INTRODUÇÃO: O processo saúde-doença está intrinsecamente conectado com as condições concretas de vida e com as diversas realidades sociais, acarretando o forte vínculo entre a situação de saúde e os fatores históricos, sociais, econômicos, culturais e biológicos. A formulação sobre Determinantes Sociais da Saúde (DSS) busca ampliar o enfoque sobre as condições de vida e bem-estar, salientando a distribuição de renda, as condições de vida e trabalho, as redes de suporte social, entre outros, como fatores que afetam a qualidade de vida. Os DSS buscam, assim, evitar a análise fragmentada, englobando a concepção de Determinantes Estruturais. Estes procuram compreender as condições de distribuição de riqueza, poder e prestígio na origem dos problemas de saúde. Assim, a estrutura de classes sociais, a distribuição de renda e o preconceito de gênero e raça são considerados na proposição de políticas de saúde. OBJETIVO: Sistematizar o conhecimento a respeito dos DSS e seus componentes Estruturais e Intermediários, segundo o potencial para contribuir na elaboração de políticas sociais e de saúde. MÉTODO: Trata-se de uma pesquisa de revisão de escopo (Scoping Review), metodologia que amplia e aprofunda o mapeamento e a síntese do conhecimento. As etapas foram: identificação da questão de pesquisa e dos estudos relevantes; seleção dos estudos; extração de dados; separação, sumarização, relatório e comunicação dos resultados. Foram pesquisadas as seguintes bases de dados eletrônicas: Web of Science, CINAHL, Scopus, LILACS e Pub-Med, que engloba o MEDLINE. Adicionalmente, foi realizado levantamento específico nas revistas: International Journal of Epidemiology, Journal of Epidemiology and Community Health, American Journal of Public Health e American Journal of Epidemiology. RESULTADOS: Após a retirada das duplicatas, foram localizados 752 artigos; e após a triagem, 19 artigos foram analisados em profundidade. Dentre os países nos quais as pesquisas selecionadas foram desenvolvidas, destacaram-se Estados Unidos e Inglaterra com seis e quatro publicações respectivamente (31,6% e 21%) seguidos de três publicações no Canadá (15,7%), duas no Brasil (10,5%), duas na Nova Zelândia (10,5%), duas na Austrália (10,5%) e uma no México (5,2%). As discussões sobre os Determinantes Estruturais da saúde são mais recentes. A análise permitiu tratar das diferenças entre termos comumente utilizados, como desigualdade, disparidade e iniquidade. Os marcadores sociais da diferença mais problematizados na formulação dos DSS Estruturais foram: racismo gênero, classe social e situação migratória. Por serem os marcadores sociais mutuamente construídos, a perspectiva teórica da interseccionalidade foi apresentada como recurso metodológico para entender suas inter-relações. CONCLUSÃO: Foi possível identificar neste trabalho uma agenda síntese que perpassa ações na área econômica, propondo a redistribuição da riqueza; políticas públicas intersetoriais e mudanças no arcabouço jurídico, destacando que os determinantes sociais são mais bem compreendidos quando se reconhece a dialética entre contextos específicos e os macrodeterminantes políticos e econômicos, identificando os diferentes significados e consequências para a saúde / INTRODUCTION: The health-disease process is intrinsically connected with concrete conditions of life and with the diverse social realities, which brings about the strong ties between the health situation and historical, social, economical, cultural, and biological factors. The formulation of Social Determinants of Health (SDH) seeks to broaden the focus on conditions of life and well-being, emphasizing the distribution of income, the work and life conditions, the net of social support, among other factors that affected the quality of life. SDH seek, in this way, to avoid a fragmented analysis, embodying the conception of Structural Determinants, which seek to comprehend the conditions of distribution of wealth, power, and prestige in the origins of health problems. Thus, the structure of social classes, the distribution of income, and the prejudice of gender and race are taken into account in the proposition of health policies. OBJECTIVE: systematizing knowledge about the SDH and their structural components, according to the potential to contribute in the elaboration of social and health policies. METHODOLOGY: The following research employs the Scoping Review Methodology, which enlarges and deeps the mapping and the synthesis of knowledge. The phases of our work were the following: identification of the research issue and relevant studies; selection of the studies; extraction of data; division, summarization, reports, and communication of results. The following electronic databases were researched: Web of Science, CINAHL, Scopus, LILACS, and Pub-Med, which comprehends MEDLINE. Additionally, specific journals were surveyed: International Journal of Epidemiology, Journal of Epidemiology and Community Health, American Journal of Public Health, and American Journal of Epidemiology. OUTCOMES: After removing the duplicates, 752 articles were found, and after the screening 19 articles were analyzed in depth. Among the countries in which the selected researches were conducted, the following are noteworthy: England and the USA with four and five publications respectively (21% and 26,3%), followed by three publications in Canada (15,7%), two in Brazil (10,5%), two in New Zealand (10,5%), two in Australia (10,5%) and one in México (5,2%). The discussions on Structural Determinants of Health are more recent. The analysis allowed us to treat the differences among terms commonly used, such as inequality, disparity, and inequity. The social markers of difference more problematized in the formulation of the Structural SDH were racism, gender, social class, and migration situation. For being social markers mutually built, the theoretical perspective of intersectionality was presented as a methodological resource to understand its inter-relations. CONCLUSION: This work was able to identify a synthesis-agenda, which passes through actions in the economical field, proposing the redistribution of wealth, intersectoral public policies, and changes in the juridical frame, emphasizing that the social determinants are better comprehended when the dialectics between specific contexts and the political-economical macro-determinants are acknowledged, identifying the different meanings and consequences for Health

There is increasing concern about hepatitis C virus (HCV) and potential HIV transmission among ethnic Vietnamese injecting drug users (IDUs) in Australia. To date ethnic and cultural differences in vulnerability to blood-borne viruses (BBV) have received little attention and few studies have attempted to explore the role of cultural beliefs and values in influencing injection risk behaviour. This study aimed to systematically explore the cultural beliefs and behavioural practices that appear to place ethnic Vietnamese IDUs at increased risk of BBV infection, identify barriers to this group accessing health and preventive programs, and document antibody HIV and HCV prevalence and associated risk behaviours. The first component of the research consisted of an ethnographic study designed to explore underlying explanatory models of health and illness employed by Vietnamese IDUs and identify cultural influences on risk behaviours and vulnerability to BBVs. These data were subsequently used to inform the development of the instrument used in the second component ??? a cross-sectional survey and collection of capillary blood samples designed to assess risk behaviours and antibody HIV and antibody HCV prevalence. Analysis of data from both components indicates that cultural beliefs and practices influence risk-taking and health-seeking behaviours and suggests pathways through which this influence occurs. Relevant cultural characteristics include those pertaining to spiritual and religious beliefs, the role of the family and traditional Vietnamese family values, cultural scripts of self-control and stoicism, the importance of ???face??? and non-confrontational relationships, trust and obligation, and a reluctance to discuss problems with outsiders. Vulnerability to BBVs is influenced by these cultural characteristics, together with Vietnamese IDUs??? perceptions of risk, knowledge about HIV and HCV, and situational and environmental factors. Main factors contributing to the under-utilisation of health services include the use of self-managed care practices, ambivalence surrounding Western medicine, long waiting times, concerns in relation to confidentiality, stigmatisation of drug use, and limited knowledge of BBVs. The data indicate a need for interventions based on understanding of culturally specific meanings and contexts of health, illness and risk in order to better meet the needs of this vulnerable group.

<p>Teenage pregnancy is one of the major public health problems facing teenage girls in Zambia (Webb, 2000 / Warenius, 2008). Teenage girls‟ access to and utilization of adolescent&nbsp / reproductive health (ARH) services is important for the prevention of teenage pregnancies and sexually transmitted infections (STIs) amongst teenagers.High incidence of teenage pregnancies has been noted in the district despite availability of ARHservices. Teenage pregnancy is a major contributing factor to the high school drop-out rate amongst the girls and is one of the challenges faced by non-governmental organizations (NGOs) that support girl child education, such as the campaign for female&nbsp / education (CAMFED) as well as for government agencies such as the Ministry of Education. The high incidence of teenage pregnancies could be an indication of poor access to&nbsp / and utilization of ARH services and therefore an assessment of the accessibility and utilization of the ARH services was done to explore the reasons for this.This research aimed to explore the factors affecting teenage girls‟ access to and utilization of ARH services in the Mpika district, Zambia. The research was a qualitative, descriptive and exploratory study using individual interviews with ten in-school teenage girls, four key informants rendering ARH services and a focus group discussion (FGD) with ten pregnant teenage girls. By exploring these particpants‟ perceptions and experiences, appropriate interventions to improve accessibility to and utilization of ARH services could be designed that would be appropriate for the local context in order for them to be effective. Thematic analysis with categorizing and coding methods was used to analyze the data. The study used the theory of planned behaviour (TPB) which stipulates that an individual‟s attitude,subjective norms and perceived behavioural control influence behaviour as a framework to explain the findings of the results of the study. The findings of the study indicated that physical, psychological and social barriers hindered adolescents from accessing and utilizing ARH services. The findings also suggested that high levels of knowledge about RH services do not necessarily translate into accessibility and utilization of ARH services. Accessibility to and utilization of ARH services by adolescents can also be determined by an individual‟s attitude, subjective norms, and perceived behavioural control as illustrated by the TPB. Adolescents need to feel comfortable using ARH services. Therefore the three variables of TPB should be taken into consideration when designing comprehensive ARH programmes in order to accommodate the unique reproductive health needs of the adolescents. There is need to encourage participation in and involvement of adolescents in planning and&nbsp / &nbsp / implementation of ARH programmes. The participants also made recommendations which included strengthening information and education on ARH, strengthening adolescent-friendly services, improving staffing levels and promotion of school health services.</p>

Source: Dissertation Abstracts International, Volume: 70-03, Section: B, page: 1622. Adviser: Stephen H. Linder. Includes bibliographical references.

Adviser: Stephen H. Linder. UMI number 3350227. Includes bibliographical references (p. 130-134).

M. Tech. Business Information Systems / Field-based healthcare is the provisioning of healthcare outside a traditional healthcare facility whose location is fixed. Although healthcare is not location and time dependent, the delivery of the service is often constrained to particular location and time. That is, although data accuracy and timely access to medical information is vital, healthcare service providers are not mobile enough to provide the on-demand healthcare service to patients. With restricted mobility, mistakes, unavailability and inaccuracy of information can have life-threatening consequences. To this point, this mini-dissertation argues that Mobile Information Technology (IT) Innovation could leverage field-based healthcare. Thus Mobile IT is considered essential to reducing medical errors, enhancing patient safety and improving quality of healthcare service delivery. Mobile IT can also be leveraged to meet ICT infrastructural challenges of field-based healthcare. That is, to enhance this service delivery, Mobile IT innovation will include the use of mobile devices such as mobile phones, smart phones, pocket computers, wireless networks and other technologies such as Radio Frequency Identification, smart cards, as well as information systems accessed through these technologies. In recent years, cases of Mobile IT application in healthcare service, particularly in South Africa, suggest the use of Mobile IT for disease management, monitoring as well as evaluation of patient care activities. There is a need for an empirical study to highlight the determinant factors that influence Mobile IT innovation for field-based healthcare. In response to this need, this study captured and unraveled the complexity of Mobile IT innovation for field-based healthcare through a case study conducted at a healthcare service provider.

The basis of my study is the belief that governance of the local delivery of health could usefully include full and wide community representation and participation by the stakeholders and the larger community. The study was initially carried out in 2003 and now the same clinic has been targeted to carry out an update to see whether the perceptions have changed; if so why and if not what the status is. This study investigates the proposition that if communities do not participate in policy formulation processes, implementation is crippled. The case study is of free health-care policy in a small area of Pietermaritzburg, the Mpumuza area. This area is chosen because it has a local clinic that is being used by the local people to get free primary health care services, covered by the national policy. My interest in the study is influenced by the role I played as a public servant within the district Department of Health one and a half years ago. I dealt, on a daily basis, with service delivery (with a focus on facilitation of the process of service delivery). My interest is to know how the processes of policy development unfold in practice. The study will be examining what the different writers allude to in relation to policy formulation and implementation, the legislative framework pertaining to health policy, the actual case study and finally the conclusions drawn and recommendations, which are open for further exploration in other studies. The study looks at the impact of lack of involvement of the community members (who are at the receiving end) and the role of service providers (who for the purposes of this study will be confined to the nurses that offer the health services at the specific local clinic). Basically the study found that the subject of involving communities in policy formulation is a crucial one if the policy is to be successfully implemented and these are detailed later in the document. / Thesis (M.Soc.Sc.)-University of KwaZulu-Natal, Pietermaritzburg, 2007.

Background: The purpose of this research was to examine how the Three Bridges Community Health Centre conceptualizes and addresses the issue of accessibility for gay men. This research explored the intersection and disjuncture of how accessibility for gay men is understood and practiced from multiple perspectives (staff and clients). It revealed perceived and real barriers and opportunities for gay men in accessing health services, and provides insight into the mechanisms Three Bridges Community Health Centre employs to provide comprehensive health care to a local population that is not easily identifiable. Methods: Case study is the central defining methodological feature of this research. This study applies both inductive and deductive approaches. The data are qualitative, derived from 14 semi-structured interviews, document analysis (25 documents with a total of 398 pages) and participant observation (approximately 33 hours). Analysis and interpretation of the data were accomplished through the various procedures and techniques associated with qualitative data analysis, including the use of a qualitative software package - NUD*IST 4.0. Results: The study revealed twelve main factors that facilitate (and obstruct) accessibility for gay men. They were developing a mission of accessibility for vulnerable populations; assessing gay men's health issues, barriers and needs; utilization of the clinic; delivery of appropriate programs and services; available providers with appropriate knowledge, attitudes and behaviour; cultural accessibility (e.g., gay-friendly environment, multiple languages); geographic accessibility (location); physical accessibility (architecture); financial accessibility (affordability); functional accessibility (convenience); awareness (marketing & publicity of services and location); and partners in accessibility (e.g., community, health authorities, government). Each section of this chapter details how Three Bridges addresses each of these elements (the strengths), the challenges (e.g., time, money and personnel) in addressing these issues, as well as suggestions for improving accessibility. These factors would also be relevant for any primary care setting about to embark upon an examination of how (well) it addresses access for gay men, and other vulnerable populations. Conclusions: Partnerships with community-based agencies and recruitment of queer staff are critical in creating cultural accessibility for queer people. Many of the challenges raised by staff need to be addressed at a policy, region-wide level. Cultural accessibility for queer people also needs to be addressed by other healthcare settings.

<p>Teenage pregnancy is one of the major public health problems facing teenage girls in Zambia (Webb, 2000 / Warenius, 2008). Teenage girls‟ access to and utilization of adolescent&nbsp / reproductive health (ARH) services is important for the prevention of teenage pregnancies and sexually transmitted infections (STIs) amongst teenagers.High incidence of teenage pregnancies has been noted in the district despite availability of ARHservices. Teenage pregnancy is a major contributing factor to the high school drop-out rate amongst the girls and is one of the challenges faced by non-governmental organizations (NGOs) that support girl child education, such as the campaign for female&nbsp / education (CAMFED) as well as for government agencies such as the Ministry of Education. The high incidence of teenage pregnancies could be an indication of poor access to&nbsp / and utilization of ARH services and therefore an assessment of the accessibility and utilization of the ARH services was done to explore the reasons for this.This research aimed to explore the factors affecting teenage girls‟ access to and utilization of ARH services in the Mpika district, Zambia. The research was a qualitative, descriptive and exploratory study using individual interviews with ten in-school teenage girls, four key informants rendering ARH services and a focus group discussion (FGD) with ten pregnant teenage girls. By exploring these particpants‟ perceptions and experiences, appropriate interventions to improve accessibility to and utilization of ARH services could be designed that would be appropriate for the local context in order for them to be effective. Thematic analysis with categorizing and coding methods was used to analyze the data. The study used the theory of planned behaviour (TPB) which stipulates that an individual‟s attitude,subjective norms and perceived behavioural control influence behaviour as a framework to explain the findings of the results of the study. The findings of the study indicated that physical, psychological and social barriers hindered adolescents from accessing and utilizing ARH services. The findings also suggested that high levels of knowledge about RH services do not necessarily translate into accessibility and utilization of ARH services. Accessibility to and utilization of ARH services by adolescents can also be determined by an individual‟s attitude, subjective norms, and perceived behavioural control as illustrated by the TPB. Adolescents need to feel comfortable using ARH services. Therefore the three variables of TPB should be taken into consideration when designing comprehensive ARH programmes in order to accommodate the unique reproductive health needs of the adolescents. There is need to encourage participation in and involvement of adolescents in planning and&nbsp / &nbsp / implementation of ARH programmes. The participants also made recommendations which included strengthening information and education on ARH, strengthening adolescent-friendly services, improving staffing levels and promotion of school health services.</p>

In 1997, the UK's Labour government introduced several health policy changes, including plans for greater collaboration with private providers. Building on previous cross-sectional research, we explore longitudinal inequities in physician access as these policy changes were materializing. Using GEE models we examine the effect of income and private health insurance (PHI) coverage on access to physicians in the general UK population from 1997 to 2003. The study finds no income inequities in GP access. In contrast, those in the highest income quintile are more likely to access consultants overall (OR:1.10, CI: 1.01,1.19), particularly private consultants (OR:2.49, CI:1.80,3.44). Not surprisingly, PHI is a strong predictor of private consultant access (OR:8.72 CI: 7.04,10.82), but a weak predictor of overall consultant access (OR:1.09, CI:1.01, 1.17). None of these findings exhibited significant time trends across the years of study, thus indicating that the existing inequities remained stable in the UK, despite the aforementioned reforms.