Source: Masters Abstracts International, Volume: 47-06, page: 3554. Adviser: David W. Smith. Includes bibliographical references.

Thesis (M.D.)--University of Hong Kong, 1984.

The purpose of this cross-sectional, descriptive, correlational study was to describe the relationships among demographic factors (age, gender, education, income), perceived severity of illness, perceived barriers to action, perceived self-efficacy, and interpersonal influences (social support) and health-promoting behaviors (HPB) and to identify predictors of HPB. A nonprobability sample of 110 participants with Chronic Renal Failure (CRF) was recruited from the outpatient clinic of Burirum hospital and Surin hospital located in north-eastern Thailand. All participants were individually interviewed by the principal investigator in a private area within an outpatient clinic. Six variables were significantly correlated with the HPB. They were age, education, perceived severity of illness, perceived barriers to action, perceived self-efficacy and social support. According to the results from the analyses of demographic data and HPB, participants who were younger and had higher educational levels practiced more HPB. From the analyses of perceived severity of illness, perceived barriers to action, perceived self-efficacy, and social support and HPB, the results showed that participants with lower levels of perceived severity of illness and lower levels of perceived barriers to action reported better HPB. In contrast, the participants with higher levels of perceived self-efficacy and social support reported better HPB. By using a stepwise multiple regression analysis, two predictors were identified from 8 predictor variables, and those two accounted for 78.2% (p < 0.01) of the variance in HPB. Two variables that contributed significantly to the variance in the HPB were perceived self-efficacy ([beta] =.769, p < 0.01), and social support ([beta] = .162, p < 0.01); whereas age, gender, income, educational level, perceived severity of illness, and perceived barriers did not contribute to the variance in the HPB. The study found that participants who experienced better perceived self-efficacy and social support reported better HPB. In contrast age, gender, income, educational level, perceived severity of illness, and perceived barriers did not enter as predictors in this stepwise regression equation. / text

Almost everyone experiences an incident, illness, or concern that requires clinical advice or assistance. Most persons obtain the desired care and renew their daily activities. Some people, however, appear to be (medical) problem-prone, wellness-resistant or reinforced by illness sequelae. Individuals who maintained illness behaviors are often called, for example, chronic pain, asthma, or psychiatric patients by caregivers who focus on diagnoses. Some patients may be viewed as primarily chronic, with specific diagnoses considered secondary. Chronicity is here defined as a measure of individual, situation, exposure, and provider interaction outcomes. Independent of disease processes, chronicity-producing interactions often predict inappropriate and atypical medical utilization patterns. The assessment of chronicity, its precursors, and dynamics may identity high risk person, situation, provider, and environment combinations and permit more effective and relevant prevention and treatment strategies. The study patient chronicity, the Pre-Assistance Questionnaire (PAQ) was developed with 320 items on medical, personal, and situational topics. PAQ responses from 60 medical and 40 psychiatric VA outpatients were correlated with three estimators of patient chronicity: PAQ totals (from an empirically-derived key), clinicians' subjective ratings of patients' chronicity, and indices of subjects' 2 year use of VA medical center resources. PAQ totals correlated significantly with 240 items, medical usage with 119, and clinicians' ratings with 100. For replication, a 40 item short form was given to 120 medical and 80 psychiatric outpatients. Thirty-four items correlated significantly with two of the three measures, 26 with all three. The short form demonstrated high reliability (alpha = .91; test-retest reliability = .90; split-half reliability = .89). PAQ totals, chronicity ratings, and use indices showed no significant differences across from administrations although the psychiatric patients scored significantly higher (more chronic) on all measures. The findings support a general chronicity construct and suggest many applications from the screening of potential employees to the development of specific treatment plans matched to particular PAQ patterns. The major message, however, is that public health, medical, psychological, and sociological constructs may be integrated into a comprehensive model of medical utilization patterns that provides views of illness, wellness, and health care delivery and assessment.

Meeting the health care needs of people with chronic conditions presents one of the greatest challenges for 21st century health care system renewal. Appropriate redesign of health care delivery with this complex patient population in mind requires information from many sources. Although much is known about the patient experience of chronic illness much less is understood about how patients navigate their health care delivery context. The purpose of this qualitative study was to examine the point of view of patients dealing with multi-morbidity. These people have a unique understanding of how health care delivery links across time, place, and settings because of the care they require for their multiple chronic conditions. An interpretive descriptive design was used to examine patient navigation from the perspective of 20 adult patients with chronic kidney disease, and co-existing diagnoses of diabetes mellitus and/or cardiovascular disease. The findings generated from iterative, constant comparative analysis add important patient perspectives about health care system navigation. From the consumer perspective health care navigation is challenging, requiring (a) ongoing discovery about the complex social structures that make up the health care system, and (b) learning how to strategically use this knowledge to manage the health care system. The findings highlight the disjunctures and misalignments in the health care delivery system, the cumulative health care-related burden of multiple chronic conditions for consumers, and consumer concerns about subtle inequities in the health care system. As health care renewal efforts gain momentum new knowledge from the perspective of consumers, such as that captured in this research, is important. The consumer perspective provides a valuable opportunity for stakeholders in health care policy- and decision-making to contextualize and make greater sense of the information used in making decisions about health care service delivery for vulnerable populations, like patients with multiple chronic conditions.

Meeting the health care needs of people with chronic conditions presents one of the greatest challenges for 21st century health care system renewal. Appropriate redesign of health care delivery with this complex patient population in mind requires information from many sources. Although much is known about the patient experience of chronic illness much less is understood about how patients navigate their health care delivery context. The purpose of this qualitative study was to examine the point of view of patients dealing with multi-morbidity. These people have a unique understanding of how health care delivery links across time, place, and settings because of the care they require for their multiple chronic conditions. An interpretive descriptive design was used to examine patient navigation from the perspective of 20 adult patients with chronic kidney disease, and co-existing diagnoses of diabetes mellitus and/or cardiovascular disease. The findings generated from iterative, constant comparative analysis add important patient perspectives about health care system navigation. From the consumer perspective health care navigation is challenging, requiring (a) ongoing discovery about the complex social structures that make up the health care system, and (b) learning how to strategically use this knowledge to manage the health care system. The findings highlight the disjunctures and misalignments in the health care delivery system, the cumulative health care-related burden of multiple chronic conditions for consumers, and consumer concerns about subtle inequities in the health care system. As health care renewal efforts gain momentum new knowledge from the perspective of consumers, such as that captured in this research, is important. The consumer perspective provides a valuable opportunity for stakeholders in health care policy- and decision-making to contextualize and make greater sense of the information used in making decisions about health care service delivery for vulnerable populations, like patients with multiple chronic conditions.

Thesis (Ph.D.)--University of Western Sydney, Nepean, 1997. / Includes bibliography.

Thesis (Ph.D.)--York University, 2006. Graduate Programme in Economics. / Typescript. Includes bibliographical references (leaves 141-151). Also available on the Internet. MODE OF ACCESS via web browser by entering the following URL: http://proquest.umi.com/pqdweb?index=0&did=1251858901&SrchMode=1&sid=2&Fmt=2&VInst=PROD&VType=PQD&RQT=309&VName=PQD&TS=1195140742&clientId=5220

Thesis (Ph. D., Education)--University of Idaho, April 25, 2006. / Major professor: Karen Wilson Scott. Includes bibliographical references (leaves 149-162). Also available online (PDF file) by subscription or by purchasing the individual file.

Thesis (M.H.S.A.)--University of Michigan, 1976.