.78%, deserving exceptions of some professionals how much the limitation of the system in relation to the collected data locally. The training necessity was raised as possibility of qualification in the search for a bigger knowledge in the use of the system. Of the total of respondents, only 29.4% had related to have done training. Another important point mentioned referred to needs adjusting the agenda of activities of the ESF, with the objective to provide time to discuss about the system and the information it generated. The author believes that with the implementation of emerged proposals of a study he enters the diverse involved actors in the process health-illness, where is contemplated not only the professionals of front line, but coordinating and also managing and mainly the users, the information generated for the system will be possible to reach better levels of quality in relation and thus if it will be able to consider and to accomplish action that they consequently search the reach of the main objective, that is to take care of the population with more quality, and, to provide a better quality of life for the citizen.

Philosophiae Doctor - PhD / The prevention of abortion related complications and mortality is dependent on the availability, accessibility and usability of emergency post-abortion care (PAC) throughout the health care system. Unfortunately, abortion is not legal in Nigeria and Nigerian women, especially adolescents, are often unable to obtain adequate post-abortion care services due to a variety of reasons. A review of literature shows that adolescent PAC patients receive worse care than older women seeking PAC services. There is widespread recognition of the need to overcome these barriers and make it easier for women to obtain the PAC services they need. Therefore, overall aim of this research study was to provide empirical information on the barriers and challenges to adolescents' PAC and develop a policy document to inform reproductive health services for Nigerian hospitals. To develop this policy document, the study specifically sought to assess knowledge of reproductive-health and related post-abortion care services among health care providers; describe the adolescents' perception of post-abortion care received; determine the service providers' perspectives on adolescents' post-abortion care challenges and barriers; analyze the challenges and barriers faced by adolescents in obtaining post-abortion care services; explore ways in which the knowledge about challenges and barriers to adolescents' post-abortion care can be used to inform policy; develop policy document and make recommendations in key areas to improved PAC services in Nigeria as part of working towards improving reproductive health services.

Este estudo busca caracterizar o agente comunitário de saúde dos Núcleos de Saúde da Família ligados ao Centro de Saúde Escola da Faculdade de Medicina de Ribeirão Preto-USP, bem como, identificar as repercussões que o desenvolver deste trabalho tem lhe trazido. A abordagem teórica baseia-se nas políticas de saúde do Brasil, tendo como enfoque principal a reorganização da assistência à saúde com o Programa Saúde da Família. Trata-se de um estudo exploratório e descritivo, a partir de entrevistas semi-estruturadas com dez agentes comunitários de saúde que possuíam mais de dois anos no exercício da atividade. A análise dos dados se processou de forma qualitativa, emergindo os seguintes temas: o ser agente comunitário de saúde, o cenário do trabalho e as potencialidades do trabalho do agente comunitário de saúde. Identificamos que esse profissional da saúde desempenha um trabalho complexo e possui um papel de sujeito mediador e terapeuta comunitário. Utiliza como ferramentas no seu trabalho tecnologias leves como o acolhimento, o respeito, o vínculo e a solidariedade. Responsabiliza-se pelo projeto que está inserido, vislumbrando a sua própria família e a si mesmo e aponta uma ambigüidade de sentimentos que o leva ora para a satisfação, ora para a insatisfação no trabalho. Nesta prática contextualizada, colabora com a construção de um novo modelo assistencial, quando, num processo educativo, ensina alunos de graduação de vários cursos da área da saúde e mesmo aos profissionais que estão inseridos na Saúde da Família a promover uma atenção à saúde humanizada. Por isso, identificou-se uma nova atribuição a este profissional, sendo esta, participar da formação de recursos humanos para a saúde da família. / This study aims at characterizing the communitarian health agent in Health Nuclei for the Family who are linked to Health Center established by The School of Medicine Course in Ribeirão Preto, State of Sao Paulo, Brazil, as well as, identifying the repercussion the developing of this work has brought. The theoretical approach used in this case is based in Health Politics in Brazil, aiming specifically the re-organization of the health assistance with the Program Health for the Family. We dealt with an exploratory and descriptive study starting with interviews with ten communitarian agents who had more than two year experience in their activity. The data analysis was processed using the qualitative focus, from which the following themes emerged: being a communitarian agent, the scenario of that work, the potentialities of the communitarian health agent’s work. We identified that this professional of health performs a complex work and has a role as negotiator and community therapist. He or she employs these following tools for his or her work the instruments: respect, reception, ties and solidarity. The communitarian agent showed to be responsible for the project he or she is in, viewing their work from his or her own family and from his or her personality. The study shows a certain ambiguity in feelings which can drive him or her to satisfaction and also to unhappiness sometimes. In this practice in context, the agent contributes for the construction of a new assistance model, when taking part in educational process. The agent teaches graduation students in different courses of Health field and promotes an humanitarian attention to health. This way, a new duty was identified for this professional, i.e., the participation in the formation of human resources to the health of the family.