On September 20th, 2017, Hurricane Maria made landfall on the island of Puerto Rico causing devastating results. An Island with a history of decades of economic recession, inadequate infrastructure, and a negative effect of a century of colonial rule by the United States, Hurricane Maria unquestionably intensified the catastrophic circumstances in Puerto Rico. (Cons 2017; Torres 2018; Gay et al 2019). The aftermath of Hurricane Maria left thousands homeless and without basic resources in the Island. The study examines the effects of disparate social factors on individual responses to trauma before, during, and after the disaster and illuminates the circumstances affecting migratory decisions and displacement to Central Florida. To accomplish this, I analyzed 16 in-depth interviews about individuals' experiences with Hurricane Maria and subsequent displacement to Central Florida immediately following the storm. First, consistent with the fundamental premise of the Model of Conservation of Resources (COR), the individual's aim to retain, protect, and build resources after a natural disaster significantly affected trauma responses by Hurricane Maria survivors. The storm had a major impact on the individual's ability to preserve, safeguard, and restore critical resources after the storm. Second, individuals use narratives to create meaning, alleviate stress, and increase group identification as coping mechanisms after the traumatic event. Finally, experience with discrimination and prejudice and difficulties with English language proficiency once in the US, affected individual responses to trauma. Overall, pre-disaster social inequalities had a significant effect on trauma responses during and after the storm.

Objective: In 2018, 11.1% of American households were food insecure at least once. Annual reports on food insecurity conducted by the United States Department of Agriculture study the prevalence of household food insecurity; however, they fail to conceptualize the consequences that are associated with being food insecure. The objective of this study is to analyze the impacts of food insecurity on academic performance of children currently enrolled in an Orange County, Florida, K-12 public school. Methods: One focus group and 10 one-on-one interviews were conducted with parents who have at least one child currently enrolled in a K-12 public school in Orange County, Florida, to capture the concerns that they have regarding food and their children's academic performance. In addition to this qualitative approach, a quantitative survey was administered to the respondents to measure the extent to which they are food insecure. Results: The data from this study show that food insecurity can impact a child's ability to perform to their fullest potential in school. Mainly parents reported that their household's access to food impacts their children's ability to concentrate in school. Further, more salient findings emerged, such as the costs of living in Orange County, a need for greater government assistance, reliance on outside sources of food to feed their children, transportation issues, and health issues. Conclusion: Sociodemographic factors are known to have an effect on a child's academic performance. The findings represented in this paper suggest that social factors related to poverty disadvantage children in their pursuit of succeeding academically.

In 2017, only 56% of births in Orange County, Florida, received adequate prenatal care - care that has been shown to prevent maternal and infant death. The Florida Department of Health uses the Kotelchuck Index to determine care adequacy. This index rates care adequacy based on when the mother first receives care, and how many recommended appointments she attends. Prenatal care is rated "inadequate" if it starts after the fourth month of pregnancy, and/or if less than half of the recommended appointments are attended. Receiving earlier and consistent prenatal care has been shown to be an effective way to improve birth outcomes. In Florida, counties that have low adequate prenatal care rates like Orange County's tend to be less populous and rural. However, Orange County stands out with its large population of 1.3 million and more urban environment; other Florida counties similar in population and environment to Orange tend to have rates like that of the state's, at approximately 70%. The objective of this study is to determine which factors contribute most significantly to prenatal care inadequacy in Orange, Duval, Hillsborough, Miami-Dade, and Pinellas counties; determine the differences between the most significant factors in Orange County and those in the other four counties; and to determine if residing in Orange County in of itself a risk factor for inadequate prenatal care, using logistic regression. By identifying factors that may lead to low adequacy rates, interventions intended to increase care adequacy in Orange County can be better targeted towards populations in need.

September 20th, 2017 was a devastating day for many Puerto Ricans as Hurricane Maria made landfall in Puerto Rico. A majority of people were left without electricity, water, transportation, and communication between friends and family. In addition, many experienced losses such as destruction of their home and personal belongings as well as the death of family members and friends. This resulted in a decline in mental health. According to previous literature, key indicators of poor mental health in Puerto Rico after Hurricane Maria were increased diagnoses of depression, anxiety, and Post Traumatic Stress Disorder (PTSD). This study provides a comprehensive literature review that examines differences in mental health and trauma between those who, after Hurricane Maria, migrated to Florida compared to those that remained in Puerto Rico. I also used interviews from a previous study and various newspaper articles to answer my research question. Preliminary findings suggest that trauma and anxiety have been identified in both groups. Finally, I was able to interview a mental health counselor from Puerto Rico via Zoom. Findings from the literature review and other data sources explored several contextual differences related to mental health including trauma, PTSD, resilience, depression, anxiety, as well as medical and psychological needs.

Thesis (M.S.W.)--University of Hong Kong, 1980.

The use of outcome measures by rehabilitation professionals has been advocated for many years; however, routine use is still lacking. Literature on the factors influencing the use of outcome measures locally is limited; therefore, the purpose of this study was to determine the factors that influence the use of outcome measures by community-based physiotherapists in Gauteng Province. While 75 community-based physiotherapists from Gauteng Province invited to participate in the study, 48 community-based physiotherapists responded. A descriptive cross-sectional approach was used in this study. A validated questionnaire was piloted to test its applicability to the South African setting. Thirty-seven per cent of the participants used at least one outcome measure in practice. Support from colleagues and positive attitudes were identified as factors that facilitated the use while lack of knowledge, lack of skills and lack of time were identified as barriers towards the use of outcome measures. The only statistically significant relationship found was between the lack of knowledge and the lower level of use of outcome measures. In conclusion, it was evident that there was poor usage of outcome measures by community-based physiotherapists in Gauteng Province and the barriers identified ranged from individual level to organisational level. Recommendations are made regarding policy for the implementation of policies and guidelines on outcome measures and monitoring thereof in form of audits. Special interest groups could offer courses on outcome measures and physiotherapists be encouraged to undergo postgraduate education. Therefore, the researcher suggests that continuous training be provided within the workplace and outcome measures be adopted. / Dissertation (MPhysiotherapy)--University of Pretoria, 2017. / Physiotherapy / Mphysiotherapy / Unrestricted

Governance is a response to a recognition that traditional forms of decision-making have become inadequate to address complex societal and health problems generated by significant social and global changes (Chhotray & Stoker, 2009). The contributions of scientific and technical knowledge towards solving these complex problems have also been recognized as insufficient (Jasanoff, 2007). Community-based research (CBR) is an approach to research which is designed to make use of the knowledge of community and university members and their participation and collaboration ―in all phases of the research process, with a shared goal of producing knowledge that will be translated into action or positive change for the community‖ (Lantz, Israel, Schulz & Reyes, 2006, p. 239). However, although the contributions of lay knowledge have been acknowledged, how governance or collaborative decision-making is arranged in the context of community-based research is not well described in the literature. In order to address this knowledge gap, a study was undertaken in which in-depth interviews were conducted with community and university members of Canadian CBR collaborations to determine their governing experiences. Results are reported in a thesis by research papers. The first paper focuses on describing the governance structures that CBR collaborations used. In the second paper, the nature and content of problems which occurred in governing CBR collaborations, point to the importance of theory for conceptualizing and solving governance problems. To develop a theory of participation in governance of community-based research, the third paper uses Arnstein‘s theory of participation to propose a grounded theoretical basis for implementing participation in governance of CBR collaborations (Arnstein, 1969). Governance is a means of organizing, shaping and steering a course of decision-making. Governance is a critical component in the organization of knowledge production. Study and theory of governance in community-based research may help in improving understanding and implementation of a critical population health practice.

Governance is a response to a recognition that traditional forms of decision-making have become inadequate to address complex societal and health problems generated by significant social and global changes (Chhotray & Stoker, 2009). The contributions of scientific and technical knowledge towards solving these complex problems have also been recognized as insufficient (Jasanoff, 2007). Community-based research (CBR) is an approach to research which is designed to make use of the knowledge of community and university members and their participation and collaboration ―in all phases of the research process, with a shared goal of producing knowledge that will be translated into action or positive change for the community‖ (Lantz, Israel, Schulz & Reyes, 2006, p. 239). However, although the contributions of lay knowledge have been acknowledged, how governance or collaborative decision-making is arranged in the context of community-based research is not well described in the literature. In order to address this knowledge gap, a study was undertaken in which in-depth interviews were conducted with community and university members of Canadian CBR collaborations to determine their governing experiences. Results are reported in a thesis by research papers. The first paper focuses on describing the governance structures that CBR collaborations used. In the second paper, the nature and content of problems which occurred in governing CBR collaborations, point to the importance of theory for conceptualizing and solving governance problems. To develop a theory of participation in governance of community-based research, the third paper uses Arnstein‘s theory of participation to propose a grounded theoretical basis for implementing participation in governance of CBR collaborations (Arnstein, 1969). Governance is a means of organizing, shaping and steering a course of decision-making. Governance is a critical component in the organization of knowledge production. Study and theory of governance in community-based research may help in improving understanding and implementation of a critical population health practice.

Community Based monitoring (CBM): How facilitators can help Dalit and Adivassi communities in rural villages to participate in government programs to improve their health, educate their children, receive social security benefits and pensions, access rural work programs, enroll in pre and post natal care programs, and buy from government sponsored discount shops for basic necessities. In many parts of rural India the Dalit (lower caste) and Adivassi (tribal) populations are unjustly discriminated against and denied access to many government sponsored programs that could greatly improve their lives. Unnati is a NGO based in Gujarat with a location in Rajasthan. From the Rajasthan office, Unnati and partner organizations worked through facilitators to help citizens in 50 different villages form citizen collectives. These collectives were trained in basic community based monitoring techniques. Through CBM (Community Based Monitoring), these citizens with help from their facilitators, Unnati, and partner NGOs begin taking a more active role in six government sponsored programs or schemes. The facilitator manual I helped create is being used to further train current facilitators in Rajasthan and Gujarat. The manual will also be shared with other NGOs so that this program can be replicated with ease. The manual consists of an introduction to CBMs, criteria for being an Unnati facilitator, the facilitator roles and responsibilities, facilitator and village collectives’ goals, and a case study of two villages. Unnati asked me to undertake this project so that documentation exists for best practices as the CBM project continues. The CBM project began in April 2011. Survey results were recorded beginning in May. In June, surveys were reformatted and the current format has remained in place till December of 2011. Additionally, a part of the manual includes survey results as a model of correct and incorrect ways to document information as well as to show the importance of each question and what it indicates in terms of overall community health.

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