<p>ABSTRACT</p> <p>This thesis explores the re-settlement process of Latin American immigrants and refugees in the Waterloo region. This qualitative research project was designed to gain an in-depth understanding of the lived realities of participants. General questions about their re-settlement process, and more specifically about the barriers faced by members of the Latin American community were asked. Participants identified and constructed meaningful resolutions to meeting their “needs” and overcoming barriers.</p> <p>The findings are based on eleven individual, three conjoint interviews and two focus groups, with men and women of Latin American origin. Open and axial coding was utilized to explore emergent themes. These themes were introduced in subsequent interviews to thicken the data and acquire cross-gendered perspectives. By using a symbolic interactionist and sociological phenomenological framework, I attempt to understand the interplay between the individual consciousnesses of Latin Americans living in the Waterloo Region and the meanings created of their lived realities and social worlds. To obtain this understanding, I have chosen to use elements of grounded theory to discover the interrelatedness of the concepts, categories, and properties that emerged in the data (Borgatti, 2005).<strong> </strong></p> <p>What was evident though out the data was a strong sense of ethnic identity, pride and strength within the Latin American community. Participants consistently identified a sense of agency and a desire to promote and nurture the Latin American community based upon shared elements of culture, including but not limited to, the Spanish language.</p> <p>Other predominant themes that emerged in the data were: experiences of systemic racism, cultural shifts and barriers to accessing re-settlement services. The findings of this research serve to disrupt notions of the current political discourse surrounding the neutrality of multiculturalism, provide new perspectives on the re-negotiation of culture that occurs during re-settlement and finally, to provide insights into service use by Latin Americans</p> / Master of Social Work (MSW)

The focus of this study is the development and implementation of the Iterative Needs Assessment/Evaluation Model for use as part of an English curriculum reform project at a four-year university in Japan. Three questions were addressed in this study: (a) what model components were necessary for use in a Japanese university setting; (b) what survey instruments would work with such a model; and (c) what needs would the stakeholders in the project report? The site for the study was a mid-sized private, four-year university in Japan. Set as an instrumental case study (Stake, 1998), multiple methods and sources were employed. Stakeholders in the project included university students (n = 1533), teaching staff (n = 33), university administrators and staff (n = 5), and domain experts (n = 7). Data collection included the use of questionnaires, unstructured and semi-structured interviews, and systems and materials analyses. Questionnaires were developed and analyzed using Rasch analysis. The Needs Assessment/Evaluation Model was assessed using a modified version of the Checklist for Judging the Adequacy of an Evaluation Design (Sanders & Nafziger, 1985). Implementation of a full iteration of the Model indicated that use of the Iterative Needs Assessment/Evaluation Model could guide the development and evaluation of the English language program. As part of the study, valid survey instruments that can continue to aid the assessment of needs for and evaluation of the courses were developed. Data from multiple sources indicated a difference in the perception of needs between stakeholders. The processes followed through the development and application of the Iterative Needs Assessment/Evaluation Model served to incorporate these different perceptions into a cohesive language program curriculum. / CITE/Language Arts

The present study implemented Mobilizing for Action through Planning and Partnerships (MAPP), a comprehensive, multi-component, strategic planning model and tool, in the New River Valley (NRV), Virginia to mobilize the NRV community to improve its own health status and the quality of life of its residents. The current mixed methods study represents one of the first to utilize MAPP in southwest Virginia and Virginia and is the most comprehensive community health needs assessment and strategic planning effort to date in the NRV. Through MAPP, the NRV community strived to determine the most effective ways to achieve optimal community health by considering its unique circumstances and needs, prioritizing public health system issues, identifying resources, and then developing integrated plans and forming effective partnerships for strategic action. The NRV MAPP process provided a solid framework for creating a community-driven needs assessment and strategic planning approach and initiative that brought together diverse public, private, non-profit, and voluntary organizations/agencies, businesses, faith communities, academia, local government, community members, and others who shared the commitment to and had a role in the NRV community's health and overall well-being. The current study also reviews the specific findings, summarizes the benefits and successes, and highlights lessons learned (including challenges and limitations) from the NRV MAPP experience, as well as makes recommendations for current practice and future research. Additionally, it provides a step-by-step overview of the entire MAPP process for potential users as applied to a real-world community, specifically the NRV. / Ph. D.

No / Previous attempts to involve African and African-Caribbean communities in a city in north England in identifying and assessing their health needs have been largely unsuccessful. A comprehensive literature review highlighted that research on Africans and African-Caribbeans is limited and uneven, and dominated by studies focusing on cardiovascular disease, diabetes, mental health and blood disorders. Health information on these communities is largely based on immigrant mortality statistics derived from national datasets. This paper highlights how participatory approaches to community participation and engagement were used in the assessment of the health needs of culturally diverse minority communities as a means of reducing health disparities. The study sought to overcome the shortcomings of traditional techniques for health needs assessment by testing a novel method of rapid participatory appraisal using a triangulation approach to ensure that all perspectives were addressed. The research adopted a mixed-methods strategy comprising distinct phases: a comprehensive review of the literature, a qualitative needs assessment involving representatives of the African and African-Caribbean communities using meta-planning, and a review of health service provision. The approach used in the study was efficient, rapid and feasible for the African and African-Caribbean people to use in obtaining data from their peers. The findings showed a convergence between areas of need identified by health providers and community members in this appraisal, and between these results and other published literature. However, there was a divergence on the extent of change necessary, with institutional responses stressing alterations within existing systems, and community members recommending the establishment of targeted services for African and African-Caribbean communities run by ethnically matched staff.

No / Chronic obstructive pulmonary disease (COPD) is a highly prevalent condition worldwide and is associated with significant mortality. This paper gives an overview of the relevant literature regarding care needs in advanced COPD from the perspective of the patient or carer, and aims to explore the appropriateness of a palliative care approach in this group. Publications revealed that patients with COPD have a high symptom burden that impacts on quality of life and social functioning. Information provision in COPD is often lacking and the implications of diagnosis and prognosis are not routinely discussed. The impact on families and carers is considerable, many patients have significant care requirements which can affect family relationships. Although patients with COPD have regular contact with health services, access to specialist services and palliative care is poor. This paper highlights the need for increased provision for palliative care in COPD, alongside dedicated education and training for health professionals, and continued research to identify the most appropriate ways of delivering this care.

This thesis addressed the following research activities: (1) Developing and evaluating the usability of an adult age-independent online assessment tool that includes health care related content and is centered on the needs and capabilities of both older and younger users and, (2) Developing adult age-independent design guidelines. An online tool, which was developed for a previous study, was revised according to the results of the previous study and preliminary development activities based upon the user requirements of older adults (50 years or older). The online assessment tool was also tested with younger adults (between 18 and 35 years of age) to determine the differences between younger and older adults. Subsequent to these activities, a final tool that captured the needs of both older and younger adults was developed and evaluated for usability. According to the usability testing results, a design guideline set for an adult age-independent Online Needs Assessment Tool was developed and revisions were conducted in order to develop the final Online Needs Assessment Tool. The results of these studies, along with the tools developed, provide online survey and interface designers information on older and younger adult user requirements. They provide a knowledge resource for older and younger user healthcare information needs and information about the usability of one online assessment tool to accommodate both older and younger adult users. They also assist interface designers to proliferate and to facilitate more rapid application development / Master of Science

Yes / Background: There are a number of limitations to the present primary eye care system in the UK. Patients with minor eye conditions typically either have to present to their local hospital or GP, or face a charge when visiting eye care professionals (optometrists). Some areas of the UK have commissioned enhanced community services to alleviate this problem; however, many areas have not. The present study is a needs assessment of three areas (Leeds, Airedale and Bradford) without a Minor Eye Conditions Service (MECS), with the aim of determining whether such a service is clinically or economically viable. Method: A pro forma was developed for optometrists and practice staff to complete when a patient presented whose reason for attending was due to symptoms indicative of a problem that could not be optically corrected. This form captured the reason for visit, whether the patient was seen, the consultation funding, the outcome and where the patient would have presented to if the optometrists could not have seen them. Optometrists were invited to participate via Local Optical Committees. Results were submitted via a Google form or a Microsoft Excel document and were analysed in Microsoft Excel. Results: Seventy-five percent of patients were managed in optometric practice. Nine and 16% of patients required subsequent referral to their General Practitioner or hospital ophthalmology department, respectively. Should they not have been seen, 34% of patients would have presented to accident and emergency departments and 59% to their general practitioner. 53% of patients paid privately for the optometrist appointment, 28% of patients received a free examination either through use of General Ophthalmic Service sight tests (9%) or optometrist good will (19%) and 19% of patients did not receive a consultation and were redirected to other providers (e.g. pharmacy, accident and emergency or General Practitioner). 88% of patients were satisfied with the level of service. Cost-analyses revealed a theoretical cost saving of £3198 to the NHS across our sample for the study period, indicating cost effectiveness. Conclusions: This assessment demonstrates that a minor eye condition service in the local areas would be economically and clinically viable and well received by patients.

Since Hurricane Mitch there have been many humanitarian efforts to provide health care to the poor and needy of Honduras. Unfortunately there is little information available regarding the specific health needs in this country. The purpose of this project was to analyze data collected during a recent mission trip to Honduras for trends in health symptoms, diagnoses and health care practices to assist in the planning of future trips. Health Intake forms were created by Drs. Holcomb and Crigger and were filled out by 500 patients at the time of their visit to both rural and urban clinics. The forms included information on the patient's health history, current symptoms, diagnosis and treatment as well as their health habits and living conditions that might affect their health. Descriptive statistics revealed the clinic population to be primarily women and children. The most common presenting symptoms were gastrointestinal, non specific (i.e. fever, malaise . .. ) and pulmonary. Common diagnoses included intestinal parasites, arthritis and upper respiratory infections. The most frequently prescribed medications were over the counter medications (i.e. vitamins, and Tylenol) as well as antibiotics. Chi-square analysis revealed few differences between the urban and rural populations. It was discovered that many of the population continue to drink unpurified tap water, which may contribute to their gastrointestinal complaints and the frequent occurrence of intestinal parasites.

No description available.

This thesis focuses on service utilisation among children with mild ID and their families, their needs for support and their experiences of support. Aims The overall aim of the thesis was to explore and describe service utilisation patterns among families of children with mild ID from a systems perspective. Methods A cross-sectional, descriptive and comparative quantitative design was used to describe the extent of service utilisation among 84 children with mild ID and their families (paper I and II). The types and number of services utilised were investigated in relation to the child’s age, gender and school setting. Data concerning the services utilised were collected from the organisational records of social services and paediatric habilitation units. In paper III, a descriptive questionnaire design was used to describe the support needs of families of 38 children with mild ID. A confirmatory design was used to examine the relation between family needs for support and (a) parental self-efficacy and (b) parents’ control over services. A confirmatory design was also used to examine the relation between parents’ experiences of the helpfulness of the support and (a) parental self-efficacy and (b) parents’ control over services. In paper IV a longitudinal, comparative and confirmatory design was used to investigate whether social service utilisation patterns differ over time when children with mild ID in self-contained classes are compared with those integrated into mainstream classes (n=405). Results In total, 60% of the families utilised paediatric habilitation services, and 40% of the families used disability-related services provided by social services. The most commonly utilised services were services concerned support outside of the home, such as respite care and services to improve children’s participation in society. Approximately 25% of the families utilised social problems-related services provided by social services. The most commonly utilised services concerned those to support parents in their parenting roles and financial assistance. In contrast to older children, younger children were more likely to utilise paediatric habilitation services. Older children utilised a higher number of disability-related service types provided by social services. Few differences were found between males and females. The majority of families did not utilise such services that are provided by social services. It was rare for families to use both disability-related services and those that address social problems during the same year. Commonly reported family needs concerned information about what services are available for their child, their child's impairment, how to respond to their child's behaviour and how to teach their child skills. Other common needs included access to parent support networks, to find suitable leisure activities for the child, and more alone time for parents. In contrast to families with mothers who did not participate in paid work, families with mothers who were employed expressed a lower requirement for support such as counselling, contact with other parents of children with impairments, more friends and more alone time for parents. Similar results werefound for families with mothers with higher levels of education. Parents with higher levels of perceived self-efficacy reported a lower need for information, as did also parents with higher levels of control over services. Parents with higher levels of control over services experienced the support as being more helpful. Children with mild ID who attended self-contained classes were more likely to utilise paediatric habilitation services than children integrated in mainstream classes. The same pattern was found for utilisation of disability-related services provided by social services. Integrated children who changed school setting to attend self-contained classes were more likely to begin to utilise disability-related services in comparison with those children who continued to be integrated. The former also had a higher likelihood of increasing the number of disability-related service types utilised. Conclusions In addition to disability-related problems, families of children with mild ID may also be at a higher risk of experiencing social problems when compared with the general population. Furthermore, very few families utilised both disability-related services and services addressing social problems. This implies that collaboration flaws exist between those professionals concerned with child welfare services and those concerned with disability-related services. A strong predictor of service utilisation was the type of school setting: children attending self-contained classes had a higher rate of service utilisation than those attending mainstream classes. This indicates that service systems outside of school are designed to collaborate with groups of pupils in special classes rather than individual children in mainstream classes. The strong need for information by families indicates that an ecological framework should be used to identify those factors that affect information availability and effectiveness. To increase parents’ perceived level of control over services, HSO professionals need to work in a capacity building manner with the explicit goal to enhance parental self-efficacy.