<p> Mexico's innovative health reforms have attracted scholarly attention beyond its own borders, making it a valuable case to study how countries set priorities. This dissertation examines the multifaceted topic of priority setting through a multidisciplinary approach: each of the three papers of this dissertation employs one of three disciplinary perspectives: historical, quantitative or normative. The dual focus on mental health and HIV--two highly stigmatized diseases with almost opposite histories of prioritization--further underscores the social and historical aspects of health priority setting. Paper 1, "Outrage and Evidence: Julio Frenk and the Politics of Mental Health Advocacy in Mexico, 1968-2006," examines the recent history of mental health advocacy efforts in Mexico. Tracing the career of Julio Frenk, a contemporary global health leader as well as Mexico's Minister of Health from 2000 to 2006, demonstrates that mental health advocacy moved from a focus on human rights abuses to a statistical-based advocacy that emphasized the burden of mental illness. Paper 2, "Beyond Universal Treatment Access: A Multi-level Study of Mental Health Care in Public HIV Clinics in Mexico," represents the first study of the availability and usage of mental health services among HIV+ individuals in Mexican HIV clinics. This paper uses multi-level modeling of a cross-sectional survey from Mexico's National Institute of Public Health to explore factors associated with patients receiving mental health care. The results indicate that clinic-level factors account for much of the observed variation in mental health care for HIV+ individuals. Paper 3, "'What Magic is there in the Pronoun `My'?' The Role of Patient and Disease Advocates in Public Deliberations about Priority Setting for Health Policy," analyzes the risks and benefits of recent, and often controversial, attempts by countries like Mexico to include this specific class of stakeholder in public deliberation for health. Patient participation does bring the risk of bias due to their partiality. However, by drawing on deliberative democratic theory, this paper argues that such partiality confers epistemic advantages to deliberation, such that, if certain procedural and substantive constraints are met, the benefit of their participation may offset the risks.</p>

<p> Obesity is a serious global issue and it is increasing in prevalence in the United States. The purpose of this interpretive hermeneutic phenomenological study was to gain insight into the nature of the impact of work on obesity through reflecting on the lived experiences of employed adults. The research study used a van Kaam method as modified by Moustakas with in-depth, semi-structured interviews to explore factors surrounding the impact of work on obesity. Fifteen participants from two industries (Home Health Care and Education) were interviewed for the study. It was theorized that obesity was influenced by an inability to balance the demands and influence of the work environment with healthy weight management practices. The study revealed that the workplace does affect obesity because of food choices available within the organization, lack of health discussions, work hour demands, and lack of streamlined work processes that enables break periods. The most influential factors on the participants&rsquo; state of obesity were external to the workplace. The study also found that unhealthy habits and external relationships influence people&rsquo;s state of obesity. Social policy change leaders should consider the person as the epicenter of the obesity issue because unhealthy habits are passed from generation to generation and a lack of both self-control and motivation exacerbates the obesity issue.</p>

<p> In our death denying culture (Becker, 1973; Kearney, 2000), reaching the end of life often entails a process that includes not only physical, but psychological, social, emotional and spiritual suffering. Unaddressed, these may leave patients and family members with related residual trauma surrounding death experiences. In an attempt to seek ways of alleviating such suffering, this study explores the use of symbolic and guided imagery with dying patients. Imagery work often taps into the wisdom of the unconscious mind (Naparstek, 1994), that seems to know what the patient needs in the moment. Despite the increasing use of guided imagery, there is a lack of literature investigating its use in end-of-life care. </p><p> A phenomenological research method is used to understand the patient's lived experiences and their meanings. In addition, a transpersonal research methodological approach was designed to include shared experiences that offer "additional ways of knowing." This second method provides information from the participant-researcher, as certain patients were unable to articulate their experience. Transpersonal research methods allow an extension beyond the usual limits of ego and personality, acknowledging a deeper soul connection, taking into consideration new scientific findings on nonlocality or "signal-less field of interconnected consciousness." This research indicates that the researcher's and patient's unconscious can collaborate for the benefit of the patient. </p><p> Findings from 12 hospice patient pilot and case studies were reported, showing the following results: 1. recognition of meaningful symbolic imagery as a comforting, value-based, way to express the end-of-life review; 2. deep relaxation, comfort, calming and connection with the deeper self or psyche; 3. acceptance of mortality; 4. release from physical symptoms and focus on physicality; and 5. connection with a transcendent or spiritual reality or experience. </p><p> The use of guided imagery with dying patients and families offers an additional method of depth psychological practice to address the various aspects of being or "wholeness." Presently, medicine is seeking to become more "person-oriented" rather than "disease-specific"; hence, imagery work is personal and meaningful. Additional research exploring the benefits possible from this approach for family members in an effort to add value to the shared dying experience of the family group in end-of-life care is indicated.</p>

<p>The purpose of this study was to investigate knowledge regarding the gluten-free diet among non-celiacs following the diet. Specifically, this study examined how knowledge differed among gluten-free diet followers by reason(s) for following a gluten-free diet, source(s) from which information on the gluten-free diet is obtained, level of education attained, age, and sex. </p><p> A convenience sample of 129 usable knowledge assessment surveys completed by non-celiac gluten-free diet followers was utilized in this study. Participants were recruited via Facebook groups or pages, or by announcement flyers that were posted on community information boards at health food stores. It was found that participants, ages 40-49, had a greater knowledge of the gluten-free diet than those ages 20-29. Subjects who were 50 or over also had greater knowledge than those of ages 20-29 years. Results indicated that greater knowledge of the gluten-free diet is associated with older age. </p>

<p> Scholars have used studies of &ldquo;street-level organizations&rdquo; to examine how policy is implemented, adapted, and changed through the practices of workers in real-world contexts. This dissertation follows in that tradition, tracing the ways in which Medicaid reforms work their way down to the street-level in a community mental health center with its origins in the clubhouse model of treatment. Based on twelve months of direct observation of street-level practices, interviews with workers, and analysis of agency documents and reports, I examine how new managerial reforms shape the strategies that workers use to provide access to community mental health services and to advance the clubhouse logic of recovery. These findings have implications for scholarship across the domains of community mental health practice, organizational studies, and policy research, suggesting the need for further investigation into how policy reform is produced through the everyday practices of street-level organizations.</p><p> This dissertation uses organizational ethnographic methods to study workers&rsquo; practices at Community Club, a community mental health center located in Chicago, Illinois. The clubhouse is based on the idea that individuals whose lives have been adversely affected by severe mental illness can benefit from treatment in a setting that functions as a social club, where members experience themselves as valued and needed. At the same time, community mental health reforms have been advanced largely by new managerial arrangements that emphasize accountability and performance measurement. These reforms in governance and management produced considerable uncertainty for workers in how Community Club would adapt to changes in policy. This site provides an opportunity to examine how reforms &ldquo;worked&rdquo; in this particular setting and what became of the clubhouse model under new managerial arrangements.</p><p> Data were collected from November 2009 until November 2010. I directly observed therapeutic interactions at Community Club and attended weekly team and managers meetings. Interviews were recorded with frontline workers, team leaders, and program administrators as questions emerged from my day-to-day observations of direct practices. I had access to multiple sources of organizational documentation, including corrective actions, internal notices, and training materials. I attended meetings, webinars, and teleconferences at the Illinois Division of Mental Health for a year. I also attended monthly meetings at the largest community behavioral health trade association in Illinois for two years. Interviews were conducted with key informants at the state and trade levels to better understand how community mental health policy reforms took shape in Illinois. Data were analyzed in an ongoing and iterative fashion for thematic connections. Multiple data sources allowed for triangulation and fact-checking as hypotheses emerged over the course of this study.</p><p> This study finds that workers adjusted to reforms in governance and management in ways that were not reducible to formal statutes alone. First, new managerial reforms restructured the tensions that played out at the street-level as workers negotiated the competing demands of access to care. This study suggests that reforms may place pressure on workers to limit flexibility and openness, may produce both direct and indirect forms of rationing, and may introduce barriers that unevenly affect individuals who are &ldquo;harder to serve.&rdquo; Second, reforms in governance and management restructured three key logics of the clubhouse. Street-level practices that advanced community participation, informal group arrangements, and client self-determination were reshaped by organizational incentives and penalties that increased the costs for workers of providing these services. These changes had observable implications for individuals&rsquo; access to&nbsp;services and for workers&rsquo; ability to act in consonance with manifest principles of the clubhouse and recovery models of treatment. </p><p> This dissertation supports the assertion that formal policy is changed through its implementation in real-world contexts of practice. By revealing the structures that shape most decisively what policy becomes in practice, this study enhances the visibility of social welfare reforms that may otherwise obfuscate how reforms &ldquo;work&rdquo; in practice. This study suggests that social policies should focus not only on accountability and performance measurement, but also on supplying workers with adequate resources to do their jobs well. If, as advocates and researchers have long suggested, there remains significant need for services that support social connection among people with severe mental illness, then it is important for scholars and policymakers to think about how to better equip organizations with the resources they need to facilitate this dimension of care. This dissertation is based on a single case study, which limits the generalizability of its findings. Street-level organizational studies build validity over multiple iterations of case selection, using a comparative perspective to distinguish particular from systematic features of organizational practice. More studies are needed that examine how community mental health policies are produced in the everyday life of organizations, in order to better understand how polices give shape to the nature and distribution of care.</p>

<p> Prior research has established a link between SES and early-life health without providing clear theoretical or empirical evidence for using any particular conceptualization or operationalization of SES. Researchers refer to any combination of variables related to economic, educational, and occupational circumstances as SES. This abundance of operationalizations makes it difficult to determine how SES shapes early-life health. Different operationalizations may even cause inconsistent conclusions when comparing the effects of SES on child and adolescent health. Thus, by failing to consider multiple operationalizations of SES, current research is unable to provide a complete picture of how SES shapes early-life health. </p><p> To address this gap, I examined multiple operationalizations of SES derived from two conceptualizations of SES. The distinct components conceptualization views individuals' economic, educational, and occupational circumstances as components of SES and is operationalized with readily available variables related to income, wealth, education, and occupation. However, studies use different operationalizations and combinations of the economic, educational, and occupational components. The unitary conceptualization views SES as an unobservable status of individuals that falls along a single, social hierarchy and is operationalized with a single component or a composite of components. However, researchers rely on different components and different methods to construct composites. </p><p> In analyses, I considered the effects of a broad range of operationalizations related to both the distinct components and unitary conceptualizations of SES on early-life physical and mental health. I also examined the effects of these operationalizations on child compared to adolescent health. I found that different operationalizations and combinations of components could lead to different conclusions about SES and health. I found that certain operationalizations of SES could lead to inconsistent conclusions regarding differences in the effects of SES on child compared to adolescent health. Overall, I found that the distinct components conceptualization of SES provided more detailed information on the economic, educational, and occupational contexts through which SES relates to early-life health. The different operationalizations of SES within this conceptualization provided important insights about SES and health. In sum, my findings suggest that researchers should explicitly conceptualize SES in studies and consider multiple operationalizations before arriving at conclusions.</p>

Thesis (Ph.D.)--Pacific Graduate School of Psychology, 1995. / Source: Dissertation Abstracts International, Volume: 56-06, Section: B, page: 3437. Chair: Shirley Long.

Thesis (Ph.D.)--Pacific Graduate School of Psychology, 1999. / Source: Dissertation Abstracts International, Volume: 60-06, Section: B, page: 2935. Adviser: Phillip D. Akutsu.

Thesis (Ph.D.)--Pacific Graduate School of Psychology, 2005. / Source: Dissertation Abstracts International, Volume: 66-01, Section: B, page: 0581. Adviser: Julia Shiang.

Thesis (Ph.D.)--University of California, Berkeley, 2005. / (UnM)AAI3186984. Source: Dissertation Abstracts International, Volume: 66-08, Section: A, page: 3012. Co-Chairs: Elisabeth Sadoulet; Alain de Janvry.