A reading of recent studies in preventative health care behavior recalls the proverb about the blind men and the elephant: each man is able to describe the part of the animal he is closest to, but none can see, and so none can put their diverse and often contradictory opinions together to come up with an accurate description of the whole elephant. Similarly, in preventative health care studies, each researcher or research group is able to observe the preventative health care utilization patterns of specific populations at particular times, but the conclusions reached are often based on less than complete knowledge. This is especially true of the research into what makes low income people use preventative services in certain ways.

Dissertation submitted in partial compliance with the requirements for the Master's Degree of Technology: Nursing, Technikon Natal, 2002. / The Integrated Management of Childhood Illness (IMCI) is an approach that aims to reduce the mortality and morbidity in children under the age of five years. When this programme was initiated, the conditions targeted were acute respiratory infections, diarrhoea, fevers associated with malaria and measles and malnutrition. As a result of the HIV pandemic in South Africa, the identification of children who are symptomatic of HIV infection was included. This study evaluates the use of the HIV portion of the IMCI algorithm by nurses in selected, public sector, primary health clinics in KwaZulu Natal. IMCI nurses were observed as they used the IMCI approach while consulting with sick children. Data was collected in relation to the accuracy with which the nurses used the algorithm and the extent to which the HIV portion of the algorithm was used to guide their management decisions when consulting with the children. Seventy-two observations were undertaken. In-depth interview were conducted with 13 IMCI nurses to establish factors that influenced the use of the HIV portion of the algorithm. The study showed a poor level of accuracy when using the HIV portion of the algorithm. In addition, as a result of poor accuracy when using the algorithm to assess and classify for symptomatic HIV infection, it appeared that nurses were not using the HIV portion of the algorithm to guide management decisions regarding children who were possibly symptomatic of HIV infection. I A general poor level of knowledge about HIV infection was identified which the researcher felt could be one of the factors influencing the use of the HIV portion of the algorithm. Death anxiety, low level of counselling skills and burnout also seemed to play some role in the use of the HIV portion of the algorithm.Recommendations were made to adapt future training of IMCI nurses and include an HIV training course and a course on growth monitoring of children in this age group. Further recommendations to continually evaluate the practice of nurses were made. Future areas for research were suggested. / M

The purpose of this study was to discover the meaning of school body mass index (BMI) screening and referral to parents. The goal of school BMI screening and referral is to provide information to compel parents to change their child's diet and activity levels when overweight and obesity are identified. Measuring BMI in schools and alerting parents to findings above what is considered normal is one intervention to reduce overweight and obesity that has been utilized since 2001 in Florida. To determine the meaning of BMI screening and referral to parents a mixed methods approach was utilized. Voluntary interviews of 20 parents who had received BMI referrals for their children were conducted. Analysis of the interviews was guided by phenomenology, as delineated by van Manen (1997). A cross sectional survey developed by Ruggieri (2012), was distributed to measure parent beliefs and opinions regarding the BMI screening and their re action to referrals. Findings from interviews indicated that parents ascribe different meaning to school BMI screening and referral. Overarching themes of changing and reflecting were discovered. The themes were manifested as dichotomies; some parents reflected on their role as parent and were more satisfied with the process; they reported change of diet and activity for their families upon receipt of a BMI referral. Others reflected on the role of the school in their child's life. They were more dissatisfied with the school screening and recommended changes in the screening and referral process. Suggested changes for school screening and referrals included subthemes: sensitivity, accuracy, privacy, and notification. Parents responded in the survey that they would change diet and activity for their families if they were told by the school that their child had a weight issue. Actions taken upon receipt of a BMI referral were not limited to changing diet and activity levels but also included discussing weight with their child and others. Parents denied they would be offended by a BMI referral. School BMI screening and referral is a valuable and effective intervention to address child overweight and obesity, especially if the process is accomplished with characteristics that parents deem caring. / Includes bibliography. / Dissertation (Ph.D.)--Florida Atlantic University, 2015. / FAU Electronic Theses and Dissertations Collection

published_or_final_version / abstract / toc / Nursing Studies / Master / Master of Nursing in Advanced Practice

Thesis (MScEng)--Stellenbosch University, 2013. / ENGLISH ABSTRACT: Predictive analytics in healthcare has become one of the major focus areas in healthcare delivery worldwide. Due to the massive amount of healthcare data being captured, healthcare providers and health insurers are investing in predictive analytics and its enabling technologies to provide valuable insight into a large variety of healthcare outcomes. One of the latest developments in the field of healthcare predictive modelling (PM) was the launch of the Heritage Health Prize; a competition that challenges individuals from across the world to develop a predictive model that successfully identifies the patients at risk of admission to hospital from a given patient population. The patient-admission predictive algorithm (PAPA) is aimed at reducing the number of unnecessary hospitalisations that needlessly constrain healthcare service delivery worldwide. The aim of the research presented is to determine the feasibility and value of applying PAPAs in the South African healthcare system as part of a preventive care intervention strategy. A preventive care intervention strategy is a term used to describe an out-patient hospital service, aimed at providing preventive care in an effort to avoid unnecessary hospitalisations from occurring. The thesis utilises quantitative and qualitative techniques. This included a review of the current and historic PM applications in healthcare to determine the major expected shortfalls and barriers to implementation of PAPAs, as well as the institutional and operational requirements of these predictive algorithms. The literature study is concluded with a review of the current state of affairs in the South African healthcare system to, firstly, articulate the need for PAPAs and, secondly, to determine whether the public and private sectors provide a suitable platform for implementation (evaluated based on the operational and institutional requirements of PAPAs). Furthermore, a methodology to measure and analyse the potential value-add of a PAPA care intervention strategy was designed and developed. The methodology required a survey of the industry leaders in the private healthcare sector of South Africa to identify, firstly, the current performance foci and, secondly, the factors that compromise the performance of these organisations to deliver high quality, resource-effective care. A quantitative model was developed and applied to an industry leader in the private healthcare sector of South Africa, in order to gauge the resultant impact of a PAPA care intervention strategy on healthcare provider performance. Lastly, in an effort to ensure the seamless implementation and operation of PAPAs, an implementation framework was developed to address the strategic, tactical, and operational challenges of applying predictive analytics and preventive care strategies similar to PAPAs. The research found that the application of PAPAs in the public healthcare sector of South Africa is infeasible. The private healthcare sector, however, was considered a suitable platform to implement PAPAs, as this sector satisfies the institutional and operational requirements of PAPAs. The value-add model found that a PAPA intervention strategy will add significant value to the performance of healthcare providers in the private healthcare sector of South Africa. Noteworthy improvements are expected in the ability of healthcare provider’s to coordinate patient care, patient-practitioner relationships, inventory service levels, and staffing level efficiency and effectiveness. A slight decrease in the financial operating margin, however, was documented. The value-add methodology and implementation support framework provides a suitable platform for future researchers to explore the collaboration of preventive care and PM in an effort to improve healthcare resource management in hospitals. In conclusion, patient-admission predictive algorithms provide improved evidence-based decision making for preventive care intervention strategies. An efficient and effective preventive care intervention strategy improves healthcare provider performance and, therefore, adds significant value to these organisations. With the proper planning and implementation support, the application of PAPA care intervention strategies will change the way healthcare is delivered worldwide. / AFRIKAANSE OPSOMMING: Vooruitskattingsanalises in gesondheidsorg het ontwikkel in een van die mees belangrike fokusareas in die lewering van kwaliteit gesondheidsorg in ontwikkelde lande. Gesondheidsorgverskaffers en lewensversekeraars belê in vooruitskattingsanalise en ooreenstemmende tegnologieë om groot hoeveelhede gesondheidsorg pasiënt-data vas te lê, wat waardevolle insigte bied ten opsigte van ʼn groot verskeidenheid van gesondheidsorg-uitkomstes. Een van die nuutste ontwikkelinge in die veld van gesondheidsorg vooruitskattingsanalises, was die bekendstelling van die “Heritage Health Prize”, 'n kompetisie wat individue regoor die wêreld uitdaag om 'n vooruitskattingsalgoritme te ontwikkel wat pasiënte identifiseer wat hoogs waarskynlik gehospitaliseer gaan word in die volgende jaar en as bron-intensief beskou word as gevolg van die beraamde tyd wat hierdie individue in die hospitaal sal deurbring. Die pasiënt-toelating vooruitskattingsalgoritme (PTVA) het ten doel om onnodige hospitaliserings te identifiseer en te voorkom tem einde verbeterde hulpbronbestuur in gesondheidsorg wêreldwyd te bewerkstellig. Die doel van die hierdie projek is om die uitvoerbaarheid en waarde van die toepassing van PTVAs, as 'n voorkomende sorg intervensiestrategie, in die Suid-Afrikaanse gesondheidsorgstelsel te bepaal. 'n Voorkomende sorg intervensiestrategie poog om onnodige hospitaliserings te verhoed deur die nodige sorgmaatreëls te verskaf aan hoë-riskio pasiënte, sonder om hierdie individue noodwendig te hospitaliseer. Die tesis maak gebruik van kwantitatiewe en kwalitatiewe tegnieke. Dit sluit in 'n hersiening van die huidige en historiese vooruitskattings modelle in die gesondheidsorgsektor om die verwagte struikelblokke in die implementering van PTVAs te identifiseer, asook die institusionele en operasionele vereistes van hierdie vooruitskattingsalgoritmes te bepaal. Die literatuurstudie word afgesluit met 'n oorsig van die huidige stand van sake in die Suid-Afrikaanse gesondheidsorgstelsel om, eerstens, die behoefte vir PTVAs te identifiseer en, tweedens, om te bepaal of die openbare en private sektore 'n geskikte platform vir implementering bied (gebaseer op die operasionele en institusionele vereistes van PTVAs). Verder word 'n metodologie ontwerp en ontwikkel om die potensiële waarde-toevoeging van 'n PTVA sorg intervensiestrategie te bepaal. Die metode vereis 'n steekproef van die industrieleiers in die private gesondheidsorgsektor van Suid-Afrika om die volgende te identifiseer: die huidige hoë-prioriteit sleutel prestasie aanwysers (SPAs), en die faktore wat die prestasie van hierdie organisasies komprimeer om hoë gehalte, hulpbron-effektiewe sorg te lewer. 'n Kwantitatiewe model is ontwikkel en toegepas op een industrieleier in die private Stellenbosch gesondheidsorgsektor van Suid-Afrika, om die gevolglike impak van 'n PTVA sorg intervensiestrategie op prestasieverbetering te meet. Ten slotte, in 'n poging om te verseker dat die implementering en werking van PTVAs glad verloop, is 'n implementeringsraamwerk ontwikkel om die strategiese, taktiese en operasionele uitdagings aan te spreek in die toepassing van vooruitskattings analises en voorkomende sorg strategieë soortgelyk aan PTVAs. Die navorsing het bevind dat die toepassing van PTVAS in die openbare gesondheidsorgsektor van Suid-Afrika nie lewensvatbaar is nie. Die private gesondheidsorgsektor word egter beskou as 'n geskikte platform om PTVAs te implementeer, weens die bevrediging van die institusionele en operasionele vereistes van PTVAs. Die waarde-toevoegings model het bevind dat 'n PTVA intervensiestrategie beduidende waarde kan toevoeg tot die prestasieverbetering van gesondheidsorgverskaffers in die private gesondheidsorgsektor van Suid-Afrika. Die grootste verbetering word in die volgende SPAs verwag; sorg koördinasie, dokter-pasiënt verhoudings, voorraad diensvlakke, en personeel doeltreffendheid en effektiwiteit. 'n Effense afname in die finansiële bedryfsmarge word egter gedokumenteer. 'n Implementering-ondersteuningsraamwerk is ontwikkel in 'n poging om die sleutel strategiese, taktiese en operasionele faktore in die implementering en uitvoering van 'n PTVA sorg intervensiestrategie uit te lig. Die waarde-toevoegings metodologie en implementering ondersteuning raamwerk bied 'n geskikte platform vir toekomstige navorsers om die rol van vooruitskattings modelle in voorkomende sorg te ondersoek, in 'n poging om hulpbronbestuur in hospitale te verbeter. Ten slotte, PTVAs verbeter bewysgebaseerde besluitneming vir voorkomende sorg intervensiestrategieë. 'n Doeltreffende en effektiewe voorkomende sorg intervensiestrategie voeg aansienlike waarde tot die algehele prestasieverbetering van gesondheidsorgverskaffers. Met behoorlike beplanning en ondersteuning met implementering, sal PTVA sorg intervensiestrategieë die manier waarop gesondheidsorg gelewer word, wêreldwyd verander.

This dissertation consists of three empirical essays investigating different aspects of health care for children and families. The first essay examines the effectiveness of adherence to American Academy of Pediatrics guidelines for preventive pediatric health care. Using a national longitudinal sample of children age two years and younger, we investigate whether compliance with prescribed periodic well-child care visits has beneficial effects on child health. We find that increased compliance improves child health. In particular, higher compliance lowers future risks of fair or poor health, of some history of a serious illness and of having a health limitation. The second essay examines child health care utilization in relation to maternal labor supply. We test the hypothesis that working-mothers trade off the advantages of greater income against the disadvantages of less time for other valuable tasks, such as seeking health care for their children. This tradeoff may result in positive, negative, or no net impacts on child health investment. We estimate health care demand regressions that include separate variables for mother’s labor supply and her labor income. Our results indicate that higher maternal work hours reduce child health care visits; higher maternal earnings increase them. In addition, wage-employment, as opposed to self-employment, is detrimental to child health investment. A further finding is that preventive care demand for younger children is less sensitive to maternal time and income changes. We also find that detrimental time effects dominate beneficial income effects. The third essay studies intra-household resource allocation as it pertains to its demand for preventive medical care. We test the income-pooling hypothesis of the common preference model by using individual specific medical care consumption data and present evidence on the allocation of household resources to the medical needs of the child, husband and wife. Our results are in line with the findings of previous studies that emphasize the ongoing importance of the traditional gender role of woman as the primary caregiver. We find that the resources of the wife have a greater positive impact on child’s and her own preventive care demand than does the resources of the husband. In contrast to most studies from developing countries, we find that US families do not exhibit differential health care demand based on child gender. It is also noteworthy that the wife’s education level has a greater positive impact than that of her husband does on both the husband’s and her own preventive care utilization. / text

The purpose of the study is to identify what types of pregnancy interventions in which adolescent females in San Bernardino have participated.

Submitted in fulfillment of the requirements for the degree of Master of Technology, Information Technology, Durban University of Technology, Durban, South Africa, 2013. / This study reports on the application of decision making core technology adoption theory to empirically examine youth preferences for Human Immunodeficiency Virus (HIV) preventive actions. In order to contribute to the open discourse on whether technology adoption rate is higher for male or female, goal desire, goal intention, action desire and action intention elements of decision making core theory were tested. A mobile health information system was implemented as an HIV information disseminating tool and used for experimentation to determine adoption by youths. A dataset of 118 pupils from two high schools was used for pilot investigation. A dataset of 292 undergraduate youths aged 10-24 years from two universities in South Africa was generated to validate the research model. The Partial Least Square (PLS) analytic modelling technique was used to determine the predictive power of decision making core model from the input dataset. Results of experimentation show that regardless of the gender youth accepts to use mobile information system to access HIV information. The predictive power of the decision making core model was found to be independent of gender factor, which was also not found to moderate the relationship between Perceived Behavioural Control (PBC) and action intention. In addition, gender was not found to moderate the order of importance in factors that predict youth preferences for HIV preventive action. PBC, action desire and goal desire were selected as the most important predictors of HIV preventive actions. The factor of action desire was found to mediate the relationship between PBC and action intention such that the mediation effect was stronger for male youth (68%) than for female youth (19%). Finally, the decision making core model better predicted youth preferences for HIV preventive actions as compared to two models based on Theory of Reason Action (TRA) and Theory of Planned Behaviour (TPB).

Submitted in fulfilment of the requirements for the Degree in Masters of Technology in Nursing, Durban University of Technology, 2013. / South Africa is one of 12 countries where the under-five child mortality rate has increased. In response to this challenge, the WHO and UNICEF in the 1990s developed Integrated Management of Childhood Illness (IMCI), a strategy to reduce child mortality and morbidity. IMCI training was launched in South Africa in 1998. Health care workers trained in IMCI face many challenges when applying the new integrated case management approach. Training settings tend to differ from the actual work environment. Simulation is practiced in an enclosed environment and certain assessments are not possible for example chest in drawing, level of consciousness, oedema amongst others. In South Africa, there has been limited research on IMCI in-service and pre-service training and no research has been conducted regarding the training of student nurses on IMCI and follow up of these learners in the clinical field. Purpose of the study The purpose of this study was to evaluate the IMCI training of learners in the use of IMCI Guidelines in the KwaZulu-Natal College of Nursing (KZNCN). Methodology This study followed a descriptive quantitative approach and evaluates the training of the learners and the facilitation and training of lecturers with regards to IMCI in the KZNCN campuses. Data was collected using questionnaires for facilitators and learners on the three campuses. Results The findings of this study revealed that teaching and learning approaches used to facilitate IMCI were adequate except for clinical practice and theory which was reported to be insufficient.

This research focuses on obesity and other major risk factors for chronic diseases such as Type II Diabetes Mellitus, Heart Disease, and Stroke. Worksite wellness programs have been successful in this realm of health promotion and disease prevention for heart disease and stroke, but their effectiveness in treating diabetes has been uncertain partially due to poor patient compliance, lack of stress reduction strategies, poor diet and lack of persuasive health education on the risk of being obese. Published peer-reviewed articles were reviewed, coded and analyzed to determine best practices, using a modified systematic review approach. The findings from these studies yield results that were used to develop a new employer-sponsored wellness program that is in accordance with the recently passed Affordable Care Act. / Includes bibliography. / Thesis (M.S.)--Florida Atlantic University, 2014. / FAU Electronic Theses and Dissertations Collection