The goal of this thesis is to examine the role of the NHIS in providing basic healthcare and its accessibility especially in rural Ghana. The NHIS was first introduced in 2003 to eliminate the cash for services system of health provided services. The implementation of the scheme increased access and use of basic healthcare services. Most healthcare institutions are poised with challenges in management, delivery and utilization of healthcare services. This study aims to access the effect of the NHIS on healthcare delivery in Ghana.

Background: Since the early 1960s, survival rates among cancer survivors have been increasing. Surviving cancer can be a stressful experience due to the multifaceted changes that come with diagnosis, treatment, and recovery. Therefore, studying the mental health of cancer survivors is vital for their well-being. Among queer groups (including those identifying as gay, lesbian, or bisexual), poor mental health is more prevalent than among heterosexuals. However, cancer survivorship among queer populations is not well studied. This study examines the association between cancer survivorship and poor mental health, focusing on potential sexual orientation differences. Methods: Data are from the 2019-2021 National Health Interview Survey. Participants identified as straight (n=65,006), gay or lesbian (n=1,271), or bisexual (n=1,100). Diagnosis of anxiety and depression as well as the frequency of anxiety and depressive symptoms were regressed on cancer survivorship (assessed based on cancer diagnosis) using logistic models. Using a subsample of 2019 rotating core participants, we assessed anxiety, using the Generalized Anxiety Disorder-7 (GAD-7) scale, and depression, using the Patient Health Questionnaire-8 (PHQ-8) symptoms, to account for a potential lack of diagnosis. Models were adjusted for sociodemographic covariates and were stratified by sex. Results: After adjusting for sociodemographic characteristics there was no significant association between cancer diagnosis and mental health in the overall sample. However, when examining sexual identity-specific estimates, among bisexual males, cancer survivors had higher odds of “daily” anxiety [OR=8.07 CI (1.23,52.81)] and “weekly or monthly” depressive symptoms [OR=15.23 CI (3.17, 73.22)]. While among bisexual females, cancer survivors had significantly higher odds of anxiety diagnosis [OR=3.03 CI (1.37, 6.71)] than those who never had cancer. Moreover, bisexual male cancer survivors had higher GAD-7 [β =10.39 (4.03, 16.75)] and PHQ-8 [β =13.59 (6.03, 21.16)] scores than those who never had cancer. No other significant associations were found for other sexual identity groups. Our test for effect modification based on sexual identity on the association between cancer diagnosis and mental health outcomes suggested that the association between cancer diagnosis and mental health outcomes were similar across sexual identity groups. The p-values ranged from 0.11 to 0.92. Conclusion: Bisexual cancer survivors may experience poorer mental health than those who have not had cancer, suggesting a potential need for more targeted mental health intervention and cancer survivorship support. However, small sample sizes suggest that additional work with larger samples of cancer survivors is needed to corroborate these findings.

Objectives. The prevalence and incidence of asthma has been continually increasing with in the United States. High rates of hospitalization, emergency room visits (ER) and infrequent prescribing of controller medications indicates the lack or inadequacies of asthma management in the home as well as primary care programs. This study examines the impact of adequate asthma management and preventive care on asthma ER visits. Methods. Data from the 2003 National Health Interview Survey (NHIS) was utilized. Children (N=653) under the age of 18 years and who have had asthma episode in the past year were included for this analysis. A composite variable was created to determine adequacy of care at home and in the primary care setting using standards from the Global Initiative for Asthma (GINA) supported by the National Heart, Lung and Blood Institute.Results. The prevalence of ER visit among children who had asthma in the past 12 months was 22.7%. Approximately a quarter (24%) of the children had inadequate asthma management and preventive care. The multiple logistic regressions analysis showed that asthma management and preventive care were important determinants for asthma ER visits. Compared to children who had adequate care, children with inadequate asthma management and preventive care were two times more likely to visit the ER for asthma related problems [OR=2.06 (95%CI=1.257, 3.361)]. Child's age, maternal education, and family income were also statistically significant determinants for asthma related ER visits.Conclusions. Practices that support early interventions for asthma management and preventive care were associated with reduced risk of ER visits. Initiatives to support mandatory asthma management education and programming at primary care practices and as well as the home setting are essential in the management of pediatric asthma.

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The National Health Insurance Scheme (NHIS) in Ghana was introduced to alleviate the problem of citizens having to pay for healthcare at the point of delivery, given that many did not have the financial resources needed to do so, and as such were unable to adequately access healthcare services. The scheme is managed from the national headquarters in the capital Accra, through satellite offices located in districts right across the length and breadth of the country. It is the job of these offices to oversee the operations of the scheme within that particular district. Current literature however shows us that there is a digital divide that exists between the rural and urban areas of the country which has led to differences in the management of information within urban-based and rural-based districts. This thesis reviews the variables affecting the management of information within the scheme, and proposes an information management model to eliminate identified bottlenecks in the current information management model. The thesis begins by reviewing the theory of health insurance, information management and then finally the rural-urban digital divide. In addition to semi-structured interviews with key personnel within the scheme and observation, a survey questionnaire was also handed out to staff in nine different district schemes to obtain the raw data for this study. In identifying any issues with the current information management system, a comparative analysis was made between the current information management model and the real-world system in place to determine the changes needed to improve the current information management system in the NHIS. The changes discovered formed an input into developing the proposed information management system with the assistance of Natural Conceptual Modelling Language (NCML). The use of a mixed methodology in conducting the study, in addition to the employment of NCML was an innovation, and is the first of its kind in studying the NHIS in Ghana. This study is also the first to look at the differences in information management within the NHIS given the rural-urban digital divide.

The purpose of this study was to identify factors that predict quality of life (QOL) for aging adults and to examine and compare Baby Boomers', Older Adults' and Younger Adults' responses to the 2010 National Health Interview Survey/QOL Functioning and Disability. Significant findings included several significant values based on the multivariate regression to estimate a model to predict QOL. In particular, being male, four ethnicities other than white, being older than Boomer, age in 10 years, the Functional Difficulty Index, the Functional Limitation Index scores, chronic heart disease, asthma, and arthritis all had significant p values. Adults with chronic heart disease, asthma, or arthritis scored lower on the QOL index, but cancer, stroke, or diabetes were not associated with the QOL index. Two hypotheses had strong support. Lower scores on both the Functional Difficulty Index and the Functional Limitation Index yielded lower QOL scores. Further research recommendations include establishing reliability and validity of the QOL index; running additional regressions for demographics (ethnicity, marital status, etc.) to predict possible combinations of variables predicting QOL or barriers to QOL; and investigating the viability of incorporating the QOL index into an electronic medical record (EMR) dashboard parameter to serve as a screening mechanism for those aging adults most at risk for chronicities or co-morbidities that place them at risk for losing their ability to age in place in the home of their choosing.

Cancer is the second leading cause of death in America. It’s been suggested that regular physical activity (PA) can improve health outcomes in cancer survivors. An estimate from BRFSS data (2009) suggested that 47% of all cancer survivors met recommended guidelines and that this estimate was not different from the population at large (48%). Several factors were examined from these BRFSS data to determine whether subgroups of survivors existed who might benefit from interventions aimed at improving their PA status. The purpose of this investigation was to obtain more recent estimates of adherence to established PA guidelines for cancer survivors. Data from 2015 NHIS were obtained from the CDC website. Of the survivors, 40% met PA guidelines. Additionally, 79% were 54 years or older, more likely to be female (60%), predominantly white (80%), with more than 2 comorbidities (41%), and with some form of functional limitation (66%). Compared to a study based on 2009 BRFSS data, an even smaller proportion of survivors met PA guidelines in this study. This might be due to differences in age distributions and no limitation of the analysis according to time since diagnosis. Targeted interventions to increase activity in cancer survivors continue to be warranted.

Abstract Purpose: The United States has the highest rate of teen pregnancy of any industrialized nation. Adolescents who have their first sexual intercourse at a young age are at increased risk for teen pregnancies and acquiring a sexually transmitted disease. This study examines predictors of early onset sexual intercourse in male and female residents of the United States. Methods: A nationally representative sample of N=7,643 females and N=4.928 males ages 15-44 was procured from the 2002 National Survey of Family Growth (NSFG), Cycle 6. Age at first sexual intercourse was used to define early onset of sexual debut(<18 years). Socio-demographic and behavioral characteristics of the respondents, demographic and selected reproductive characteristics of the respondent's parents were examined using multiple logistic regression modeling. Results: Non-fispanic black, being raised without both parents, having a mother less than 18 years old at the age of first birth and age difference between partners were significant predictors of early onset of sexual intercourse for both males and females. Maternal education less than high school was a significant protective factor for female respondents [OR=0.72 (95%CI=0.58- 0.90)] and paternal education completed high school only [OR=1.4 (95% CI=l. 1-1.7)] was a significant risk factor for male respondents. Conclusions: Racelethnicity, age difference between partners, not being raised by both parents, having a mother who had her first birth before the age of 18 and parental education are important predictor variables. Further study should be conducted to investigate the protective effect of lack of maternal education for female respondents. Intervention programs for teen pregnancy and sexually transmitted infection prevention should target these at risk groups.

No description available.