The ability to access primary care services within the local community has a direct impact on the health and wellness of the community. Individuals living in rural settings face multiple challenges when attempting to access care. The purpose of this retrospective project was to identify barriers in 2 rural, underserved communities and make recommendations for process changes that could reduce these barriers. Data were gathered from 2 critical access hospitals and 2 rural health clinics located in rural, underserved areas in Iowa. Both hospitals identified access to health services as an issue within their communities. Administrative data were gathered on nonemergent use of the emergency department, which revealed peak use from 10 a.m. to 11 a.m., 12 p.m. to 1 p.m., and 4 p.m. to 5 p.m. Clinic data included patient demographics, staffing and scheduling patterns, and the number of patient visits. One site provided expanded hours, yet very little difference in the number visits to the emergency room for nonemergent care was identified. Both clinic sites reported the need for additional providers to meet the needs of their patients and provide more same-day appointments. Recommendations made to increase access were open scheduling, staggered staff schedules to increase appointments over peak demand times, and use of a dedicated case manager to improve communication and coordination of care. Increased use of technology would allow the provision of care outside the clinic setting, enhance care coordination, and promote patient participation in care. With increased knowledge regarding the barriers facing rural communities when accessing care, process changes can be implemented to reduce barriers. The overall goal is to improve health and wellness through increased access.

Objective: To determine the factors associated with an increased risk for PTSD in ambulance personnel and the barriers faced in accessing support for work related stress (WRS). Methods: A cross-sectional study of voluntary participants comprising 388 ambulance personnel was conducted. Participants completed self-administered questionnaires: Impact of Event Scale-Revised (IES-R), EMS Critical Incident Inventory (CII), EMS Chronic Stress Questionnaire (EMSCSQ), SF-36 Quality of Life questionnaire (SF-36) and Connor-Davidson Resilience Scale (CD-RISC) which were used to assess PTSD and level of occupational stressors. Results: The prevalence of PTSD in the study population was 30%. Participants were predominantly female (55%), median age 38 (IQR; 31 - 44) years with a professional qualification (83%). Those with PTSD were more likely current smokers (OR=1.76, 95% CI: 1.05 - 2.95), current illicit drug users (OR=16.4, 95% CI: 1.87 - 143.86) and problem drinkers (OR=3.86, 95% CI: 1.80 - 8.23). A self-reported mental health condition (OR=3.76, 1.96 - 7.21), being treated for a medical condition (OR=1.95, 1.22 - 3.11), exposure to chronic WRS (OR=1.05, 1.04 - 1.07) and high critical incident stress score (OR=1.03, 1.02 - 1.04) were positively associated with PTSD risk. Barriers to seeking help for WRS included concerns that services were not confidential, and that the participant's career would be negatively affected. Conclusion: The PTSD prevalence in ambulance personnel is considerably higher than that found in previous studies conducted among this occupational group in the Western Cape. Identified risk factors should inform interventions designed to support ambulance personnel and a greater focus on addressing barriers to accessing care is needed.

No description available.

No description available.

No description available.

Stroke is a leading cause of long term disability in the United States. The therapeutic benefits of intravenous thrombolytics is time dependent in an acute ischemic stroke patient and is an important determinant of 90 day and one year functional outcomes. This study investigated areas in the stroke alert process of a community based primary stroke care center that resulted in the delay of administration of thrombolytics within 60 minutes of an acute ischemic stroke patient's arrival to the emergency room. A retrospective descriptive design was utilized and chart reviews were done on 40 patients that received thrombolytics in the emergency room. Patient characteristics and time variables associated with the various steps in the stroke alert process were extracted. Findings showed that only 7.5% of the patients received thrombolytics within the recommended 60 minutes, with the longest time interval associated with time from arrival to the emergency room to time of evaluation by teleneurologist. There were no significant differences in the characteristics of patients who received thrombolytics within 60 minutes and those patients that received thrombolytics after 60 minutes. Recommendations were made for changes in organizational and practice strategies to improve timely administration, and for future research involving the effects of quality improvement initiatives

BACKGROUND: Visual impairment impacts over 15% of Americans over the age of 65, roughly 7.3 million people. Currently there is no statewide model for low vision rehabilitation services that serves individuals across the visual impairment continuum. This dissertation sought to examine the existing eye care service delivery models, identify best practices, and explore perceived barriers and facilitators to access low vision rehabilitation services for older adults in order to inform the development of a revised service delivery model. The model will guide practice and policy change for existing and future services. METHODS: A mixed methods convergent approach was used to achieve the study’s overarching objectives. First, quantitative data from a synthetic estimation, was used to categorize high and low resource communities, which informed the purposeful sampling of focus groups and provided essential data to guide model development. Next, focus groups and one-on-one key stakeholder interviews were held to understand stakeholder perspectives on access to low vision rehabilitation services in both high and low resource communities. Further, one-on-one interviews with focus group participants provided additional quantitative data on individual prioritized barriers. Taken together, qualitative and quantitative research was conducted concurrently and then merged and expanded to inform a low vision rehabilitation focused care delivery model grounded in the Institute for Health Improvement’s Chronic Care Model. RESULTS: Key findings indicate the need for a model of service delivery that provides the full continuum of care, beginning with a low vision eye exam, which is coordinated throughout the community and health systems and addresses the chronic nature of visual impairment. Care should be client-centered and provided when the client is ready to accept services. Lastly, ongoing education to health care providers, consumers, and society will facilitate productive interactions and positive health outcomes. CONCLUSION: The stakeholder-driven low vision rehabilitation focused care delivery model grounded in the Chronic Care Model will provide a structure for service delivery throughout the state. This collaboration with community and health systems, as well as case management, will assist with program sustainability and reach to all adults throughout the state living with VI. / 2020-06-30T00:00:00Z

Identifying factors that influence physical activity (PA) among individuals with Down syndrome (DS) is essential for PA promotion. Insight can be gained from guardians and health professionals. The purpose was to compare guardians and health professional perspectives on facilitators and barriers of PA in individuals with DS. Interviews were conducted with 11 guardians (5 mothers, 4 fathers, 2 legal guardians) and 11 professionals (4 PA specialists, 3 physical therapists, 4 occupational therapists). Grounded Theory was applied to data analysis. Barriers and facilitators fit the levels of the Ecological Model of Health Behavior: (a) Intrapersonal (perceived rewards); (b) Interpersonal (interaction); (c) Community (availability of programs); (d) Organizational (school systems); (e) Policy (education). Guardians and professionals agreed on the importance of enjoyment, interaction, and programs to promote PA. Differences were found among organizational and policy levels. PA in persons with DS is influenced by interactions between individual and environmental factors.

This qualitative study investigates senior ranking policemen’s perceptions, perspectives, and experiences with policewomen. More specifically, the level of awareness that senior ranking policemen have regarding the barriers and challenges encountered by policewomen, and what police organizations are doing to address the barriers and challenges. Data were generated through in-depth semi-structured interviews with nine senior ranking policemen from two police organizations within Canada. The overall methodological approach in this study was qualitative and used a process of analytic analysis informed through grounded theory (Saldaña, 2011). The research findings reveal that Canadian police organizations are gendered worksites, where policewomen continue to encounter daily organizational challenges, thereby restricting their full participation and overall wellness, within police organizations. Despite the many challenges and barriers for policewomen, the senior ranking policemen remain hopeful that policewomen will have more parity, equality, and equity in the years ahead. My study separates itself from past research on gender and policing as my study is Canadian based, with most of the previous studies being done in other parts of the world. In addition, my study separates itself as it the only one that has drawn upon the National Institute of Justice Report (Starheim, n.d.) and their subsequent 30x30 initiative, while centering senior ranking policemen’s experiences and perspectives in relation to gender equality and gender equity issues. / Graduate

In order to adequately design for and promote safe and regular use of the bicycle as a form of active transportation, researchers and policy-makers alike would benefit from the input of practiced bicyclists. These lay experts possess unique experiential knowledge of local routes, gaps in the network and the degree of comfort afforded by different types of infrastructure. Furthermore, these individuals are adept at commenting on subjectively valuable aspects of bicycling, which may assist in informing promotion and marketing of this activity. This research draws on the knowledge of lay experts who regularly bicycle in Hamilton, Ontario. The objectives of this research were to identify and understand the challenges associated with bicycling in Hamilton, and to explore the subjective identities of Hamilton’s cyclists. A thematic analysis of 10 semi-structured interviews was conducted and the following themes were identified and explored: an array of physical, structural and social deterrents to bicycling exist in Hamilton; and the identities of Hamilton’s cyclists are complex, locally rooted and multidimensional in nature. Using a critical lens, with the help of the Social Ecological Model of Health and Identity Theory, this study draws the following conclusions: cyclists are well-equipped to critically evaluate the urban spaces through which they travel; cyclists may play an important role in encouraging non-users to take up bicycling; and cyclists and auto drivers may benefit from collaborating over mutually beneficial goals. Furthermore, while many individuals who ride bicycles do identify themselves as “cyclists” this terminology can be contentious and the identity is heavily rooted in cyclists’ local context. Although this identity is primarily experienced individually, a sense of community does exist; and the identity often spans beyond the simple action of riding a bicycle. / Thesis / Master of Arts (MA) / In order to adequately design for and promote safe and regular use of the bicycle as a form of active transportation, researchers and policy-makers alike would benefit from the input of practiced bicyclists. These lay experts possess unique experiential knowledge of local routes, gaps in the network and the degree of comfort afforded by different types of infrastructure. Furthermore, these individuals are adept at commenting on subjectively valuable aspects of bicycling, which may assist in informing promotion and marketing of this activity. This research draws on the knowledge of lay experts who regularly bicycle in Hamilton, Ontario. The objectives of this research were to identify and understand the challenges associated with bicycling in Hamilton, and to explore the subjective identities of Hamilton’s cyclists. An analysis of 10 semi-structured interviews was conducted and the following themes were identified and explored: an array of physical, structural and social deterrents to bicycling exist in Hamilton; and the identities of Hamilton’s cyclists are complex, locally rooted and multidimensional in nature. This research emphasizes the contributions bicyclists have to offer social science literature and highlights the need for continual input and engagement with everyday bicycle users. This ongoing communication is important to adequately support and encourage regular and new bicycle users in practicing this healthy and sustainable means of transportation.