<p>Primary care multi-disciplinary teams were central to recent reform plans for Canadian primary care, in response to limited resources and increasing demands. Health Information Technology was also an integral part of those plans as supporting infrastructure for the modernization of healthcare services, facilitating coordination, collaboration and access to services. As provider-centric Health Information Technology matures, attention turns to the patient. The hallmark of patient-centered applications is the electronic Personal Health Record System (PHR). These systems have grown beyond simple repositories of personal health information, extending to a range of information collection, sharing, self-management and exchange functions.</p> <p>The implementation of PHRs in primary care multi-disciplinary teams involves many stakeholders including patients, physician, allied health professionals and support staff. There is significant literature on physician and patient perspectives on all PHR functions. However, little attention has been given to the other stakeholders: allied health professionals and support staff.</p> <p>In this study, we explored the views of Allied Health Professionals (AHPs) and support staff, working in a primary care clinic adopting a patient-centered, multi-disciplinary model called the Family Health Team (FHT) model. Participants provided their insight on benefits, concerns and recommendations regarding the implementation of MyOSCAR, a PHR, at their clinic. Qualitative data was collected through semi-structured one-on-one interviews that were analyzed to extract common themes and summarize participant views. Process diagrams were produced to highlight opportunities for improvement of current work processes through the integration of MyOSCAR functions.</p> <p>As more teams are created in primary care and they attempt to implement new technologies, it is important to get a complete picture of all stakeholder views. This is the first study that focuses on the views of AHPs and support staff, contributing to the literature on PHR implementations. Findings from this study can contribute to future PHR implementations by informing planning and implementation.</p> / Master of Science (MSc)

<p>Early trials of Electronic Personal Health Records (ePHRs) show they provide two strong benefits: better healthcare outcomes and lower taxpayer costs. However, consumers are concerned about the possible loss or misuse of personal health data. For people to adopt ePHRs, they must trust both the system and the operating organization. The model presented here studies consumers’ likelihood of adopting ePHRs, combining trust, distrust, risk, motivation, and ease of use; as well as their perceptions of government, software vendors, and physicians as providers of ePHRs. Based on the Technology Acceptance Model, and incorporating elements of trust-distrust dualism and perceived risk, the model was tested empirically using survey data from 366 Canadian adults. The model explains 52 percent of the variance in the intention to use an ePHR, with strong negative effects from perceived risk and distrust, and strong positive effects from trust and perceived usefulness. Other findings include further evidence that trust and distrust are different constructs, not ends of a spectrum; that Canadians’ relationship with their healthcare system is complex; and that the risks in using an online system can be overcome by the perceived benefits. Open-ended responses show that people generally trust their doctors, but are sceptical that a doctor could provide a secure ePHR. Responses indicated that participants liked the consolidation of data and ease of access, but feared loss of privacy.</p> / Doctor of Philosophy (PhD)

This study is the first report of Saudi patients in the literature on electronic personal health records (ePHRs). It investigates patients’ attitudes and expectations regarding ePHRs in Saudi Arabia. It also gives insights about addressing the gap between the interest and the utilization of ePHRs by presenting information about patients’ preferences for ePHR features and activities. The findings show higher interest rates in ePHR use compared to other studies with similar sample frame in developed countries. They also indicate high levels of perceived usefulness of ePHRs on patients’ health and healthcare. More research is needed to explore the ePHR privacy concerns of patients and the key factors in improving the use of ePHRs among specific populations such as the elderly and those patients with chronic disease. / Thesis / Master of Science (MSc) / This study is the first report of Saudi patients in the literature on electronic personal health records (ePHRs). It investigates patients’ attitudes and expectations regarding ePHRs in Saudi Arabia. It also gives insights about addressing the gap between the interest and the utilization of ePHRs by presenting information about patients’ preferences for ePHR features and activities. More research is needed to explore the ePHR privacy concerns of patients and the key factors in improving the use of ePHRs among specific populations.

M. Tech. (Department of Process Control and Computer System, Faculty of Engineering and Technology), Vaal University of Technology. / Personal health record system (PHRS) is a tool that is used in maintaining the health and wellness of an individual as well as helping with illness of an individual. PHRS gives the individual access to a wide range of credible health information, data, and knowledge. Individuals can use that access to improve their health and manage their diseases. Patients with chronic illness can track and manage their health in conjunction with their health provider, this will promote early intervention when they encounter an abnormality or complications. Continuous monitoring and storing of health information has been a challenge for patients and health providers. Personal health data monitoring and retrieval system for health providers was designed and implemented. The main aim of this study was to develop an accurate, secure and flexible personal health data monitoring and retrieval system for health providers (PHRS). This was achieved. The research showed that when a patient health information (Electrocardiogram (ECG) and temperature) was monitored, the heartbeat (ECG) sensor output the value as an analog value to the signal processing (NodeMCU) which was then converted to a digital value. The temperature sensor used in this research is a digital sensor which lowers the amount of ADC conversion that was done. The digital values are displayed on LCD, its send to a personal health data storage system which was designed for health information storage purposes. It also sends the value to a retrieval system which is an android application that is connected to the data storage system to display health information to the health providers from a remote location. Personal health data storage and the retrieval system are secure due to the Message queuing telemetry transport (MQTT) protocol used in the application layer. The MQTT protocol is secure due to the secure socket layer (SSL) which is an encryption based on presentation layer embedded inside the MQTT protocol. After the comparison of the software simulation and the prototype test, the differences in the value for the heartbeat and temperature sensor indicate 0.04 BPM and 0.04 oC which shows the accuracy of the sensing circuit. Personal health data monitoring and retrieval system developed is applicable and useful to multiple entities in and around South Africa such as; Ministry of health, hospitals, sport and recreations.

No description available.

Background: The health determinant model indicates that certain sociocultural, sociodemographic, environmental, and lifestyle factors influence health status and wellbeing of any population group in any given nation (Dahlgren & Whitehead, 1991). Previous studies have suggested the need for regional and interregional comparison of health inequalities due to the interaction of these factors. However, few studies have undertaken such investigation, especially among university students in developing countries. The aim of this study was to investigate the health status and lifestyle behaviours by sex and ethnicity among university students in Nigeria. Method: The study was cross sectional. Full time university students were recruited from six universities within three ethnic groups in Nigeria for the study. Data collection was both subjective and objective. The subjective data was based on an anonymous questionnaire, while the objective data involved direct measurements of height in (m) weight in (kg), and blood pressure (mmHg). Ultimately, 1549 responses were valid, while 563 responses were rejected for various reasons including missing data especially sex and ethnicity. The variables examined were, socio-demographic, general health, mental health, cognitive resources and lifestyle behaviours. Descriptive tests, chi-square tests and analysis of variance (ANOVA) tests were conducted. Results: Regarding regional characteristics in socioeconomic status, the result indicated sex and ethnicity effects, and irrespective of ethnicity, female students had better monthly income than male students did. The result suggested that students from the Hausa ethnic group reported better monthly income than students from the other ethnic groups. There is evidence that income have a significant effect on health determinant factors. For example, income affects the choice of residential location, ability to pay for health care services, register for gym for physical activity, afford healthy lifestyles, (e.g. eating fruits and vegetables), participate in social activities and maintain positive self- esteem (WHO, 2006; Varela-Mato et al., 2012). With regard to social support, the result indicated sex*ethnicity effects, where female students from the Hausa and Igbo ethnic groups reported better social support than male students, in contrast to the Yoruba ethnic group, where male students reported better social support than females. Students from the Hausa ethnic group saw their GPs more often, had regular medications and had depression more than other ethnic groups. In addition, the result indicated higher prevalence of smoking and the use of psychotic drugs among students from the Hausa ethnic group than other groups. On the other hand, the Yoruba ethnic group had the lowest monthly income, saw their GPs few times and had less frequent medication than the other ethnic groups. In addition, students from the Yoruba ethnic group had low consumption of fruits and are more physically inactive compared to other ethnic groups. Regarding sex characteristics, the study suggested that irrespective of ethnicity female students are less healthy when compared to male students. In addition, significant sex *ethnic interaction effects (P < 0.001) were observed, in most variables examined in the study, indicating that the students health and lifestyles are both sex and ethnicity dependent. The study suggested that female students from the Hausa ethnic group reported better income and social support, compared to students from the other ethnic groups; however, they also reported regular medication, overweight or obesity, mental health problems, and poor cognitive health than female students from Igbo and Yoruba ethnic groups. In addition, the Hausa male students’ preferred smaller female body size compared to male students from the other ethnic groups. On the other hand, Igbo female students had a better cognitive health and preferred small female body size than female students from the other ethnic groups. The Yoruba female students are less overweight or obese, but had the highest preference for big female body size and are the least depressed group in the sample. With regard to male students, the result suggested that Igbo male students had regular medication and depression more than other male groups. They also preferred bigger female body size and had better cognitive health than other male groups. On the other hand, Yoruba males reported overweight or obese, than the other male groups. Conclusion: The findings indicated that the health of female students in the sample was poorer than the health of male students; with female students from the Hausa ethnic group, demonstrating the worst possible health outcome. The result also suggested that both high and low socioeconomic statuses are associated with health compromising behaviours among university students in Nigeria. The findings indicated that high cognitive health appraisal might be related to students reporting better mental health especially depression in both male and female students. This study is the first to report that there is an interaction between the different layers of health, in the health determinant model proposed by Dahlgren and Whitehead (1991). Secondly, this study has made a major contribution to the understanding that people who live among regions with conflict and violence may report poor health (both physical and mental) compared to those that live in a conflict free zones. Consequently, the results of the present study suggest that conflict and violence be included among the health determinant factors in the health determinant model proposed by Dahlgren and Whitehead (1991).

The circadian cycle, although seasonally adjusted, consists of two phases: a nocturnal period of darkness and a diurnal period of light. Many parameters of human physiology display either a nocturnal or diurnal peak as seen in athletic performance, immune, endocrine, physiology and cognitive function, respectively. The studies included in this thesis focused on the diurnal (morning or AM versus evening or PM) effect of high-intensity self-paced exercise on physiological and immunological measures and the influence of individual preference for activity or chronotype on these responses. Self-paced time-trials were completed in an environmental chamber (6°C) in the AM and PM and displayed a similar effect on physiological and biological parameters. Performance times were non-statistically quicker (P > 0.05) at PM. Physiological parameters heart rate, rate of perceived exertion, lung function and self-paced treadmill speed were not found to be statistically different at AM or PM trial (p > 0.05). Core body temperature (CBT), was significantly higher (p0.05). CD8+ T-lymphocyte cell-surface markers for naïve/senescence and differentiation (CD27CD45RA and CD27CD28) reported no diurnal difference between AM and PM exercise in experienced and experienced/recreational distance runners respectively (P > 0.05). However, a higher percentage of highly differentiated phenotypes were found in the recreationally active population. Neutrophils displayed a pronounced elevation in response to PM exercise with the mechanism driving this response unclear at this time. Cortisol concentration displayed less inflammatory responses in the morning compared to the evening with higher values pre, post and one-hour post AM trials. Chronotype showed no effect on physiology or biology at rest or in response to exercise. Chapter 4 presents data from a study that investigated diurnal physiology and immune response to high-intensity exercise in highly-trained men. Recreational and experienced endurance male runners at differing diurnal time-points were investigated in Chapter 5, while individual chronotype differences and circadian phase responses were explored in Chapter 6.In summary, it is concluded from this work that there was a lack of evidence showing a diurnal effect on running performance and subsequent immune response. Elevated circulating immune counts prior to exercise, irrespective of diurnal phase, appear to govern exercise-induced responses. The effect of high intensity exercise is subject to three distinct variables: the fitness status and experience of the individual completing the exercise, the time of day at which the exercise is undertaken, and the phase response of exercise at that point of the circadian cycle. No diurnal phase mediated a divergent effect on variables examined was observed at 09.00hrs and 17.00hrs. These time-points should be considered not sufficiently dissimilar to elucidate diurnal variation in trained and healthy males.

Researchers have linked physical activity (PA) with positive health outcomes. Unfortunately, PA in young people continues to be reported as a concern with many not achieving the recommended guidelines. Further, participation in childhood and adolescence is positively associated with PA into adulthood, highlighting the importance of PA habits in young people for lifelong participation. Gender, socio- economic status (SES), and motivation have all been shown to be important factors that influence participation, and as such are a focus of this thesis. Mixed methods research was adopted to ‘investigate the nature of PA in young people within a Scottish context' including quantitative (study one) and qualitative (studies two and three) methodologies. The initial motivation for study one emerged through my personal interest in understanding the nature of young people's participation in structured club activities and the role SES, gender and motivation play in a Scottish context. Sport is often used as a proxy for PA and as such, young people's participation is frequently reported on sports club based activities. On reflection, this focus on ‘weekly club activity sessions,' rather than a more broad, valid, and reliable measure of PA, limited the application of the findings. Nevertheless, the findings and reflection on the methods used in study one informed the direction of the thesis moving forward. More specifically, SES was found to be the strongest predictor of club activity participation, with those from higher SES taking part in more club activity sessions than those from lower SES. No significant gender differences in participation were found. While SES was the sole predictor of school club activities, perceived competence and intrinsic motivation were also important predictors of participation in out-of-school club activities. The regression models predicted between 5% and 27% of the variance in club participation, highlighting the multi-factorial nature of the influencers of participation. In order to understand the nature of PA more broadly in young people from lower SES within a Scottish context and to investigate the complexity of participation influencers, a qualitative methodology was used. Study two investigated low SES Scottish youths' PA experiences across key development stages (i.e., childhood, adolescence and newly identified early adulthood, study two). Results suggested that young people from low SES participate in a high variety of unstructured PA throughout their lives, which is under reported in the literature. Participation in structured sport based activities in childhood, particularly those in which a young person forms a sport ‘identity,' influences future adherence, but also engagement and enjoyment of school physical education (PE). For many young people, particularly those from less affluent backgrounds, school PE may be the only opportunity for them to participate in structured PA. While some young people embraced school PE, others perceived PE a threatening, so leading them to avoid or drop out altogether. Findings showed that in addition to previous experience, the nature of the PE climate also influenced participation as young people entered early adulthood. As well as shedding light on the broad nature of young people's PA from low SES backgrounds, the findings from study two highlighted the role that schools (e.g., through PE) have in influencing young people's PA and associated attitudes. Study three aimed to investigate young people's PA, motivational influences, and the role of schools from the perspective of qualified Scottish PE teachers, knowledgeable on policy issues and active in the development of future teachers. The main findings from study three showed that family influences (mostly parents) and SES were key towards the formation of young people's attitudes and behaviours towards PA, particularly in sports. Those young people with parents not showing any interest in PA were more likely to be inactive compared to those youngsters with active parents. Young people from lower SES backgrounds were less likely to participate in sports activities, thus preventing them from gaining the necessary experiences (and competencies) needed to successfully take part in many school PE activities. Also, this study found that secondary school PE is perceived by many pupils as threatening which subsequently led many to avoid PE altogether. Many young people are not achieving the curriculum expected health and well-being benefits through school PE. The results also highlighted the huge challenge and role conflict that is apparent for PE teachers in schools, which is a barrier to effective promotion of PA and positive attitudes in a range of young people. This thesis supports the contention that SES is an important factor in young people's PA. While those from lower SES were shown to participate in less structured sport club activity than those from higher SES, evidence emerged suggesting that young people from lower SES participate in a variety of unstructured PA which is underreported in the literature. The complexities of PA participation were also apparent where previous experience, parents and school PE were found to have important roles, which either facilitated or debilitated motivation, and participation. This thesis also highlighted that there are serious challenges in delivering an effective PE experience to pupils with a wide range of ability and backgrounds. These challenges were exacerbated by the vagueness of policy guidance (e.g., within Scotland's curriculum for excellence), the pressures of certification, and the mostly sport dominated culture of PE. Implications for policy and practice in relation to the motivational climate of PEemerged. Recommendations for future research and practice in this area are discussed.

The purpose of this research study was to describe course content on unintentional injuries in undergraduate personal health and wellness courses at four year public and private colleges and universities identified by the Eta Sigma Gamma directory in the United States. An instrument was created, validated and tested for reliability, and used to assess course content areas related to unintentional injuries in undergraduate personal health and wellness courses. The sample for the study included 106 participants (N=106) from public and private colleges and universities in 36 states. Chi-square analysis, ANOVA, factor analysis, and MANOVA tests were used to determine if significant differences existed in course content areas based on selected demographic characteristics. Results indicated that college and university faculty members report teaching about unintentional injuries. Findings indicated that significant differences do exist in unintentional injury course content areas. The top five content areas identified by faculty members include water-related injuries, firearm safety, motorcycle injuries, motor vehicle passenger safety, and motor vehicle impaired driving. Factor analysis results revealed that unintentional injury course content areas can be categorized into three groups: personal content, motor vehicle content, and injury content. The level of statistical significance was set at 0.05.

Despite rapid advances in technology, there is currently a complex, and somewhat disjointed approach to the way health information is collected, stored, and organized for both healthcare consumers and professionals. Incompatible electronic medical records from various healthcare providers add to the complexity of a system tasked with delivering a patient’s relevant medical information in a timely manner to the appropriate point of care. Personal health records (PHR) grew out of the efforts to produce an integrated electronic record to manage the multifaceted aspects of healthcare required by both healthcare consumers and professionals. PHRs are a transformative technology with the potential to alter patient-provider relationships in a way that produces a more efficient and cost effective healthcare system as a result of better patient outcomes. PHRs can potentially include a wide variety of users ranging from the lay public to clinical professionals. As such, it is important to identify potential user groups and their corresponding health information needs in order to design PHRs that maximize accessibility, usability, and clinical relevance. This study focused on laypeople who represented a wide age-range of individuals, evenly split in gender, with an above average level of computer literacy. Most of the participants had not used an electronic PHR prior to this study. However, after a hands-on session with PHR software, most participants found it to be easy to use, accompanied with the functionality they expected from such a system. Most participants were satisfied that an electronic PHR would meet their health information needs and would recommend the use of PHRs to family and friends. Anyone in the general public is a potential PHR user. However, this study found that individuals with chronic conditions and those with complex health needs had the most to gain from using a PHR as an integral part of their healthcare routine. This study also demonstrated that an individual’s health condition has a stronger influence on their perceptions about the usefulness of PHRs than does their demographic background (age, education, computer literacy). Finally, this study established that PHRs are considered by participants of the study to be useful tools in meeting their health information needs. / Graduate / 0723 / 0769 / 0984 / dguarin@uvic.ca