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  • About
  • The Global ETD Search service is a free service for researchers to find electronic theses and dissertations. This service is provided by the Networked Digital Library of Theses and Dissertations.
    Our metadata is collected from universities around the world. If you manage a university/consortium/country archive and want to be added, details can be found on the NDLTD website.
1

Telehealth Implementation in Family Planning Clinics in Two Southeastern States During COVID-19

Cox, Jessica, Beatty, Kate, Ventura, Liane, de Jong, Jordan 18 March 2021 (has links)
COVID-19 was declared a pandemic by the World Health Organization on March 11th, 2020. Many states issued stay-at-home orders to prevent the spread of the coronavirus. Any non-essential clinical services were canceled or postponed to decrease in-person visits at clinics, which led to clinics having decreased patient volume. Telehealth was used as a way to continue clinical care to patients in an alternate form. Health departments (HD) provide fundamental services to patients based on a sliding fee scale. Federally Qualified Health Centers (FQHC) provide a wide variety of health care services to underserved communities. Policies on the implementation of telehealth varied between the two systems. The concentration of this study is on the characteristics of telehealth service provision before and during the COVID-19 pandemic and future considerations for clinic service provision. A quantitative analysis was conducted through statewide surveys. The statewide surveys assessed clinic characteristics and contraceptive care service provision among HD family planning clinics and FQHC clinics in two Southeastern states, South Carolina (SC) and Alabama (AL), with similar clinic structures. The survey was conducted from July- November 2020. Survey items included evaluating the impact of COVID-19 on clinical service provision, including services provided prior to (2019) and during (March-June 2020) the pandemic. The response rate was 86.8% (N=112) among HD clinics and 53.8% (N=127) among FQHC clinics. Chi-Squared tests of independence were used to assess differences in service provision among HD and FQHC clinics in SC and AL. Fischer’s Exact test was applied where categorical responses were fewer than five. Among survey respondents, 64.9% (N=72) of HD clinics and 38.9% (N=49) of FQHC clinics indicated no telehealth services were provided prior to the pandemic (p < .0001). Nearly 35% (N=85) of all clinics reported introducing at least one telehealth service during the pandemic. The most prevalent telehealth service provided by HD clinics during the pandemic was prescribing refills of hormonal contraceptive methods at 58.2% (N=64). FQHC clinics’ most prevalent telehealth service provided during the pandemic was primary health care at 89.8% (N=114). Regarding the future of telehealth, 12.4% (N=12) of HD clinics plan to continue all telehealth services offered during March-June 2020, whereas 52.5% (N=62) of FQHC clinics plan to continue all telehealth services offered during March-June 2020 (p < .001). These findings highlight the significance of policy and procedures among the HD clinics in states that have a centralized health department structure. The telehealth services adopted by HD clinics and FQHC clinics varied and further research is needed to understand the barriers to telehealth provision in each state. The importance of reimbursement policy for telehealth services plays a vital role in providing contraceptive services, thus it may be critical to expand billing options and maintain reimbursement of telehealth through Medicaid.
2

Issues of access to health services for people with learning disabilities : a case study of cervical screening

Nightingale, Christine Elizabeth January 1997 (has links)
No description available.
3

Motivations, expectations and decision making of women seeking cosmetic breast surgery : a quantitative and qualitative analysis

Allcock, Sarah January 1997 (has links)
No description available.
4

Anxiety Mediates the Relationship between Sexual Trauma Stigma and Somatic Health Complaints

Altschuler, Rebecca, Caselman, Gabrielle, Hinkle, Madison, Dodd, Julia 12 April 2019 (has links)
Existing research demonstrates that sexual trauma victims experience increased risk of adverse health outcomes including cardiovascular disorders, increased risk of chronic pain, and somatic health complaints. Similarly, sexual trauma is correlated with increased risk of adverse psychological effects including PTSD, depression, and anxiety. Perceived stigmatization as a result of sexual trauma has been hypothesized to be a mechanism through which sexual trauma affects health. Sexual trauma stigma (STS) has been found to mediate the relationship between sexual trauma and psychological distress. The experience of stigmatization has also been linked to somatization and is associated with increased anxiety. Similarly, among a sample of participants with a trauma history, adversity and resultant discrimination predicted somatic health complaints with post-traumatic stress symptoms (PTSS) partially mediating this relationship. However, the experience of STS specifically and its effect on somatic health complaints and anxiety has not yet been examined. As anxiety is associated with somatic symptoms, and is often comorbid with PTSS, it may be a mechanism through which STS effects somatic health complaints. Therefore, the current study seeks to examine the relationship between STS and somatic health complaints as well as the potential mediating effect of anxiety. It was hypothesized that STS would predict somatic health complaints, and that anxiety would mediate this relationship. An international sample of 528 women with a sexual trauma history was recruited via social media (Reddit) and mediation results were found using the “psych” package for RMarkdown (Version 5.2.2) with bootstrapping (5000 samples). Overall, the model was significant R2 = .19, (F(2,1230) = 148.53, p < .01). Regression analyses revealed that sexual trauma stigma was a significant predictor of both anxiety (b = .21, SE = .01, p < .01) and somatic health symptoms (b = .13, SE =.01, p < .01), and that anxiety also predicted somatic symptoms (b = .39, SE = .03, p < .01). Anxiety was found to significantly mediate the relationship between sexual trauma and somatic health symptoms, b = .08, SE = .01, 95% CI [0.06, 0 .11]. Current findings confirm the relationship between sexual trauma stigma and somatic health complaints and identify anxiety as an important mediator of this relationship. Providers should be aware that experiences of sexual victimization are related to feelings of stigmatization and may increase anxiety, impacting somatic health complaints. These findings indicate future clinical implications for trauma informed care within medical settings to better serve women who may experience stigma related to sexual trauma and highlights anxiety as a key target for interventions to reduce somatic symptoms.
5

Qualidade de vida relacionada à saúde de mulheres grávidas com baixo nível socioeconômico. / Health related quality of life of lower socioeconomic class pregnant women.

Marlise de Oliveira Pimentel Lima 14 July 2006 (has links)
Este estudo teve como objetivos: descrever a qualidade de vida relacionada à saúde de um grupo de mulheres grávidas assistidas em um serviço de pré-natal e; identificar a influência da idade gestacional, do número de queixas, da renda per capita e da percepção da suficiência da renda na qualidade de vida relacionada à saúde das mulheres grávidas. A amostra constou de 202 gestantes matriculadas em um serviço filantrópico de pré-natal de baixo risco, de São Paulo, SP, no ano de 2005. Os dados sociodemográficos e obstétricos foram obtidos por meio de entrevista e o da avaliação da qualidade de vida relacionada à saúde por meio do questionário auto-aplicado, o “MEDICAL OUTCOMES STUDY 36-ITEM SHORT FORM HEALTH SURVEY (MOS-SF-36)”. Os dados sociodemográficos das gestantes mostraram: idade média 24,97 anos, raça caucasiana (51,5%), escolaridade média de 8,88 anos, com parceiro fixo (89,6%), procedente de diferentes regiões da cidade de São Paulo; 52,5% exerciam atividades domésticas; 36,6% moravam em casas de alvenaria alugadas; renda familiar média de R$984,25 e per capita de R$312,80. Para 67,2% das gestantes a satisfação das necessidades básicas pela renda familiar foi percebida como pouco suficiente ou insuficiente. As características obstétricas foram: média de gestação de 2,09, 37,1% primigestas, 51,98% tinham filhos com idade média de 5,13 anos, idade gestacional média de 24,97 semanas, 85,1% citaram alguma queixa como dor em baixo ventre, náuseas e vômitos, lombalgia, pirose, dor em membros inferiores e cefaléia. Os coeficientes Alfa de Cronbach dos domínios variaram de 0,81 (Capacidade Funcional e Saúde Mental) a 0,41 (Aspecto Social). Em relação à qualidade de vida o maior escore médio foi em Estado Geral de Saúde e o menor em Aspectos Físicos. A idade gestacional apresentou uma fraca associação inversa com os domínios de Capacidade Funcional, Aspectos Físicos e Dor. Gestantes sem queixas diferiram das com três ou mais queixas nos domínios Dor, Estado Geral de Saúde, Vitalidade, Aspectos Sociais e Saúde Mental. A renda per capita não mostrou significância estatística em nenhum domínio. A percepção da suficiência da renda mostrou diferenças estatisticamente significantes nos domínios Dor, Vitalidade, Aspectos Emocionais e Saúde Mental. / The objectives of this study was to describe the health related quality of life of a group of pregnant women enrolled in a pre-natal service and identify the influence of the gestational period, number of complaints, per capita income and perception of sufficient income in the pregnant women’s health related quality of life. The sample consisted of 202 pregnant women registered in a low-risk prenatal philanthropic service of the city of Sao Paulo in the year 2005. The obstetric and demographic data were obtained through interviews and a self-administered questionnaire, the “MEDICAL OUTCOMES STUDY 36-ITEM SHORT FORM HEALTH SURVEY (MOS-SF-36)” to evaluate the health related quality of life. The demographic data showed an average age of 24.97; Caucasian (51.5%); average schooling of 8.99 years; 89.6% had a partner; coming from different regions of the city of Sao Paulo; 52.5% engaged in domestic activities; 36.6% lived in rented houses; and the average family income was R$984.25 and per capita was R$312.80. For 67.2% of the pregnant women, the satisfaction of basic necessities by the family income was perceived as barely sufficient or insufficient. The obstetric characteristics were: gestational average of 2.09; 37.1% primigravida; 51.98% had children with the average age of 5.13; average gestational age of 24.97 weeks; 85.1% reported complaints such as lower abdominal pain, nausea, vomiting, lumbago, pyroses, legs pain and cephalalgia. The Alfa de Cronbach’s coefficients of the domains varied from 0.81 (Physical Functioning and Mental Health) to 0.41 (Social Functioning). In relation to the quality of life, the highest average score was in General Health and the lowest was in Role Limitation due to Physical Problems. The gestational ages showed a weak inverse relationship with the Physical Functioning, Role Limitation due to Physical Problems and Bodily Pain domains. The subjects without complaints differed from those with three or more complaints in the Bodily Pain, General Health, Vitality, Social Functioning and Mental Health domains. The per capita income did not show to be statistically significant in any category. Unlike the perception of sufficient income, which provided statistically significant differences in the Bodily Pain, Vitality, Role Limitation due emotions and Mental Health domains.
6

Mulheres no climatério: nível de informações, ansiedade, depressão, qualidade de vida e resultados de uma intervenção psicológica / Women in the climateric: level of informations, anxiety, depression, quality of life and results of a psychological intervention

Jaqueline Rodrigues da Cunha Netto 24 June 2002 (has links)
Em decorrência do aumento da expectativa de vida, um número cada vez maior de mulheres tem oportunidade de vivenciar o climatério e a menopausa. O climatério deve ser compreendido como evento biológico determinado pelo contexto sócio-cultural. Para muitas mulheres, em função da desinformação e de mitos, este período é visto negativamente. Este estudo teve como objetivos caracterizar um grupo de mulheres no climatério quanto ao nível de informações, ansiedade, depressão e qualidade de vida, e verificar os resultados de uma intervenção psicológica, sobre estes aspectos. Os sujeitos foram 45 mulheres com idades entre 45 e 60 anos, divididas em 6 grupos, pacientes do Ambulatório de Ginecologia do Centro Médico Social e Comunitário de Vila Lobato e do Centro de Saúde Escola Prof. Dr. Joel Domingos Machado da FMRP-USP. Foi desenvolvida uma intervenção psicológica, em contexto grupal, com o objetivo de informar sobre a síndrome do climatério, apoiar e preparar psicologicamente as pacientes. A intervenção consistiu em 12 encontros semanais com duração de 1:30 h cada. Visando facilitar a discussão e vivência dos temas propostos (definição de climatério e menopausa, sexualidade, envelhecimento, relacionamentos familiares e processo de envelhecimento), foram utilizadas técnicas de dinâmica de grupo. As participantes, ao início e ao final da intervenção, foram avaliadas quanto ao nível de informações, ansiedade, depressão e qualidade de vida. Os instrumentos utilizados foram: Inventário de Ansiedade Traço-Estado (IDATE), Inventário de depressão de Beck, Instrumento de Avaliação de Qualidade de Vida (WHOQOL-Bref) e um questionário, elaborado pelo pesquisador, sobre conhecimentos a respeito do climatério, menopausa, sexualidade, envelhecimento e hábitos de vida saudáveis. Na avaliação inicial do questionário de conhecimentos, as questões referentes ao climatério, menopausa e sexualidade apresentaram os maiores percentuais de respostas incorretas. Nas questões sobre envelhecimento, os resultados apontaram que a maioria das participantes acredita que a velhice é uma fase possível de ser vivida de maneira positiva. Esse dado é contraditório, quando comparado com o resultado da questão que considera a velhice como uma etapa com consequências apenas negativas. As participantes demonstraram conhecer os comportamentos que podem contribuir para uma vida mais saudável no climatério. Entretanto, a maioria delas relatou não praticá-los. A avaliação inicial apontou que quanto à ansiedade traço e estado, as mulheres avaliadas apresentaram resultados considerados normais quando comparados à padronização. Na avaliação inicial da depressão, as participantes apresentaram alterações no estado de humor (disforia). Em relação à qualidade de vida, na avaliação pré intervenção, os escores apresentados pelas participantes, quando comparados ao estudo normativo, mostraram-se reduzidos nos aspectos psicológicos e sociais. A comparação dos resultados das avaliações pré e pós intervenção mostrou que, no questionário de conhecimentos, houve aumento significativo no percentual de respostas adequadas, nas questões referentes à diferença entre climatério e menopausa, conceitos de climatério e menopausa, finalidade da terapia de reposição hormonal, beleza e sensualidade no climatério. A avaliação final apontou diminuição na média da ansiedade estado comparada à aplicação inicial, o que pode indicar uma contribuição da intervenção neste sentido. Quanto à depressão, a diminuição média dos escores mostra que, após a intervenção, as participantes enquadraram-se na categoria sem depressão. A partir destes resultados, conclui-se que intervenções visando informar e preparar as mulheres para vivenciar o climatério podem contribuir para melhorar a qualidade de vida. / Because of the increase in life expectancy, an increasing number of women have the opportunity to experience the climacteric and menopause. The climacteric should be understood as a biological event determined by the sociocultural context . Because of lack of information and popular beliefs, many women have a negative vision of this period. The objective of the present study was to characterize a group of women in the climacteric in terms of extent of information, anxiety, depression and quality of life and to verify the results of a psychological intervention about these aspects. Forty-five women aged 45 to 60 years attended at the Gynecology Outpatient Clinic of the Medical Social and Community Center of Vila Lobato and at the Teaching Health Center Prof. Dr. Joel Domingos Machado, FMRP-USP, were divided into 6 groups. The intervention consisted of 12 weekly meetings lasting 1:30 h each. Group dynamics techniques were used in order to facilitate the discussion and experience of the proposed topics (definition of climacteric and menopause, sexuality, family relations, and aging process). The participants were evaluated at the beginning and at the end of the intervention in terms of level of information, anxiety, depression, and quality of life. The instruments used were the State-Trait Anxiety Inventory (STAI), Beck Depression Inventory, an Instrument for the Evaluation of the Quality of Life (WHOQOL-Bref), and a questionnaire elaborated by the investigator about knowledge concerning the climacteric, menopause, sexuality, aging, and healthy life habits. In the initial evaluation of the questionnaire, the questions referring to climacteric, menopause and sexuality presented the highest percentages of incorrect responses. The replies to the questions about aging indicated that most of the participants believed that old age is a phase of life that can be lived in a positive manner. This is a contradictory result when compared to the responses to the question that considers old age as a stage of life with only negative features. The participants showed that they were aware of the behaviors that can contribute to a healthier life during the climacteric. However, most of them reported that they did not practice these behaviors. The initial evaluation showed that the results obtained for the women studied were normal when compared to the reference standard with respect to state-trait anxiety. In the initial evaluation of depression, the participants showed changes in mood (dysphoria). With respect to quality of life, the scores obtained in the initial evaluation were found to be reduced in terms of psychological and social aspects when compared to normative studies. Comparison of the pre- and post-intervention evaluations showed that there was a significant increase in the percentage of adequate responses to the questions concerning the difference between climacteric and menopause, the purpose of hormonal replacement therapy, and beauty and sensuality during the climacteric. The final evaluation indicated a decrease in mean anxiety state compared to the initial evaluation, possibly indicating a contribution by the intervention. With respect to depression, the mean decrease in the scores showed that, after intervention, the participants fitted the category without depression. On the basis of these results, we conclude that interventions aiming at informing and preparing women about experiencing the climacteric can contribute to improving the quality of life.
7

Qualidade de vida relacionada à saúde de mulheres grávidas com baixo nível socioeconômico. / Health related quality of life of lower socioeconomic class pregnant women.

Lima, Marlise de Oliveira Pimentel 14 July 2006 (has links)
Este estudo teve como objetivos: descrever a qualidade de vida relacionada à saúde de um grupo de mulheres grávidas assistidas em um serviço de pré-natal e; identificar a influência da idade gestacional, do número de queixas, da renda per capita e da percepção da suficiência da renda na qualidade de vida relacionada à saúde das mulheres grávidas. A amostra constou de 202 gestantes matriculadas em um serviço filantrópico de pré-natal de baixo risco, de São Paulo, SP, no ano de 2005. Os dados sociodemográficos e obstétricos foram obtidos por meio de entrevista e o da avaliação da qualidade de vida relacionada à saúde por meio do questionário auto-aplicado, o “MEDICAL OUTCOMES STUDY 36-ITEM SHORT FORM HEALTH SURVEY (MOS-SF-36)". Os dados sociodemográficos das gestantes mostraram: idade média 24,97 anos, raça caucasiana (51,5%), escolaridade média de 8,88 anos, com parceiro fixo (89,6%), procedente de diferentes regiões da cidade de São Paulo; 52,5% exerciam atividades domésticas; 36,6% moravam em casas de alvenaria alugadas; renda familiar média de R$984,25 e per capita de R$312,80. Para 67,2% das gestantes a satisfação das necessidades básicas pela renda familiar foi percebida como pouco suficiente ou insuficiente. As características obstétricas foram: média de gestação de 2,09, 37,1% primigestas, 51,98% tinham filhos com idade média de 5,13 anos, idade gestacional média de 24,97 semanas, 85,1% citaram alguma queixa como dor em baixo ventre, náuseas e vômitos, lombalgia, pirose, dor em membros inferiores e cefaléia. Os coeficientes Alfa de Cronbach dos domínios variaram de 0,81 (Capacidade Funcional e Saúde Mental) a 0,41 (Aspecto Social). Em relação à qualidade de vida o maior escore médio foi em Estado Geral de Saúde e o menor em Aspectos Físicos. A idade gestacional apresentou uma fraca associação inversa com os domínios de Capacidade Funcional, Aspectos Físicos e Dor. Gestantes sem queixas diferiram das com três ou mais queixas nos domínios Dor, Estado Geral de Saúde, Vitalidade, Aspectos Sociais e Saúde Mental. A renda per capita não mostrou significância estatística em nenhum domínio. A percepção da suficiência da renda mostrou diferenças estatisticamente significantes nos domínios Dor, Vitalidade, Aspectos Emocionais e Saúde Mental. / The objectives of this study was to describe the health related quality of life of a group of pregnant women enrolled in a pre-natal service and identify the influence of the gestational period, number of complaints, per capita income and perception of sufficient income in the pregnant women’s health related quality of life. The sample consisted of 202 pregnant women registered in a low-risk prenatal philanthropic service of the city of Sao Paulo in the year 2005. The obstetric and demographic data were obtained through interviews and a self-administered questionnaire, the “MEDICAL OUTCOMES STUDY 36-ITEM SHORT FORM HEALTH SURVEY (MOS-SF-36)" to evaluate the health related quality of life. The demographic data showed an average age of 24.97; Caucasian (51.5%); average schooling of 8.99 years; 89.6% had a partner; coming from different regions of the city of Sao Paulo; 52.5% engaged in domestic activities; 36.6% lived in rented houses; and the average family income was R$984.25 and per capita was R$312.80. For 67.2% of the pregnant women, the satisfaction of basic necessities by the family income was perceived as barely sufficient or insufficient. The obstetric characteristics were: gestational average of 2.09; 37.1% primigravida; 51.98% had children with the average age of 5.13; average gestational age of 24.97 weeks; 85.1% reported complaints such as lower abdominal pain, nausea, vomiting, lumbago, pyroses, legs pain and cephalalgia. The Alfa de Cronbach’s coefficients of the domains varied from 0.81 (Physical Functioning and Mental Health) to 0.41 (Social Functioning). In relation to the quality of life, the highest average score was in General Health and the lowest was in Role Limitation due to Physical Problems. The gestational ages showed a weak inverse relationship with the Physical Functioning, Role Limitation due to Physical Problems and Bodily Pain domains. The subjects without complaints differed from those with three or more complaints in the Bodily Pain, General Health, Vitality, Social Functioning and Mental Health domains. The per capita income did not show to be statistically significant in any category. Unlike the perception of sufficient income, which provided statistically significant differences in the Bodily Pain, Vitality, Role Limitation due emotions and Mental Health domains.
8

The Effects of the Patient-Provider Interaction During Contraceptive Counseling on the Satisfaction with and Confidence Using the Selected Birth Control Method Among Southern Women

McCartt, Paezha, Hale, Nathan 12 April 2019 (has links)
INTRODUCTION) Modern contraception is a safe and effective clinical service for reducing unintended pregnancy and improving birth spacing for women. Provider counseling is an important factor that may influence women’s decision making, satisfaction, and self-efficacy with contraception use. This study measures women’s perceptions of recent provider interactions and examines the extent to which these perceptions are associated with method satisfaction and confidence in use. We hypothesize that women who perceive more positive interactions are ultimately more satisfied and confident with their contraceptive method choice. METHODS) A cross-sectional survey of adult reproductive-aged women in two southern states (aged 18 to 44 years old) was used for the analysis. The Statewide Survey of Women was conducted in 2017 by NORC at the University of Chicago. Women were asked to rate providers across a series of statements reflecting aspects of patient-centered contraceptive counseling using a 5-point Likert scale. Responses were dichotomized to reflect those with very good/excellent experiences compared to those with less favorable experiences (Poor, Fair, Good). Women were subsequently asked about their level of satisfaction with current contraceptive methods and confidence in use, also using a 5-point Likert scale. These measures were also dichotomized. A chi-squared test for independence and unadjusted logistic regression models were used to examine associations between patient-provider interactions, satisfaction and confidence in contraceptive use. FINDINGS) The survey included 4,281 respondents. The majority of women reported being satisfied with their current contraceptive method (92.6%) and confident in its use (94.9%). Approximately 93% of women who felt respected as a person by their provider also reported being satisfied with their current birth control method, compared to 73% among women who did not feel respected as a person (p<0.001). Among women who felt their provider allowed them to say what mattered to them about their birth control method, 93.5% were satisfied with their current method, compared to 75% among those who did not feel allowed to say what mattered (p<0.001). Women who felt like their provider took their preferences for birth control into consideration were also more satisfied with their current birth control method compared to those who did not feel the same way (93.7% versus 73.5%; p<0.001). Women who felt their provider allowed them to say what mattered and those who felt their provider took their preferences into consideration were also associated with higher rates of confidence in correct use. Women reporting that their provider gave them enough information to make the best decision about their birth control method was also associated with greater confidence in correct use (95.6% versus 87.5%; p=0.007). CONCLUSION) Findings suggest that positive patient-provider interactions are associated with increased satisfaction in current contraceptive method use. Interestingly, women reporting that providers did not give them enough information to make the best decision about birth control methods also reported being less confident in using their current method. Collectively, these findings support existing evidence suggesting that patient-provider interactions are important for patient-centered care and can be used to inform future clinical practice guidelines around contraceptive counseling.
9

A Qualitative Research Synthesis of Contextual Factors Contributing To Female Overweight and Obesity over the Life Course in Sub-Saharan Africa

Ozodiegwu, Ifeoma, Littleton, Mary Ann Ann, Ph.D., Quinn, Megan, Mamudu, Hadii 12 April 2019 (has links)
Adult women are disproportionately burdened by overweight and obesity in Sub-Saharan African (SSA) countries and there is limited understanding of the sociocultural context of this problem. In this qualitative research synthesis, we aimed to surface contextual influences that potentially predispose adult women and adolescent girls to overweight and obesity. PubMed, CINAHL, PsychInfo, PROQUEST, EMBASE, Web of Science were searched to locate qualitative research articles conducted in sub-Saharan African countries beginning in year 2000. After assessment for eligibility and critical appraisal, 16 studies were included in the synthesis. Textual data and quotes was synthesized using the methods proposed by the Joan Briggs Institute and a thematic analysis framework. The synthesized studies were conducted in South Africa, Ghana, Kenya and Botswana. The three overarching themes across these studies were body size and shape ideals, barriers to healthy eating, and barriers to physical activity with cultural and social factors as cross-cutting influences within the major themes. Culturally, the ideal African woman was expected to be overweight or obese, and voluptuous and this was associated with their identity. While overweight and obesity was not acceptable among adolescent girls, they also desired to be voluptuous. Healthy food choices among women and girls were hampered by several factors including affordability and peer pressure. Both adult women and girls experienced ageism and institutional discrimination as barriers to physical activity. This is the first qualitative research synthesis to amplify the voices of women and girls in SSA countries highlighting the challenges they face in maintaining a healthy weight. Sociocultural, institutional and peer-related factors were powerful forces shaping body size preferences, food choices and participation in physical activity. Our study findings provide insights for the design of contextually appropriate interventions and lay the foundation for further research studies.
10

Uneasy Tensions in Health Care Delivery in a Rural Appalachian Coal Mining Community: Envisioning Alternative Solutions

Lee, Renee Gravios 28 June 1996 (has links)
Research consistently supports that some segments of society are at considerably higher risk for illness and death than the national average. While the existence and extent of poor health outcomes for these "vulnerable populations" are well documented, less research attempts to explain why such inequities persist and how they might be resolved. Thus, many vulnerable individuals fail to get adequate health care. How can health care delivery be improved to better serve those consumers most at risk of poor health? Addressing this issue requires an in-depth understanding of the unique health and social needs of vulnerable consumers and how these needs are being met (or not met) by the health care industry. Based on field research using a variety of methods, this study examined health care delivery to one at-risk population, women in a rural Appalachian coal mining community, with the ultimate goal of envisioning service design and distribution strategies that might better serve disadvantaged populations. Consistent with the change-oriented goal of this research, a feminist approach guided this study. Women's everyday experiences in managing their health needs were explored through an analysis of their health care stories. Health care providers were also interviewed in order to explore both sides of the service encounter dyad. The voices of the women and the providers reveal uneasy tensions in health care delivery and illuminate why the current system does not meet the actual health care needs of the women or their community. A variety of solutions are offered to improve health care delivery. / Ph. D.

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