A reading of recent studies in preventative health care behavior recalls the proverb about the blind men and the elephant: each man is able to describe the part of the animal he is closest to, but none can see, and so none can put their diverse and often contradictory opinions together to come up with an accurate description of the whole elephant. Similarly, in preventative health care studies, each researcher or research group is able to observe the preventative health care utilization patterns of specific populations at particular times, but the conclusions reached are often based on less than complete knowledge. This is especially true of the research into what makes low income people use preventative services in certain ways.

Urgent Care Centers (UCCs) are a recent innovation in the American system of health care delivery. The number of UCCs has increased significantly in recent years. Many researchers point out that the rapid growth of UCCs is expected to escalate during the next few decades. This growth will create more competition among providers of these facilities in the health care market, and the competition could lead to an uneven distribution of UCCs within cities. While health officials and planners are interested in attracting more patients by expanding UCC services, they are often unfamiliar with the factors that go into site selection decisions. Understanding the factors influencing UCC location is crucial to explaining why UCCs cluster in certain urban areas, while other areas are under-served. It is also important for providers who want to enhance accessibility of special population segments to UCC locations. This study uses the Portland metropolitan area as a case study. Due to the lack of access to providers' propriety data, the specific problem targeted here uses publicly available data as a proxy for providers' data to determine the factors influencing UCC location. The essence of this research is to show how these factors explain and predict existing locations of UCCs and to find out how well this publicly available data explains UCC providers' locational behavior. Most of the data for this study is provided by Metro of Portland. Other data are collected utilizing surveys and data from different public agencies and published reports. Logit analysis is used to find out which factors explain existing UCC location. The empirical findings of this research substantiate the existence of a strong relationship between the location of UCCs and land use factors. This study highlights the complexity and importance of understanding the factors influencing the location of UCCs. It rejects prior arguments that UCC location is influenced by some demographic and socioeconomic factors, while it introduces land use factors as the major determinants of UCC location. However, this study concluded that land use factors influence considered a rare phenomena that should be carried out for future research and that demographic factors may still have an indirect effect on UCC location.

The study examined the correlations between gender, ethnicity, socio-economic status, self-reported mode of exposure to HIV, the types of coping strategies utilized, social support, perceived stress, preventive resources, depression, and disease progression among 79 HIV+ patients, eleven of which were Spanish speaking, seen at a federally and city funded HIV/AIDS clinic. The first aim was to demonstrate that there is a linear relationship between gender, ethnicity, the manner in which one copes with the HIV infection (utilizing problem-focused strategies versus emotion-focused strategies), and the progression of HIV as measured by each participant’s CD4 count. The second aim of the study was to show that the higher the frequency of seeking medical support at the HIV/AIDS clinic, the lower the rate of HIV progression as measured by the CD4 count. The third aim of the study was to demonstrate that there is a significant difference in the types of coping strategies utilized by differing ethnicities to combat the stress related to HIV. Findings indicated that among the 78 participants who completed the surveys, housing status (homeless versus having a home), intravenous drug use (IVDU), Escape-Avoidance behavior, Positive Reappraisal, the perception of having familial support, and the perception of mastery were all significantly correlated with the difference in the CD4 count initially obtained at the time of the interview and the CD4 count that was obtained again 3 through 15 months later. Of the 17 of the total 78 participants who did not return to the clinic consistently, housing status was found to be significantly correlated with the difference in the CD4 count initially obtained at the time of the interview and the CD4 count that was obtained again 3 through 8 months later. Of the 61 of the 78 participants who did return to the clinic consistently, IVDU, the perception of family as supportive, the perception of having sources of comfort, the perception of the ability to scan the environment as a resource, the perception that one recognizes the opportunity to prevent stress, perceived control, the perception that one has control, the perception that one has efficacy, the perception that one can master tasks, and the perception that one can maintain self-direction were all significantly correlated with the difference in the CD4 count initially obtained at the time of the interview and the CD4 count that was obtained again 9 through 15 months later. Therefore, there was a significant difference between those patients who returned for consistent medical treatment at the clinic versus those who attended the clinic infrequently. The issues pertaining to the adherence of medical treatment as well as attempts to buffer the positive coping strategies that facilitate adherence are of critical importance to current prevention measures. In addition, it was found that there were significant differences in the manner in which differing ethnicities coped with the stressors related to HIV. The study revealed that among the 25 black men and women, coping by accepting responsibility, and coping by positively reappraising situations were predictive of ethnicity. Among the 21 Hispanic men and women and the 31 white men and women who participated in the study, none of the coping strategies were predictive of ethnicity. The identification of the differential manners in which each ethnicity copes with the stressors related to HIV has the potential to bolster both HIV treatment and prevention efforts. Further research needs to be conducted in order to further explore these important issues. / text

Introduction Self-rated health (SRH) is a widely used indicator of health service utilisation and reflects self-perceived objective health condition. Poorer non-comparative SRH was shown to be related to higher inpatient and outpatient utilisation in Western and elderly populations. Little is known about how healthcare utilisation relates to SRH in non-Western settings, such as Hong Kong and in adult populations. The association of age- and time- comparative SRH with healthcare utilisation is also unclear. This study aimed to assess the association of three types of SRH (non-, age- and time- comparative SRH) with inpatient and outpatient utilisation in Hong Kong‟s general populaion. Methods Data were derived from 2011 Thematic Household Survey (THS), covering 23,892 non-institutional residents aged 20 and above. The study adopts Andersen‟s Behavioral Model of Health Service Use for the analytical framework. Healthcare utilisation was measured by inpatient use during the past year and outpatient use (including General Outpatient Clinic (GOPC) and Specialist Outpatient Clinic (SOPC)) during the past month, in terms of ever-use and the amount of use (bed-days and number of outpatient visits). SRH was measured with a 5-point Likert Scale: non-comparative SRH from “Excellent” to “Poor”; age- and time- comparative from “much worse” to “much better”. Logistic regression and zero-truncated negative binomial/ Poisson regression were applied to examine the association of SRH and chronic diseases with healthcare utilisation in the public and private sector separately as per the Andersen behavioral model. Results “Fair/ poor” non-comparative SRH was associated with higher inpatient and outpatient utilisation. The association was not significant for hospital bed-days. Similarly, age-comparative SRH was associated with inpatient (except private bed-days) and outpatient utilisation (except the number of SOPC visits). “Worse/ much worse” time-comparative SRH was associated with higher healthcare utilisation, but the relationship was less clear for private hospitalisation. The presence of cancer, cardiovascular diseases, diabetes, lower respiratory diseases, and musculoskeletal diseases were associated with higher healthcare utilisation, with stronger association observed for ever-use than the amount of use. The relationships between musculoskeletal diseases and inpatient utilisation, between cardiovascular diseases and diabetes and the number of private outpatient visits, and between lower respiratory diseases and GOPC utillisation were not significant. Conclusions The present study suggests SRH to be a useful health indicator of health service utilisation. All three SRH measures were associated with health service utilisation and no marked differences were observed between different measures. Poorer SRH were strongly related to higher public inpatient utilisation, with stronger association observed for ever hospitalisation than bed-days. Poorer SRH measures were also related to higher outpatient uilisation in both sectors during the past month. All the selected chronic conditions were related to increased healthcare use. The associations were less clear for hospital bed-days and the private sector. Future studies should focus on the predictive validity of SRH on future healthcare utilisation. / published_or_final_version / Public Health / Master / Master of Philosophy

Background: The relationship between informational support and use of health care services among individuals newly diagnosed with cancer remains little documented despite its importance for optimal care delivery. Aim: To document the role of informational support in light of patterns of health services used by women and men newly diagnosed with cancer. Method: A sequential mixed methods approach (i.e., quantitative-qualitative) was conducted among women and men newly diagnosed with either breast or prostate cancer. First, an existing quantitative database was used to determine whether an intervention relying on multimedia tool as a complement to the provision of usual cancer informational support to patients (N = 250) would modify subsequent health care service use. A follow-up qualitative inquiry with distinct individuals also newly diagnosed (N = 20) was conducted to explore this relationship further. Next, the resulting quantitative and qualitative findings were merged and reanalyzed using a quantitative-hierarchical approach to enhance our understanding of the phenomenon. Findings: Several personal and contextual factors were found to qualify the relationship between cancer informational support and health service use. Although quantitative analyses showed no significant differences in terms of overall reliance on health care services among participants who received more intense cancer informational support as opposed to those who received care as usual, several sex differences were noted in terms of number of visits to health care professionals, time spent with nurses and satisfaction with cancer information received. Qualitative findings revealed that participants reported a variety of experiences pertaining to cancer information received (e.g., positive, unsupportive or mixed) as well as several processes at play (e.g., cancer information seen as enabling, confirming, or conflicting). These differences in informational support, in turn, influenced their subsequent service utilization (e.g., more phone calls made to health professionals, reduction in face-to-face visits, reluctance to use cancer-related services). The mixed data analysis clarified further the findings allowing a broader perspective to emerge. Conclusion: Findings underscore that the relationship between cancer information and use of services is not as straightforward as initially anticipated. These findings provide initial insights that may inform future research on the topic and assist health care providers in optimizing their cancer informational interventions to guide patients in their reliance on health care services.

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This study explored and described the experiences of Eritrean immigrants regarding utilisation of healthcare services in Indianapolis. Qualitative descriptive phenomenological design was utilised. Data were collected using a semi-structured interview format, on eight conveniently selected Eritrean immigrants, living in Indianapolis. Data were analysed using Interpretive Phenomenological Analysis Framework for data analysis. Three superordinate themes emerged from data analysis: Healthcare financing system, Positive side of healthcare services and Challenges related to utilisation of healthcare service. All these factors have an impact on the utilisation of the Healthcare services by Eritrean immigrants. Recommendations have been put forward to advocate for policy change regarding financing of healthcare services for immigrants and improved healthcare services to accommodate cultural diversity. Further research should be conducted on ways of improving utilisation of healthcare services by Eritrean immigrants in Indianapolis. / Public Health / M.A. (Health Studies)

This study explored and described the experiences of Eritrean immigrants regarding utilisation of healthcare services in Indianapolis. Qualitative descriptive phenomenological design was utilised. Data were collected using a semi-structured interview format, on eight conveniently selected Eritrean immigrants, living in Indianapolis. Data were analysed using Interpretive Phenomenological Analysis Framework for data analysis. Three superordinate themes emerged from data analysis: Healthcare financing system, Positive side of healthcare services and Challenges related to utilisation of healthcare service. All these factors have an impact on the utilisation of the Healthcare services by Eritrean immigrants. Recommendations have been put forward to advocate for policy change regarding financing of healthcare services for immigrants and improved healthcare services to accommodate cultural diversity. Further research should be conducted on ways of improving utilisation of healthcare services by Eritrean immigrants in Indianapolis. / Public Health / M.A. (Health Studies)

Indiana University-Purdue University Indianapolis (IUPUI) / This qualitative study was successful in utilization of grounded theory methodology to ascertain nurses’ decision-making processes following their awareness of having made a medical error, as well as how and/or if they corrected and reported the error. Significant literature documents the existence of medical errors; however, this unique study interviewed thirty nurses from adult intensive care units seeking to discover through a detailed interview process their individual stories and experiences, which were then analyzed for common themes. Common themes led to the development of a theoretical model of thought processes regarding error reporting when nurses made an error. Within this theoretical model are multiple processes that outline a shared, time-orientated sequence of events nurses encounter before, during, and after an error. One common theme was the error occurred during a busy day when they had been doing something unfamiliar. Each nurse expressed personal anguish at the realization she had made an error, she sought to understand why the error happened and what corrective action was needed. Whether the error was reported on or told about depended on each unit’s expectation and what needed to be done to protect the patient. If there was no perceived patient harm, errors were not reported. Even for reported errors, no one followed-up with the nurses in this study. Nurses were left on their own to reflect on what had happened and to consider what could be done to prevent error recurrence. The overall impact of the process of and the recovery from the error led to learning from the error that persisted throughout her nursing career. Findings from this study illuminate the unique viewpoint of licensed nurses’ experiences with errors and have the potential to influence how the prevention of, notification about and resolution of errors are dealt with in the clinical setting. Further research is needed to answer multiple questions that will contribute to nursing knowledge about error reporting activities and the means to continue to improve error-reporting rates