Manitoba Parent-Child Coalitions are tasked with identifying community support needs and priorities for parents with young children and developing a sustainable plan for addressing needs. The methods used to establish community needs and priorities vary considerably. Use of a systematic participatory needs assessment (NA) process such as the Concerns Report Method (CRM) could provide communities with important information about parents’ community support needs while involving parents in the decision-making process. The CRM uses a mixed methods exploratory sequential research design. Phase 1 of the CRM involved the use of several qualitative methods: a document review, interviews and focus groups with parents (N=29) and service providers (N=11). Phase 1 results were used to develop a Community Concerns Report Survey for parents (N=319) and service providers (N=47) used in Phase 2. Logistic regression helped to determine the family characteristics that were associated with parent perceived community support needs. Existing community data revealed important socioeconomic differences across neighbourhoods, but the Early Development Instrument showed that kindergarten children from all socioeconomic backgrounds were not ready for school. Four themes emerged from the interviews and focus groups: 1) Availability of/ access to community supports, 2) Barriers and facilitators to participation, 3) Parent and child transition periods, and 4) Making connections with parents/ service providers. The survey results extended our understanding of these issues and showed that parents and service providers prioritized community support needs differently but also had shared areas of concern. Finally, very few of the family characteristics were associated with parent perceived needs. Despite only examining the first two phases of the CRM, this study adds to the body of literature on use of the CRM in the context of identifying the community support needs of parents with young children. The NA process highlighted the strengths and limitations of the different methods used and the CRM as a methodology in determining community support needs. As well, the challenges associated with reconciling the different findings were discussed. Coalitions seeking to engage different stakeholders in a NA process should consider using the CRM to identify community support needs and priorities. / October 2014

Many individuals, especially those in rural areas, experience barriers to accessing medical care. Some barriers are attitudinal and represent perceived quality of care, such as patient satisfaction; however, some rural residents report elevated patient satisfaction scores, regardless of limited access to these services. Identifying how perceived need for medical care is related to patient satisfaction has not been previously explored. Using an online survey to collect data from a national sample (n=535), the current study used the Patient Satisfaction Questionnaire-Short Form (PSQ-18) and a single-item measure of perceived need to examine the association between these two variables, and further, whether rural status, measured by a single-item measure, moderated this association. Results indicated a significant negative correlation between patient satisfaction and perceived need, r(423)=-.12, p=.012. Although the overall moderation model was significant, F(5, 388)=7.10, p<.001, perceived need was not significantly associated with patient satisfaction, b=-.14, p=.20, and rurality status did not significantly moderate the relationship, F(1, 388)=.44, p=.51, ��R2=0.01. However, the covariates of income, b=.11, p<.001, and sexual orientation, b=.23, p=.01, significantly predicted patient satisfaction. This study identified an association between patient satisfaction with perceived need for medical care that has not been previously explored, although this relationship was no longer significant in a larger model, indicating other important factors likely influence this relationship and contribute to the elevated satisfaction scores identified in some rural areas. The lack of moderation by rurality may be due to consistently high barriers to accessing care across all regions of the United States; while rural areas certainly experience unique barriers to care, the barriers present in urban environments may be significant enough that level of rurality in itself does not significantly affect the relationship between perceived need and patient satisfaction. Furthermore, this study highlights the importance of social determinants of health in patients’ perceptions of quality of care. Sexual orientation and income emerged as significant predictors of patient satisfaction, in that higher satisfaction was associated with those who identified as heterosexual and had higher income, consistent with previous literature. Further investigation is necessary to determine the reasons why these relationships exist; however, it is important to acknowledge that individuals with low-income and who identify as sexual minorities experience stigma and discrimination in healthcare settings. These negative experiences with healthcare likely influence perceptions and health disparities that exist within these individuals and may directly impact patient satisfaction levels, which may be influential to these findings.

Non-medical drug use in rural communities in the United States is a significant and growing public health threat. Understanding what motivates drug users in rural areas to seek substance abuse treatment may help in addressing the problem. Perceived need for treatment, a construct indicative of problem recognition and belief in problem solution, has been identified as an important predictor of help-seeking behavior. This cross-sectional study used data collected through face-to-face interviews to examine factors associated with perceived need for drug abuse treatment among not-in-treatment, adult, illicit stimulant drug users (n = 710) in rural areas of Ohio, Kentucky, and Arkansas. More than one-quarter of the sample perceived a need for treatment. Results from a stepwise multiple regression analysis showed that white users, users with better physical and mental health status, and occasional users of methamphetamine were significantly less likely to see a need for treatment. Users with higher Addiction Severity Index composite scores for family/social problems or legal problems, and users with prior drug abuse treatment experience were significantly more likely to perceive a need for treatment. These findings have practical implications for efforts addressing substance abuse in rural areas.

During the last three decades there has been an increased influx of refugees and immigrants into Scandinavia. The overall aim of this thesis was primarily to improve our knowledge of malocclusion and orthodontic treatment need, both normative and self-perceived, in adolescents of varying geographic origin. A further aim was to determine whether any differences with respect to perception of general appearance and psychosocial well-being were related to geographic origin. Papers I and II concerned self perceived and normative orthodontic treatment need. About 500 12-13 year-old subjects, stratified into different groups: A-Sweden, B-Eastern/Southeastern Europe, C-Asia and D-other countries, answered a questionnaire and underwent clinical examination by the author. In paper III the association between the two variables in papers I and II was investigated. Paper IV was a follow up study, at 18-19 years of age, of the relationship between geographic origin and prevalence of malocclusion, self-perceived treatment need, temporomandibular symptoms and psychosocial wellbeing. In Paper V a qualitative study of 19-20 year old subjects was conducted, to identify the strategies they had adopted to handle the issue of persisting poor dental aesthetics. The main findings were that at 12-13 years of age, immigrant subjects had a lower perceived orthodontic treatment need than subjects of Swedish background. Girls of Swedish background had the highest self perceived treatment need, whilst girls of non-Swedish background were most concerned that fixed appliance therapy would be painful. In a few of the clinical variables measured at 12-13 years of age, the Swedish group exhibited the greatest space deficiency and irregularity in both the maxillary and mandibular anterior segments and greater overjet, compared to the Eastern/Southeastern European and Asian groups. The clinical implications were negligible. The orthodontic treatment need according to “Index of Orthodontic Treatment Need - Dental HealthComponent” (IOTN-DHC) grades 4 and 5, ranged from 30 to 40 percent, without any inter-group differences. There were strong associations between subjects perceiving a need for orthodontic treatment and 6IOTN-DHC grades 4 and 5, anterior crossbite and avoiding smiling because they were self-conscious about their teeth. At the age of 18-19 years, the frequency of malocclusion was similar in all groups. Subjects of Asian origin had a higher self-perceived orthodontic treatment need than their Swedish counterparts and a higher frequency of headache than those of Eastern/Southeastern European origin. Psychological wellbeing was reduced in nearly one quarter of the sample, more frequently in girls than boys. No association was found between self-perceived orthodontic treatment need and psychological wellbeing. The theory “Being under the pressure of social norms” was generated in Paper V, and it can be applied to improve our understanding of young adults who have adjusted to living with poor dental aesthetics and also aid to identify those who are not as well-adjusted and would probably benefit from treatment. Undisclosed dental fear is an important barrier to acceptance of orthodontic treatment in early adolescence. Despite demographic changes due to immigration, no major change in the prevalence of malocclusion and normative orthodontic treatment need has been disclosed. This does not apply to adolescents and adults who immigrated at an older age.

abstract: Past literature has indicated that the majority of people with alcohol problems never seek treatment and that this is especially true of women. Relatively few studies have investigated how different types of alcohol-related consequences longitudinally predict men and women's perceived need for treatment and their utilization of treatment services. The current study sought to expand the literature by examining whether gender moderates the links between four frequently endorsed types of consequences and perceived need for or actual utilization of treatment. Two-hundred thirty-seven adults ages 21-36 completed a battery of questionnaires at two time points five years apart. Results indicated that there were four broad types of consequences endorsed by both men and women. Multiple-group models and Wald chi square tests indicated that there were no significant relationships between consequences and treatment outcomes. No gender moderation was found but post-hoc power analyses indicated that the study was underpowered to detect moderation. Researchers need to continue to study factors that predict utilization of alcohol treatment services and the process of recovery so that treatment providers can better address the needs of people with alcohol-related consequences in the areas of referral procedures, clinical assessment, and treatment service provision and planning. / Dissertation/Thesis / Ph.D. Psychology 2013

Many individuals experience barriers to accessing medical care, especially in rural areas. Some barriers are attitudinal and represent perceptions of quality care. Patient satisfaction and perceived need for medical care are two such attitudinal barriers related to health care utilization, yet the relationship between these variables has not been explored. Using data from an online survey, the current study examined the association between these variables, and further, whether rurality status moderated this association. Results indicated a significant correlation between patient satisfaction and perception of need. Although the overall moderation model was significant, perception of need was not significantly associated with patient satisfaction, and rurality status did not significantly moderate the relationship. However, the covariates of sexual orientation and income did significantly predict patient satisfaction. This study highlights the complex associations of patient satisfaction, as well as the importance of social determinants of health in patients’ perceptions of quality of care.

Magister Chirurgiae Dentium (MChD) / Objectives: Previous studies have indicated that most of the older adult population has poor oral health but only a few of them demand care for their problems. The reason for this discrepancy has never been explained adequately. The obj ectives of the study were, first, to assess the perceived oral health needs (with regards to social, functional and psychological impacts of oral diseases) of older adults aged 55 years and above, second, to assess the oral health status (periodontal disease, dental caries and oral mucosal lesions ) in an adult population aged 55 years and above.Third, compare the relationship between normative and perceived need. Methods: This was a quantitative cross-sectional, descriptive study and consisted of 100 older adults who were randomly selected from three areas in Guguletu. These areas included the home for the aged Ekumphumleni, NYl and NY2 clinics. Participants aged 55 years and above were interviewed using a structured questionnaire consisting of 32 questions and a clinical examination done. Frequency tables were computed and analysed. The relationship between variables like oral health status, perceived need and a variety of socio-demographic variables and measures of psycho-social impact of oral diseases were analysed by using the chi square test and odds ratio. Results: The ability to perceive that they had a problem and the recency of the last visit to the dentist was associated with perceived need for dental care. There was a significant relationship between the presence of symptoms which were painful and perceived need for dental care (mouth, p value=0.015; gums, pvalue=O.OOl; teeth, p value=0.0006) The positive attitude towards dental care and regular dental hygiene was an indicator of positive attitudes towards oral health care. In this study a substantial difference between perceived and normative need was also observed. 88% of the respondents perceived a need for dental care and 99% were assessed as needing treatment (normative need) but only 29% demanded the care. 63% were dissatisfied with their functional ability to chew and expressed a need for dentures. Conclusion: The aim of this study was to assess the oral health status and perceived oral health needs among older adults in Guguletu. The oral health status was poor in most of the participants and the demand for care was low even though perceived need was high. The study has shown that social, functional and psychological factors influence the demand for care in this adult population. The cost for dental care and access to these services are major barriers to the demand of care.Perceived oral health needs and the impact of oral diseases are important influences in the assessment of oral health needs in the elderly. The assessment of oral health needs as perceived by the elderly facilitates the planning and implementation of dental services with special consideration on the cost and accessibility of oral health care.

Magister Chirurgiae Dentium (MChD) / AIMS AND OBJECTIVES: Most children presenting to dental clinics have pain of varying intensity that usually, has been endured for long periods of time. A study done at Cardiff in the United Kingdom, found that only 15% of children that had dental pain visited the dentist. Therefore, understanding the motivations of patients in seeking health care is vital to the quality of life in the family and community and to the success of any oral health planning process. This study explored factors influencing the time between the initial pain experience and definitive dental treatment, that is, the time lapse. It assessed how factors such as pain, individual and community characteristics affect the timing of dental visits. METHOD: Parents or guardians accompanying children visiting two community dental clinics in Guguletu and Mitchells Plain in the Western Cape were asked to indicate how factors such as severity and duration of pain, efficacy of self-treatment, and impact on parents affected the decision to seek treatment. A total of one hundred and twenty six parents were interviewed using a structured questionnaire. The English questionnaire was translated into Xhosa and Afrikaans and used with the help of interpreters when necessary. Children attending these community dental clinics for treatment on a particular morning were included in the study sample. Children up to thirteen years of age (primary, mixed, and early permanent dentition) comprised the study sample. Only children that had a dental problem were included in the study. Children that were not accompanied by a parent or guardian were excluded. RESULTS: Close to half the children (43 - 45%) had never been to the dentist before. Parents from Mitchells Plain knew earlier of their children's dental problems (most knew14 days before visit) than those from Guguletu where most knew within the last 7 days. However, Guguletu children were presented to the dentist sooner after the painful experience (69.2% within 7 days) than Mitchells Plain where only 48.3% were presented within the same period. It was found that for these communities, the distance from the clinic, the mode of transport, and the fares charged greatly influenced dental attendance. Most families lived within 3km, and walked (more prevalent in Guguletu) or rode a taxi (more prevalent in Mitchells Plain). With taxi the most prevalent mode of transport, money was an important factor of dental attendance. Long queues at the clinic and waiting long for appointments, were cited by parents as the major hindrances to attendance. While a worsening of pain, loss of sleep and sensitivity to chewing hastened dental attendance, parental work commitment and the child's school delayed it. Most families (79%) tried some treatment at home prior to the dental visit. The remedies offered such as Disprin®, direct placement of crushed Disprin® and Panado® were a concern because they were potentially harmful. Both communities were in the low socio-economic class with Guguletu consistently the poorer of the two. They both had disrupted family life as reflected by the low rates of married parents. CONCLUSION: In the presence of pain Guguletu children were presented to the dentist sooner than those of Mitchells Plain. Accessibility of the clinics was a real concern especially in Guguletu. There was rampant inappropriate use of medications such as aspirin and antibiotics. The greatest impact of the child's pain on the parents was on affected sleep. The non-regular attendance pattern of the children closely followed that of the parents.