This thesis includes four manuscripts with overarching objectives to identify if Canadians experience unmet need for physiotherapy. McIntyre et al.’s framework was utilized across the manuscripts to explore reasons why unmet need may exist. The first manuscript presents a scoping review investigating unmet need for physiotherapy across Canada. The objective was to describe current evidence for unmet need for community-based physiotherapy services (CBPTS). Adults with chronic conditions versus those without, or who lived in rural versus urban communities were more likely to report unmet need for CBPTS. Availability and affordability were identified as reasons for unmet need. The second manuscript presents a secondary data analysis of three Canadian Community Health Survey (CCHS) cycles (2001, 2003, 2005) for three provinces: Ontario (ON), Alberta (AB), British Columbia (BC). This study investigated factors that explain variations in self-reported unmet needs of individuals with specific chronic conditions. Unmet need for treatment of a physical health problem (PHP) was the most common type of need in all three cycles. Affordability was the only domain with significant differences between cycles in two provinces. Women were less likely than men, and older persons less likely than persons 40 – 45 years, to report unmet need for treatment of a PHP. The third manuscript analyzed CCHS data for ON, AB and BC to investigate which socio-demographic variables were associated with reporting a visit to a physiotherapist in three cycles. People with lower income were less likely to report a physiotherapy visit compared to people with higher income. Women, and individuals with an injury or physical activity limitation were more likely to report a physiotherapy visit. The fourth manuscript presents themes from key informant interviews that explored the partial removal of physiotherapy from the Ontario Health Insurance Plan (“delisting”). Partial delisting contributed to increased unmet need immediately following, and more than ten years post implementation. Longstanding unmet need due to affordability and availability was identified. / Thesis / Doctor of Philosophy (PhD) / Physiotherapy is a health profession that works with people to help them stay healthy and maintain physical function. There are many people with chronic conditions who would benefit from receiving physiotherapy treatment, but are not able to do so. Three reasons that may explain why people do not receive physiotherapy are they: cannot afford to pay; cannot find a physiotherapist close to where they live or work; or they do not believe a physiotherapist will improve their health. This thesis includes four papers aimed at better understanding the reasons why people in three Canadian provinces, Ontario, Alberta and British Columbia, do not see a physiotherapist when their health would benefit from doing so. The results suggest that cost and the location where physiotherapy services are provided are reasons why some people do not receive physiotherapy care - even if they believe physiotherapy is needed. The findings from this thesis may help to inform the future organization and delivery of physiotherapy services.

No description available.

This thesis draws on the 2014 Ontario Child Health Study (2014 OCHS) to address four contemporary and policy-relevant issues associated with measuring child and adolescent mental health need and children’s mental health service use in the general population. The first and second papers focus on the development and evaluation of instruments to measure child mental disorder. The first paper develops a simple, brief symptom checklist used to measure child mental disorder conceptualized as a dimensional phenomenon, a core concept in the 2014 OCHS. The second focuses on a briefer version of this checklist to measure child mental disorder dimensionally in general and clinical populations for the purposes of assessing and monitoring children’s mental health need. The third and fourth papers use these measures as the basis for assessing children’s mental health need in evaluations of policy-relevant health service questions. The third paper focuses on a substantive question about area-level variation in children’s unmet need for mental health services using 2014 OCHS data linked to government administrative data and 2016 Census data. The fourth paper estimates the extent to which child mental health service expenditures in 2014-15 were allocated according to children’s mental health need. Together, these papers respond to the need for simple, brief, self-report measures of child and adolescent mental disorders and show how these types of measures, in combination with administrative government data sources can advance our knowledge about policy and funding decisions in children’s mental health services research in Ontario. / Thesis / Doctor of Philosophy (PhD) / The goals of this thesis are to address issues relating to: (1) measuring child and adolescent mental health need using brief, self-report problem checklists and (2) using these measures to answer questions about children’s mental health service use and service expenditures in the general population in Ontario. The individual manuscripts in this thesis respond to the need for simple, brief, self-report measures of child and adolescent mental disorders and advance our knowledge about policy and funding decisions in children’s mental health services research in Ontario.

The objectives of this thesis were to examine (1) associations between primary care type (team-based versus non-team based) and access problems (difficulty in access and self-reported unmet need), and (2) if socioeconomic variations in access problems were less graded for team-based than non-team-based primary care. Data came from a nationally representative cross-sectional survey, the 2008 Canadian Survey of Experiences with Primary Health Care. Using logistic regression, we examined the associations between primary care type and access problems, adjusting for demographic, health status, socioeconomic, and health care supply factors. We then stratified by primary care type to compare steepness of socioeconomic associations with access problems. Primary care type had no statistically significant, independent associations with access problems. No statistically significant socioeconomic gradients in access problems were observed regardless of primary care type, except that difficulty in access was statistically significantly and positively graded by education for non-team-based primary care.

Background: No previous study has focused on the inter-relationship among alcohol and drug use variables in the past year. This study aimed to classify the past year alcohol and drug use variables and investigate the selected variables in past year alcohol and drug use with the unmet need for mental health services among US adults. Methods: Data came from the 2015 National Survey on Drug Use and Health (NSDUH). Oblique principal component cluster analysis (OPCCA) was used to classify 37 variables on alcohol and drug use in the past year into disjoint clusters. Weighted multiple logistic regression analysis was used to examine the associations of selected variables with the unmet need. Results: 37 alcohol and drug use variables were divided into 7 clusters. The variable with the lowest 1-R2 ratio (R2 is the squared correlation) from each cluster was selected as follows: tobacco use, pain reliever use, tranquilizer use, stimulant use, zolpidem products use, illicit drug and alcohol use, and benzodiazepine tranquilizers misuse. Multiple logistic regression analysis showed that pain reliever use (OR = 1.33, 95% CI = 1.17–1.50), tranquilizer use (OR = 2.49, 95% CI = 2.16–2.86), stimulant use (OR = 1.22, 95% CI = 1.01–1.47), and illicit drug and alcohol use (OR = 1.54, 95% CI = 1.34–1.77) revealed positive associations with the unmet need for mental health services. Conclusion: This is the first study using OPCCA to reduce the dominations of alcohol and drug use; several alcohol and drug use variables in the past year were associated with unmet need of mental health services.

Tous mes travaux ont été réalisés à l'aide du logiciel stata 11. / La présente thèse étudie la relation entre le niveau de vie, la fécondité des femmes en union et leurs besoins non satisfaits en matière de planification familiale. Les données qui ont servi aux analyses proviennent des fichiers individuels de deux enquêtes démographiques et de santé (DHS) réalisées en Guinée en 1999 et 2005. Le niveau de vie est mesuré par un indicateur composite créé à partir des caractéristiques du logement et certains biens possédés par le ménage. Nous avons adopté deux stratégies d’analyse : analyses descriptives et multi-variées. Nous avons examiné à cet effet les niveaux et les tendances de ces deux comportements de fécondité dans les grandes villes, petites villes et villes secondaires, en milieu rural et à l’échelle nationale. Des méthodes statistiques appropriées ont été utilisées : (modèle de régression de Poisson et des modèles de régression logistique binaire et multinomiale). Les résultats des analyses descriptives montrent une faible fécondité chez les femmes issues des classes riches par rapport aux femmes pauvres et une diminution de leurs besoins non satisfaits en matière de planification familiale. Ces relations qui se sont révélées très statistiquement significatives en 1995-1999 quelque soient les milieux de résidence, ont disparu presque dans les analyses multi-variées, après avoir contrôlé certaines caractéristiques socio-économiques, démographiques et culturelles. Dans ces analyses multi-variées, l’éducation de la femme et la pratique contraceptive se sont révélées particulièrement déterminantes pour la fécondité. Par ailleurs, l’éducation de la femme, a été également un facteur important pour les besoins non satisfaits en matière de planification familiale. Il en est de même pour son âge, sa parité, sa religion, la discussion du couple sur la planification familiale, l’attitude du conjoint vis-à-vis de la planification familiale et de l’exposition aux messages sur la planification familiale qui restent aussi d’importants facteurs des besoins non satisfaits en matière de planification familiale. Le terme d’interaction groupe d’âge et le nombre d’enfants en vie, s’est avéré, lui aussi fortement significatif indiquant que l’effet de la parité sur les besoins non satisfaits en matière de planification familiale ne prend pas le même sens selon le groupe d’âge auquel appartient la femme. En définitive, nos analyses, nos analyses ont mis en évidence que la relation négative entre le niveau de vie, la fécondité et les besoins non satisfaits se vérifie mais avec des degrés variés selon les milieux de résidence et les périodes d’enquête. Les écarts entre les groupes contigus sont également très faibles. / The goal of this thesis is to study the relationship between the married women standard of living, their fertility and their unmet need for family planning. The data used for the analysis have been taken from two individual demographic survey files (DHS) carried out in Guinea in 1999 and 2005. The standard of living is measured using a composite indicator established from the housing characteristics and some capital goods of the family. We have adopted two strategies of analysis: Descriptive and Multivariate Analysis. Thus, we have studied the levels and tendencies of these two behaviors of fertility in the large cities, small or secondary cities, rural places, and at the national scale. Statistics appropriate methods of regression (Poisson regression method, logistic binary method and multinomial method). The results of descriptive analysis have confirmed a weak fertility in women from rich classes in comparison with poor women and a reduction of their unmet need for family planning. The relationship which proved very statistically significant in 1995-1999 whichever the place of residence was not observed with the multivariate analysis method, after controlling some socioeconomic, demographic and cultural characteristics. In the multivariate analysis, the woman education and her behavior in terms of contraception were particularly important in her fecundity. Moreover, the woman’s education, her age, parity (married status), her religion, the discussion of the couple about the family planning, the husband attitude concerning the family planning constitute some important factors of unmet need for family planning. The term of Interaction age group and number of living children turns out strongly significant, indicating that the parity (man-woman) effect can change according to the age group of the woman.   In fact, our analysis have shown with clearly that the negative relationship between the standard of living, the fertility and the unmet need is confirmed with various degrees according to the place of residence and the survey period. The differences between the closely related groups are too weak.

Magister Philosophiae - MPhil / The purpose of this research is to study the effect of different demographic and socio economic factors on the contraceptive use among currently married women of age 15-49 in the two regions of Ethiopia, Amhara (17,214,056) and Oromiya (27,158,471). Data are obtained from the 2005 Ethiopian Demographic and Health Survey (EDHS). Information on contraceptive use was provided by current use 1334 (14.7), future use 4017 (52.0), unmet need for spacing 1817 (20.0) and limiting 1249 (13.3) currently married women aged 15-49 interviewed in the 2005 Ethiopian Demographic and Health Survey (EDHS). / South Africa

La présente thèse étudie la relation entre le niveau de vie, la fécondité des femmes en union et leurs besoins non satisfaits en matière de planification familiale. Les données qui ont servi aux analyses proviennent des fichiers individuels de deux enquêtes démographiques et de santé (DHS) réalisées en Guinée en 1999 et 2005. Le niveau de vie est mesuré par un indicateur composite créé à partir des caractéristiques du logement et certains biens possédés par le ménage. Nous avons adopté deux stratégies d’analyse : analyses descriptives et multi-variées. Nous avons examiné à cet effet les niveaux et les tendances de ces deux comportements de fécondité dans les grandes villes, petites villes et villes secondaires, en milieu rural et à l’échelle nationale. Des méthodes statistiques appropriées ont été utilisées : (modèle de régression de Poisson et des modèles de régression logistique binaire et multinomiale). Les résultats des analyses descriptives montrent une faible fécondité chez les femmes issues des classes riches par rapport aux femmes pauvres et une diminution de leurs besoins non satisfaits en matière de planification familiale. Ces relations qui se sont révélées très statistiquement significatives en 1995-1999 quelque soient les milieux de résidence, ont disparu presque dans les analyses multi-variées, après avoir contrôlé certaines caractéristiques socio-économiques, démographiques et culturelles. Dans ces analyses multi-variées, l’éducation de la femme et la pratique contraceptive se sont révélées particulièrement déterminantes pour la fécondité. Par ailleurs, l’éducation de la femme, a été également un facteur important pour les besoins non satisfaits en matière de planification familiale. Il en est de même pour son âge, sa parité, sa religion, la discussion du couple sur la planification familiale, l’attitude du conjoint vis-à-vis de la planification familiale et de l’exposition aux messages sur la planification familiale qui restent aussi d’importants facteurs des besoins non satisfaits en matière de planification familiale. Le terme d’interaction groupe d’âge et le nombre d’enfants en vie, s’est avéré, lui aussi fortement significatif indiquant que l’effet de la parité sur les besoins non satisfaits en matière de planification familiale ne prend pas le même sens selon le groupe d’âge auquel appartient la femme. En définitive, nos analyses, nos analyses ont mis en évidence que la relation négative entre le niveau de vie, la fécondité et les besoins non satisfaits se vérifie mais avec des degrés variés selon les milieux de résidence et les périodes d’enquête. Les écarts entre les groupes contigus sont également très faibles. / The goal of this thesis is to study the relationship between the married women standard of living, their fertility and their unmet need for family planning. The data used for the analysis have been taken from two individual demographic survey files (DHS) carried out in Guinea in 1999 and 2005. The standard of living is measured using a composite indicator established from the housing characteristics and some capital goods of the family. We have adopted two strategies of analysis: Descriptive and Multivariate Analysis. Thus, we have studied the levels and tendencies of these two behaviors of fertility in the large cities, small or secondary cities, rural places, and at the national scale. Statistics appropriate methods of regression (Poisson regression method, logistic binary method and multinomial method). The results of descriptive analysis have confirmed a weak fertility in women from rich classes in comparison with poor women and a reduction of their unmet need for family planning. The relationship which proved very statistically significant in 1995-1999 whichever the place of residence was not observed with the multivariate analysis method, after controlling some socioeconomic, demographic and cultural characteristics. In the multivariate analysis, the woman education and her behavior in terms of contraception were particularly important in her fecundity. Moreover, the woman’s education, her age, parity (married status), her religion, the discussion of the couple about the family planning, the husband attitude concerning the family planning constitute some important factors of unmet need for family planning. The term of Interaction age group and number of living children turns out strongly significant, indicating that the parity (man-woman) effect can change according to the age group of the woman.   In fact, our analysis have shown with clearly that the negative relationship between the standard of living, the fertility and the unmet need is confirmed with various degrees according to the place of residence and the survey period. The differences between the closely related groups are too weak. / Tous mes travaux ont été réalisés à l'aide du logiciel stata 11.

本研究主要在探討30歲至45歲未婚女性的網路購物行為。先從次級資料的分析，來界定所研究的族群與範圍。接者，以深度訪談的質性方式，去了解未婚熟女網路購物的習性與實務(Habits and Practices)。並根據深度訪談的結果來設計問卷，進行量化分析。最後，從126份回收的有效問卷中，去了解未婚熟女的網路購物行為、其在網路購物上未被滿足的需求、及其對現有購物網站的品牌印象及品牌滿意度。 研究發現，未婚熟女族群對於現有購物網站的「個人資料安全性」、「售後服務」、「退換貨服務」、「詳細商品說明」、「網頁整齊不凌亂」等方面，仍有未滿足之處。同時，在以上未滿足的點上，表現較好的購物網站，會有比較高的品牌滿意度。 / This research is about the on-line shopping behavior of 30-45 unmarried women. First of all, the researcher defined the target audience by the analyzing the secondary data collected. Secondly, by deeply interview with 4 unmarried women aged 30-45, the researcher tried to understand the habits and practices of the on-line shopping behavior of 30-45 unmarried women. In addition, based on the deeply interview result, the researcher designed the questionnaire for following quantity analysis. From the 126 effective questionnaires collected, the researcher analyzed the on-line shopping behavior of the target audience, their unmet needs of on-line shopping and their brand image and brand satisfaction of existing shopping websites. The research discovered that personal information security、after-sale service、exchange and refund、detailed product introduction、clean and ordered web page are the unmet needs of the target audience. And those shopping websites which perform better on the unmet needs have higher brand satisfaction.

Cette thèse porte sur les difficultés d'accès aux soins dentaires dans le marché français semi-régulé. L'analyse cible la barrière financière d'accès aux soins dentaires et ainsi le rôle et le mécanisme de fixation des prix. La première partie permet de contextualiser la délivrance des soins dentaires en France et montre que la profession de chirurgiens-dentistes est particulièrement isolée dans le domaine sanitaire français. L'objet de la seconde partie est d'identifier les déterminants de l'accès aux soins dentaires. Nous montrons que le programme de prévention pour les enfants M'T'dents, entièrement gratuit, n'était utilisé que par les ménages les plus aisés et touchait peu les ménages défavorisés qui en ont le plus besoin. L'importance du support social dans l'accès aux soins est aussi affirmée dans notre seconde étude empirique. L'accès primaire aux soins dentaires des adultes présente la principale barrière d'accès. Une fois cette difficulté surmontée, les patients engagent le plus souvent les traitements suivants nécessaires, avec des niveaux de dépenses qui peuvent être importants même pour les moins aisés. À la suite de ces résultats, nous nous sommes intéressés spécifiquement au rôle du prix. Nous avons montré que plus le prix des prothèses dentaires était élevé, plus le renoncement à ces soins pour raisons financières était important. D'après nos travaux, l'intensité de la concurrence impacte négativement la fixation des prix contrairement à la solvabilité de la demande. Les prix entre concurrents sont aussi des compléments stratégiques. Ce sont autant de facteurs susceptibles d'être régulés pour lutter contre le renoncement aux soins dentaires et les inégalités sociales de santé qui en résultent. / This thesis concerns the difficulties to access dental care in the semi-regulated French market. The analysis targets the financial barrier of access to dental care and so the role and the mechanism of price setting. The first part gives the background of the French dental care delivery and shows that the profession of dental surgeons is particularly isolated in the French sanitary domain. In the second part we identify the decisive factors of the dental care access. We show that the free preventive program for the children Lov'Ur'Teeth was used only by the wealthiest and affected little the most disadvantaged households, which need it much more. The decisive impact of the social support in access to dental care is also a strong result in our second empirical study. The primary access to the dental treatment presents the main barrier of access. When people overcome this difficulty, they mostly continue the ensuing necessary treatments, that could be very expensive. Following these results, we focused in the role of the price. We showed that the more the prosthetic prices are high, the more is the renunciation for these cares. According to our works, the intensity of the competition impacts negatively the price setting, contrary to the demand's solvency. The prices between competitors are also strategic complements. That are many potential factors to be regulated to fight against the dental unmet need and the resulting social health inequalities.