Thesis (M.S.)--University of Wisconsin--Madison, 1963. / Typescript. eContent provider-neutral record in process. Description based on print version record. Includes bibliographical references (leaves 87-92).

<p> Strategies to reduce uninsured utilization of Emergency Departments (EDs) such as improved access to primary care, care coordination and management, alternative roles and functions for navigation, and emerging health information technology, cannot be fully realized independent of one another. The call for hospital systems to implement and evaluate population health management strategies as a key component of the U.S. Healthcare system&rsquo;s transition to value-based care provides both the need and opportunity to research cost effective strategies for reducing preventable ED visits and hospitalizations, and associated costs among the uninsured. The Oklahoma City-County Health Department (OCCHD) Community Health Worker (CHW) Program is a small cohort pilot project implementing care coordination and management, and alternative role and functions for navigation strategies, as a partnership between local public health and non-profit hospitals. </p><p> Utilizing a pre- and post-intervention design, this study used secondary data from the program. The project captured the impact of the intervention on selected health risk indicators, ED utilization and associated self-pay charges. Data include demographic information, financial self-pay charges, and ED visit records of all study participants for a twelve-month period prior to study enrollment and for a twelve-month period following intervention. The intervention resulted in reduced volume and costs associated with uninsured utilization of EDs and preventable hospital visits. The intervention did not result in improvement of selected health risk measures including blood pressure, non-fasting glucose and BMI. This study demonstrates partnership between local non-profit hospitals and the local health department CHW program in Oklahoma County is a cost-effective strategy for reducing Emergency Department (ED) costs and preventable ED visits and hospitalizations associated with care for uninsured adults between the ages of 18 and 64.</p><p>

STATEMENT OF THE PROBLEM: While non-governmental organizations (NGOs) play an important role in providing services, care and support to vulnerable populations, often small and medium sized NGOs in developing countries lack the capacity (i.e., systems and structures) to effectively carry out their functions. Many capacity-building interventions (e.g., staff training and technical assistance) are resource intensive, and not affordable to small and medium NGOs. The objective of this study is to assess the effectiveness of online capacity building resources, a non-conventional and less resource intensive capacity building method, in helping small and medium sized Nigerian NGOs build capacity. METHOD: We conducted a mixed-methods evaluation using a two-arm cluster randomized controlled trial with 72 NGOs across five states in Nigeria. All NGOs received a baseline organizational capacity assessment, using the Measuring Organizational Development and Effectiveness (MODE) tool. Organizational capacity was scored on a scale between 0 and 100, where the higher value indicates higher capacity. The treatment group received written recommendations and online resources on capacity building; the comparison group received only written recommendations. The outcome of interest was the change in the organizational capacity of the NGOs after six months measured using the MODE tool. Also, we conducted in-depth interviews of 25 NGO directors. RESULT: At baseline, young (age ≤ 10 years), and less resourced (annual budget <$25,000) NGOs had weaker organizational capacity. At endline, there was significant improvement in organizational capacity score for NGOs in both the experiment group (15.4 percentage points increase (p<0.0001)) and comparison group (19.1 percentage points increase (p<0.0001)). However, multilevel regression analysis showed no statistically significant difference in organizational capacity improvement between the two groups (p=0.09). Improvement in organizational capacity was inversely associated with baseline organizational capacity (p<0.0001). Qualitative data showed that peer networking, engagement of stakeholders in organizations’ capacity building decision making, and internal task sharing bolstered organizations’ ability to improve capacity. CONCLUSION: Capacity assessment and provision of written capacity building recommendations to NGOs (with or without online resources) helped small and mid-sized NGOs strengthen their organizational capacity within six months. The effectiveness of the intervention is greater among NGOs with weaker organizational capacity at baseline.

Adolescent pregnancy and marriage can occur from ages 15 to 19. It is an important indicator of adolescent health. Nicaragua has the highest rate of adolescent pregnancy in Latin America. Adolescent marriage is also a public health challenge in Nicaragua. Studies from the non-governmental organizations, such as the United Nations, indicate this problem can be analyzed using the public health socio-ecological model. Additionally, the field recommends changing access to contraceptives, culture around contraceptive use, and improving education to reduce adolescent pregnancy and marriage.

BACKGROUND: Efforts to curb the opioid epidemic have generated multiple guidelines to increase the safety of opioid prescribing for chronic nonmalignant pain (CNMP). We performed a qualitative analysis of an intervention (TOPCARE, “Transforming Opioid Prescribing in Primary Care”) aimed at improving primary care physician (PCP) adherence to opioid prescribing guidelines. We explored 1) how TOPCARE influences PCPs’ knowledge, attitudes, and behavior regarding the opioid guidelines, 2) how PCPs’ clinical contexts influence implementation of TOPCARE, and 3) how characteristics of TOPCARE influence PCPs’ adherence to the opioid prescribing guidelines. METHODS: We conducted in-person, semi-structured interviews with 22 of 24 intervention PCPs from TOPCARE, a cluster RCT at 4 safety-net clinics. The multi-component TOPCARE intervention consists of a registry of patients who take opioids for CNMP, population management by nurse care managers (NCMs), education by academic detailers (ADs), and electronic decision support tools. We performed thematic analysis of transcribed interviews, double-coding every third interview. Our conceptual model merged two frameworks: Cabana et al.’s “Why don’t physicians follow clinical practice guidelines?” and Rycroft-Malone’s “Promoting Action on Research Implementation in Health Services” (PARiHS). RESULTS: Themes related to PCP knowledge that emerged from the interviews were increased knowledge of the content of the guidelines, increased strategies for application of the guidelines, and meaningful feedback. Attitude-related themes were PCPs’ personal stances toward the guidelines, increased outcome expectancy, reduced anxiety, and perceiving patients who take opioids for CNMP as challenging. Behavior-related themes were guideline-concordant prescribing becoming routine and increased transfer of tasks to NCMs. PCPs revealed clinic resources, clinic leadership, variability of practice style, and historico-political context to be important aspects of their clinical contexts that influenced their implementation of TOPCARE. The themes TOPCARE as NCM, integration of NCM into workflow, NCM as trusted member of the treatment team, supportive consultation, and population health approach all emerged as characteristics that PCPs found central to the effectiveness of the TOPCARE intervention in improving their adherence to opioid guidelines. CONCLUSION: An intervention to improve adherence to opioid guidelines increased PCPs’ knowledge and outcome expectancy. PCPs experienced tangible and emotional support to reduce variability and enable guideline-concordant care. / 2019-11-08T00:00:00Z

BACKGROUND: A substantial decline in the rate of teen births and changes in the population of teen parents have occurred over the past two decades with corresponding shifts in service needs. Past research has found services to teen parents to have initial or preliminary success, with little to no long-term change enacted. A novel service being implemented in Chelsea, Massachusetts has shown promise in dealing with very high risk teen parents. QUESTION AND SPECIFIC AIMS: A. Has the decline in teen births in Massachusetts come primarily from teens at lower medical and socio-demographic risk resulting in the current cohort of teen mothers constituting a higher risk group? B. How does the novel approach used by the High-Risk Young Mother’s Program at Roca Inc. effectively engage and serve a high-risk population? C. What lessons can be applied from this approach to services for high-risk teen mothers in other settings? METHODS: Both qualitative and quantitative methodology provided the basis for an in-depth examination of teen parenting services in a time of transition. This investigation examined two cohorts of teen births data in Massachusetts to compare changes in the population of teens giving birth from a time when teen births were high (1999–2003) in Massachusetts to more recently (2009–2013) after a dramatic decline. A case study was then developed of an innovative program that has had success in reaching a higher risk population in order to discern lessons for the field. Research was guided by the PARiHS implementation science theoretical framework in order to understand the barriers and facilitators to organization change tailored to reach this vulnerable population. RESULTS: Modest changes in the population of teens giving birth in the later cohort indicate a consolidation of risk in certain communities. Teens who gave birth in the more recent cohort were more likely to be Hispanic, more likely to report no prenatal care, less likely to have a father reported on the birth certificate, and more likely to have anemia. The Roca Inc. program involved adaptation and flexibility, adherence to a theory of change, and dedication to serving girls who have experienced trauma. Implications Further research is needed to assess the changes in teens giving birth despite overall declines in teen pregnancy nationally. The Roca Inc. program can serve as a model for reaching and successfully serving vulnerable youth and families. / 2018-05-08T00:00:00Z

<p> A casi 40 a&ntilde;os de la epidemia del VIH, la atenci&oacute;n adecuada a las personas con esta condici&oacute;n contin&uacute;a siendo un desaf&iacute;o para el campo de la salud p&uacute;blica. A pesar de que se han logrado grandes avances en t&eacute;rminos de prevenci&oacute;n, tratamiento y la calidad de vida de las personas viviendo con VIH, a&uacute;n existen brechas para controlar la epidemia. En el caso de una condici&oacute;n de salud como el VIH, la vulnerabilidad de contagiarse est&aacute; directamente influenciada por determinantes sociales de la salud. El riesgo de contagiarse con VIH es mayor en personas que est&aacute;n en desventaja en las relaciones sociales de poder. Se realiz&oacute; un an&aacute;lisis de m&eacute;todos mixtos para identificar las principales barreras y facilitadores para la prevenci&oacute;n del VIH entre un grupo de hombres j&oacute;venes gays, bisexuales y otros hombres que tienen sexo con hombres. Se hizo un an&aacute;lisis de contenido de siete entrevistas semiestructuradas y un an&aacute;lisis descriptivo de una encuesta con 144 participantes, ambos grupos entre las edades de 16-29 a&ntilde;os. Se utiliz&oacute; la t&eacute;cnica de &ldquo;weaving&rdquo; para la integraci&oacute;n de los datos. Los principales facilitadores para la prevenci&oacute;n del VIH que se desprenden de estos resultados est&aacute;n relacionados a educaci&oacute;n sexual, el acceso a servicios de prevenci&oacute;n de ITS, el conocimiento de VIH, las pruebas de VIH, la percepci&oacute;n acerca del uso del cond&oacute;n, los servicios de consejer&iacute;a y prevenci&oacute;n de VIH y las experiencias de apoyo social. Por otro lado, las principales barreras para la prevenci&oacute;n del VIH que se identificaron estuvieron relacionadas a la cobertura de salud, la pobre interacci&oacute;n con proveedores de servicios de salud, la falta de educaci&oacute;n sexual, el bajo conocimiento y acceso a PrEP y las experiencias de estigma y discrimen. El enfoque de este estudio hacia los determinantes sociales estructurales favorece el reconocimiento de las acciones necesarias para facilitar el acceso a diferentes m&eacute;todos de prevenci&oacute;n del VIH. Es necesario que se reflexione y act&uacute;e para evaluar el acceso a servicios de salud y prevenci&oacute;n de VIH, as&iacute; como el conocimiento de las personas para accederlos, utilizarlos y que la experiencia est&eacute; libre de estigma y discrimen.</p><p>

<p> <i>Background:</i> Intimate partner violence (IPV) is a significant public health issue. One in five women and one in seven men will experience severe physical violence from an intimate partner in their lifetime in the US; and one in three women globally (Breiding, Basile, Smith, Black, &amp; Mahendra, 2015; World Health Organization, 2017). Notwithstanding such stark statistics, there is a gap in research on batterers and on batterer intervention and prevention programs (BIPP). <i>Purpose:</i> Program processes related to follow-up of clients were evaluated at the Center Against Sexual and Family Violence Batterer Intervention and Prevention Program (CASFV BIPP) through a mixed-methods process evaluation. The research incorporated community-based participatory research methods in that the project was co-developed with the community partner (CASFV) and addressed program interests and needs. <i> Methods:</i> The process evaluation consisted of examining inputs, activities and outputs related to evaluation questions. Data collection methods include survey research among 110 BIPP program clients, development of a program description and logic model, data gathered through qualitative interviews with program staff, and presentation of data on recidivism rates collected by the program. Qualitative data were analyzed using thematic content analysis. Quantitative data analysis focused on descriptive statistics using the SPSS Data Analysis Package. <i>Results:</i> Nearly 60% of clients were between the ages of 25 and 38; 79% were male; 79.1% were Hispanic; and 94.5% felt the program had benefited them. A majority of clients (78.2%) agreed to be contacted by cellphone two years after completing the program as a follow-up measure. The research with clients and staff indicated that follow-up by cellphone two years after completion was the best protocol for following up with clients because the time frame allowed for completion of other obligations such as parole that may affect recidivism rates. In addition, client satisfaction with the program was the strongest predictor for receptivity to follow-up (<i>p</i> = .004). <i>Conclusions:</i> Current follow up protocols were examined to recommend a standardized protocol, and it was recommended that follow-up be conducted by cellphone two years after program completion. Based on data obtained from client and staff, it was further recommended that additional means of contact such as email and social media be explored in the near term.</p><p>

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