Five years ago, a massive earthquake and its subsequent aftershocks rocked the core of Nepal. Recovery from these quakes has been a long and difficult process. This thesis will explore findings from a qualitative evaluation of Lumanti Support Group for Shelter, an NGO in Kathmandu, Nepal that implemented a residential reconstruction program in four peri-urban communities in Kathmandu Valley. These findings are a culmination of 26 semi-structured interviews and document analysis. This research highlights the processes of reconstruction and the forms of resistance that occurred through disaster governance.

In regions of the world that experience a deficit of surgical care, educational initiatives can foster the development of a skilled surgical workforce. Implicit in training these health workers is the mandate to retain them in the country in order build capacity. Eyal’s framework presents ways in which locally relevant training can improve retention and outlines the ethical and pragmatic concerns of such initiatives. In 2006, Guyana established it’s first surgical training program, an example of locally relevant training. The University of Guyana Diploma of Surgery (UGDS) program was selected for this case study research. Consistent data collection, supported by a systemic procedure to analyze that data, is paramount to increase the effectiveness of the UGDS program. The purposes of this dissertation research were two-fold. Firstly, it sought to understand how the UGDS program influences retention and the ways in which the UGDS members contribute to capacity building and the program’s sustainability. Secondly, this program evaluation provides a useful context to inform Eyal’s framework. 8 graduates, 2 trainees, 4 faculty members and 2 persons identified as policy makers were interviewed. Interviews were conducted face to face, and then transcribed. Surveys were administered to graduates and trainees and reflective journals were coded and analyzed. Overall, the data mapped fairly well onto Eyal’s framework. The results of the study suggest that the benefits and concerns Eyal outlines would be better represented along a continuum rather than being classified as either advantageous or disadvantageous with respect to retention. While Eyal’s claims generalize across settings, he should acknowledge this limitation and consider the important role that context plays. Overall, the results suggest that the UGDS program has positively influenced retention and capacity building. Key recommendations were made to the UGDS program that aim to improve retention and capacity building. As regions continue to face challenges associated with providing adequate surgical care, fostering retention and capacity building is recommended so that a sustainable surgical workforce can meet surgical needs. / Thesis / Master of Health Sciences (MSc)

Publication bias (PB) makes the resources for meta-analysis (M-A) unreliable in the sense of completion and accuracy, so to investigate, identify and correct PB is a very important issue in M-A. The current study proposed an empirical comparison in both detection and correcting PB, using a Monte Carlo study. Conditions to be manipulated include the number of primary studies, number of missing studies and true effect size. RANNOR in SAS will be used to generate normally distributed random variables and, for each condition, 10,000 M-As will be simulated. Type I error rates are to be calculated for the conditions with no PB and powers were estimated for the conditions with PB and adequate type I error control. Finally, a demonstration of how M-A can and should be used as a part of program evaluations was given. / text

Chronic diseases such as diabetes, cardiovascular disease, cancer, and depression exist in 45% of the U.S. population and are responsible for 70% of the deaths and 75% of the $2 trillion in annual medical expenditures. Healthy eating, being physically active, managing stress, and avoiding tobacco have well-documented relationships to improved health and well-being, and chronic disease prevention.Integrative healthcare, a holistic approach to care that is patient-centered, personalized, and focused on health and well-being, incorporates conventional and complementary and alternative medicine (CAM). Integrative healthcare has the potential to provide high quality care that prevents illness and promotes optimal wellness, resulting in decreased health care costs and a healthier nation. Although integrative healthcare is increasing in popularity, few integrative healthcare programs have been studied and relatively little is known about the processes, outcomes, feasibility, efficacy, effectiveness, or sustainability of these programs.The purpose of this project was to evaluate selected organizational processes and patient outcomes of an integrative health care program. The three specific aims of the project were to analyze the program theory through the development and evaluation of the program logic model, to evaluate selected organizational processes, and to examine selected client outcomes, including satisfaction.This inquiry used the CDC Framework for Program Evaluation as a guide. The study employed a descriptive design with both qualitative and quantitative methods, including key informant interviews with program staff and a client focus group. De-identified data on pre and post measurements of client Wellness Inventory scores, weight, BMI, and advanced cardiac panels, and post program surveys obtained from the program director were analyzed using descriptive statistics and the paired t test or the Wilcoxon signed-rank test.The evaluation of an existing integrative healthcare program provides potentially useful information to the stakeholders of the program and a valuable referral resource for other providers in the community. Dissemination of the information may also be used as a model and an inspiration for other advanced practice nurses to develop innovative practice models that support holistic, wellness-focused care.

Objective: The purpose of this DNP Project was to investigate factors that influence the sustainability of a prior nursing physical assessment education intervention with intensive care unit (ICU) nurses working at Saint Luke’s Hospital in Haiti. Methods: A qualitative design, utilizing focus group interviews and direct observation was used. Two focus group interviews were held at St. Luke’s Hospital. Participants were identified via purposeful sampling, with the aid of key informants, to include Haitian nursing and medical administration, ICU staff nurses, and physicians that participated in the prior nursing education intervention. An interpreter was present during the interviews. The interviews were audio taped, allowing verbatim translation and transcription into English. The transcription was analyzed to identify themes regarding factors that influenced the sustainability of the prior nursing physical assessment education. Findings: The majority of themes identified in the nursing focus group interview were mirrored in the physician focus group interview and aligned with current literature. These included staffing, nursing knowledge regarding physical assessments, and continuing education. The nursing focus group indicated that ongoing communication and collaboration were factors influencing sustainability. In the physician focus group, the theme of interdisciplinary integration also emerged. Conclusion: There is limited literature discussing the factors that influence sustainability of nursing education in developing countries. A program evaluation to examine these factors for the prior nursing education at St. Luke’s Hospital had not been conducted. Findings indicate that there are numerous factors that influenced the sustainability of the prior nursing physical assessment education intervention. Although these findings are not transferable to other settings or populations, understanding means to increase sustainability may be influential in future nursing education endeavors with St. Luke’s Hospital in Haiti.

The purpose of this study was to examine perceptions of Texas Adult Protective Services (APS) case managers (CM) in regard to their relationships with the law enforcement community and area courts. The sample consisted of 138 Texas APS CMs. The survey measured respondents' perceived strengths and weaknesses of their relationships with both the law enforcement community and with area courts. Items also included respondents' interest in receiving additional training and their perceptions of level of job-readiness of newly hired APS CMs. Data were analyzed quantitatively using SAS. Findings of the survey revealed high ratings of perceived teamwork on the part of the CM are associated with high relationship ratings with both area courts and law enforcement. Findings also revealed that high ratings of perceived autonomy on the part of the CM are associated with lower relationship ratings with law enforcement personnel but not with area courts.

Students are reaching middle school 2 or more years behind in reading ability. As a result, they are unable to meet state testing standards. In 2007, the READ 180 program was implemented at an urban middle school in Virginia to address the reading gaps of these middle school students. The purpose of this sequential mixed-method program evaluation was to analyze the reading success of 30 READ 180 students and the perceptions of 4 teachers who taught the READ 180 curriculum. The theoretical framework that served as a basis for this study was Vygotsky's zone of proximal development, which holds that independent thinking is facilitated by developmentally-appropriate instruction. Research questions examined the strengths and weaknesses of the program and its effectiveness on helping the students improve their reading ability. Student scores from the program assessments were examined using a paired samples t test and by comparing central tendencies. An analysis showed a 15% increase in students' SRI pre- and posttest scores, noting that 6.67% of students passed the reading SOL. Themes from the teacher interviews indicated that the teachers perceived the training to be sufficient and that the materials and technology were authentic; however, updated curricula materials were needed. The quantitative and qualitative research data were used to generate an evaluation report to share explicit research findings with the school division and parents about the programs' successes and needs for improvement. Social change was supported by evaluating a reading intervention program designed to increase middle school students' reading ability.

This study examines, from an administrative perspective, the structures and processes that support positive outcomes in early psychosis. This examination is undertaken by means of a case study across two eras (1991-1998 and 1999-2006) of early intervention in psychosis care in the Saskatoon Health Region, a Canadian health region with a catchment population of about 300,000. This case study was undertaken using a mixed methods approach, including assessments of early intervention clients, a psychiatrist satisfaction survey, a utilization and cost analysis of emergency room and in-patient care, and focus groups of early intervention program stakeholders. In response to the first study question, the study identified two elements of structure that contribute to the effective provision of early intervention services: a diverse inter-professional team and a nested program model. Next, the study identified one element of structure that detracts from the effective provision of early intervention services: staff stress and burn-out. In response to the second study question, the study identified one element of process that contributes to the effective provision of early intervention services: a strong school outreach and programming component. The study also identified one element of process that detracts from the effective provision of early intervention services: co-morbid substance abuse. In response to the third study question, one key administrative outcome was identified: a reduced cost of in-patient hospital care. It is anticipated the results from this study will assist mid-sized health authorities in meeting the needs of low-incidence and complex client groups.

This study sought to examine the performance of participants in training courses of the Agricultural and Environmental Services (AES) unit and determine variables affecting participants' scores on the General Standards Examination (GSE). The data sample for the study comprised 150 individuals who completed the 8-hour course between February 2011 and February 2012 and submitted instruments developed for this study (demographic and evaluation survey, pre-test, post-test, and GSE). The demographics of the pest control industry in Texas - or, more specifically, the demographics of those taking a Structural Pesticide Applicator Training (SPAT) course from AES - have not changed much since 1998. The major differences in demographics between the two groups of individuals investigated (commercial and non-commercial applicants) were in age and size of business where employed. Commercial participants tended to be younger than non-commercial participants. Those seeking commercial certification tended to be employed in smaller firms than did those seeking non-commercial certification. This study found moderate, positive correlations between the pre-test, post-test, and GSE. Finally, though the examination scores were correlated, there were statistically significant differences between participants' performances on the pre-test, post-test, and GSE. These differences were quadratic; all three pairs - pre-test and post-test, post-test and GSE, and pre-test and GSE - differed, with pretest scores in the middle, then post-test scores highest, and GSE scores lowest. The researcher recommended that further research be conducted on demographic variables that may affect the outcome of the examinations, and that the rigor and relevance of the pre-test and post-test be increased to predict more accurately the results of the GSE.

This study examines, from an administrative perspective, the structures and processes that support positive outcomes in early psychosis. This examination is undertaken by means of a case study across two eras (1991-1998 and 1999-2006) of early intervention in psychosis care in the Saskatoon Health Region, a Canadian health region with a catchment population of about 300,000. This case study was undertaken using a mixed methods approach, including assessments of early intervention clients, a psychiatrist satisfaction survey, a utilization and cost analysis of emergency room and in-patient care, and focus groups of early intervention program stakeholders. In response to the first study question, the study identified two elements of structure that contribute to the effective provision of early intervention services: a diverse inter-professional team and a nested program model. Next, the study identified one element of structure that detracts from the effective provision of early intervention services: staff stress and burn-out. In response to the second study question, the study identified one element of process that contributes to the effective provision of early intervention services: a strong school outreach and programming component. The study also identified one element of process that detracts from the effective provision of early intervention services: co-morbid substance abuse. In response to the third study question, one key administrative outcome was identified: a reduced cost of in-patient hospital care. It is anticipated the results from this study will assist mid-sized health authorities in meeting the needs of low-incidence and complex client groups.