Thesis (M. Soc. Sc.)--University of Hong Kong, 1990.

Thesis (M.Soc.Sc.)--University of Hong Kong, 1990. / Also available in print.

The present study examines the extent to which blacks are segregated in the suburban community of Coconut Grove, Florida. Hypersegregation, or the general tendency for blacks and whites to live apart, was examined in terms of four distinct dimensions: evenness, exposure, clustering, and concentration. Together, these dimensions define the geographic traits of the target area. Alone these indices can not capture the multi-dimensional levels of segregation and, therefore, by themselves underestimate the severity of segregation and isolation in this community. This study takes a contemporary view of segregation in a Dade County community to see if segregation is the catalyst to the sometime cited violent response of blacks. This study yields results that support the information in the literature review and the thesis research questions sections namely, that the blacks within the Grove do respond violently to the negative effects that racial segregation causes. This thesis is unique in two ways. It examines segregation in a suburban environment rather than an urban inner city, and it presents a responsive analysis of the individuals studied, rather than relying only on demographic and statistical data.

BACKGROUND:The Affordable Care Act of 2010 proposed maximum penalty equal to 1% of regular Medicare reimbursements which prompted change in how hospitals regard 30-day readmissions. While several hospital to home transitional care models demonstrated a reduction in readmissions and cost savings, programs adapted to population needs and existing resources was essential.METHODS:Focusing on process and outcomes evaluation, a retrospective analysis of a modified community based care transitions program was conducted.RESULTS:In addition to high levels of patient satisfaction with the care transitions program, participants' confidence with self care was significantly improved. Further, the program evaluation demonstrated a 73% reduction in readmissions and an actual Medicare cost savings during the 9-month study period of $214,192, excluding the cost to administer the program.CONCLUSIONS:While there are several transitional care programs in existence, a customized approach is desirable and often required as the most cost effective way to manage care transitions and employ evidence based policy making. This study established some of the pitfalls when implementing a community-based transitional care program and demonstrated encouraging outcomes.

This research focused on diversion and community-based alternatives to custody for young offenders. For the purposes of this research, diversion, and community-based responses to youth crime include informal processes and non-incarcerating sanctions utilized for young offenders for the purposes of diverting youth away from the formal justice system at any juncture, and/or reintegrating that offender within the community. Measures of interest included extrajudicial measures, extra-judicial sanctions, conferencing, restorative justice, and intensive support and supervision under the YCJA (2002). This research followed a qualitative approach to examine policy and practice. Phase 1 involved an examination of over a decade of policy-related discussions within the House of Commons and Senate as well as their respective committees and resulting legislation reported by Legisinfo. Initially, all transcripts were examined. At a later stage, a proportional stratified random sample was drawn, restricting the sample to 32 items. Phase 2 involved semi-structured interviews conducted with 14 professionals in the field of youth justice with the aim of accessing practice narratives on policy implementation. Chain-referral and maximum variation sampling techniques were employed to access a diverse group of professionals including police, youth workers, restorative justice personnel and probation officers in the regions of Greater Vancouver, the Fraser Valley and Vancouver Island in the province of British Columbia. Participants ranged in length of service from one year to over 35 years. Thematic narrative analysis of phases 1 and 2 occurred iteratively with data collection. In this dissertation, I present findings regarding community youth justice measures at three levels: the operational/practice level, the policy-making level and the macro socio-political level. Specifically, findings related to the operational level include: insufficient resources available to individual workers; narrowing the net of youth who are eligible for services; a reliance on informal and formal charitable contributions to provide basic youth justice services; and outsourcing of diversion strategies by government to community organizations. On a policy-making level, I discuss findings related to the complex fusion of restorative justice and diversion strategies; the substitution of anecdotes for evidence in policy-making; and the simple rather than complex stories used to frame the “youth justice problem” by policy-makers. Finally, on the macro socio-political level, I highlight the reversal of the welfare state and the associated implications of this reversal. I analyze and discuss the impacts that ideological and policy shifts have on policy-making and individual practice, notably on the efforts of professionals who must begin the work of closing the gaps in youth justice services, and who do so based on their own understanding of social responsibility and the “ethos of care.” This research contributes to the body of work on youth justice in Canada by exploring the connections and disconnects between policy discourses at each of the political, policy and practice levels and highlights how such a multi-dimensional analysis is a meaningful way to assess an important social policy issue. / Graduate / 0627 / lorinda.stoneman@gmail.com

Background: The role of community matron (CM) was introduced to provide a single point of access to patients living with co-morbid long-term conditions who had, or were at risk of, frequent emergency admissions to hospital. CMs utilised case management as a means of managing this growing population of patients with fragile health. Since its inception, many changes in service delivery have impacted on the role. Aim: The aim was to undertake a mixed methodology study of the factors that have affected embedding of the community matron role in 3 geographical areas. Methodology: A pragmatic mixed methods approach (QUAL quan) was utilised. Settings and participants: The studies were based in health services within 2 cities and a rural area in central England. Participants for the qualitative components of the study were purposefully sampled. The sample comprised professionals: community matrons (n=21), managers (n=4), former commissioners (n=2) and GPs (n=3); and patients (n=10) and their family carers (n=5). Quantitative data for 212 people with long-term conditions were derived from the anonymised Patients at Risk of Rehospitalisation database (PARR data) held by area 1. Methods: Qualitative data were collected from participants using semi-structured interviews and audio diaries. For the quantitative component using PARR, some patient journeys within area 1 were explored. In addition, a sample of patients who were case managed by a CM (n=106) were matched with a set of patients who were not (n=106) and the data was examined. Findings: Participants were largely positive about the role of CM. However, difficulties with role setup had led to numerous changes which affected how the role has embedded. Additionally, this impacted understanding of the role by health care professionals, and caused practical and emotional difficulties for some CMs as they perceived the role to be eroded. The quantitative findings showed that CMs did not make a significant difference to hospital bed days used by patients on their caseload. Evaluating the role and finding an effective means of showing the work undertaken by CMs, which is often invisible, proved difficult. Conclusion: Embedding of the CM role has been affected by numerous changes in service delivery. Invisibility of community nursing rather than autonomy of the community matron role seems to be a key factor in the challenges of embedding the role. The significance of these findings is that using a mixed method approach and Liaschenko and Fisher’s adapted model may help CMs to improve the visibility of their role, and so helping the role to be less prone to the challenges of service redesign.

Thesis (PhD (Interdisciplinary Health Sciences. Human Nutrition))--Stellenbosch University, 2008. / Objectives: To determine the impact of facility-based semi-intensive and home-based intensive counseling strategies to improve exclusive breastfeeding rates and to identify factors associated with exclusive breastfeeding. Methods: This was a randomized trial in which villages in the Kibera slum, Nairobi Kenya were assigned to two intervention groups and a control group. Study participants from among 34-36 week pregnant, HIV-negative women, attending antenatal clinic at Lang’ata health centre, were assigned to study groups and followed up in their homes until 6 months postpartum. Experimental group 1, the Home-Based Intensive Counseling Group (HBICG)] received 7 counseling sessions; 1 prenatally and 6 postnatally. Experimental group 2, the Facility-Based Semi-Intensive Counseling Group (FBSICG) received 1 counseling session prenatally. The control group (Control Group) received irregularly provided health education by health personnel. Information on infant feeding practices, using a validated 24-hour recall questionnaire was collected monthly at participant homes; observations were conducted on a random 10% sub-sample to verify the reported information. Qualitative data from focus group discussions provided information on the rationale for feeding choices. Information on infant morbidity and weight measurements were taken on a monthly basis. Results: At six months, exclusive breastfeeding rate was 23.6% in HBICG; 9.2% in FBSICG; and 5.6% in CG. Mothers from HBICG had a 4.2 increased likelihood to exclusively breastfeed compared to those in the CG (RR=4.20; 95% CI; 1.66-10.64; p=0.002). Cumulative exclusive breastfeeding rate for 6 months was 3.2% in the CG; and 6.9% and 15.6% in the FBSICG and HBICG respectively (p<0.00001). Mothers from HBICG had a 3.4 increased likelihood to practice exclusive breastfeeding for 6 months compared to those in CG (RR=3.4; 95% CI: 1-34-8.80; p=0.010). Exclusive breastfeeding rates in FBSICG were insignificantly higher than those in the CG. The median duration of exclusive breastfeeding was one month in both the CG and FBSICG and three months in the HBICG. The predictors of exclusive breastfeeding were non-giving of post-lacteal feeds; planned long breastfeeding duration; living in smaller households; non-ownership of telephones and televisions; absence of breast health problems; and correct knowledge of breastfeeding duration. The major hindrances to exclusive breastfeeding were: inadequate knowledge of exclusive breastfeeding; cultural perceptions about infant feeding; and absence of mother from home for long periods. The prevalence of acute respiratory infections and diarrhoea were significantly lower among exclusively breastfed infants than those non-exclusively breastfed. The prevalence of underweight was significantly lower among the exclusively breastfed infants than those non-exclusively breastfed at one month (p=0.006) and three months (p=0.005). Conclusions: It is feasible to promote and sustain exclusive breastfeeding for six months in low socioeconomic conditions, using the home-based intensive counseling strategy. Breastfeeding promotion programmes should adopt strategies to allow for wider dissemination of information, targeting both mothers and the community at large, as this study showed family members were major decision-makers in the choice of infant feeding practices. Hospital-based breastfeeding education should offer detailed information on a consistent basis. Breastfeeding promotion messages should be re-packaged to address cultural perceptions in infant feeding practices.

The tourism industry in Peru has grown faster than any other sector in the country’s economy. Peru has used Incanismo, the exaggeration of the Inca culture and identity, to appropriate culture and tourism in and around Cusco. This method has led to significant economic advancements throughout the city. Because of this, traditional Quechua-Speaking communities outside of Cusco have begun to promote a similar method in order to experience the same success. In doing so, many meanings of community values and traditions are changing. Though I began my research with a negative perspective and found the tourism industry to be exploitative, the time I spent living and volunteering in the local community of Ccorccor helped me to recognize the potential positive opportunities that tourism could offer. With a Hopeful Tourism model, I offer suggestions for the incorporation of a broader, more inclusive Andean identity, rather than the previous Inca-specific one. Hopeful Tourism is way for communities to re-cultivate their own unique characteristics and heritages, while supporting economic development. Not only will this maintain tourism throughout Peru, but it will do so in a culturally sustainable way. / text

This dissertation explores the complex structures and diverse experiences of globalization through the specific analytical lens of community-based natural resource management (CBNRM). CBNRM is an undertaking which is fundamentally local but also integrally connected to transnational conservation ideology and national structures of authority. While recent critiques of community-based conservation projects have challenged the universal efficacy of the approach, CBNRM continues to be a ubiquitous conservation paradigm and to provide lingering hope for local empowerment through resource management. Focusing on two community-based conservation groups formed in Tanzania and Zanzibar, this dissertation looks at the experience of local groups attempting to engage with broader national or international conservation networks by focusing on three tropes of globalization theory: intersections between traditional ecological knowledge and western science, the relationship between civil society and the state, and the specific mechanisms for local engagement with national and global entities. The community groups in this study use dynamic and adaptive strategies to channel resources into their communities. However, they also face significant structural constraints, many of which reveal the neocolonial effects of transnational conservation ideology. This work explores both the factors limiting or manipulating local participation in resource management and the strategies used by these two community-based conservation groups to ensure their participation in spite of those limitations.

The diagnosis of HIV is a life-changing event that requires people to deal with the disease, as well as cope with HIV stigma. Both people living with HIV or AIDS (PLHA) and their close family members (CFM) are stigmatized, but CFM also stigmatizes PLHA. This interaction affects the relationship between PLHA and their CFM. The aim of this study was to evaluate the effect of a comprehensive community-based HIV stigma reduction intervention on PLHA and their CFM as well as to explore and describe their experiences during and after the intervention. A holistic multiple case study design as well as a qualitative description approach was used. The study was conducted in both an urban and a rural setting. Purposive sampling was used for the PLHA and snowball sampling for the CFM. The case record for the case study consisted of several sources. In-depth-interviews were used to explore their experiences. The data was analysed using open coding and text document analysis. Both groups gained a richer understanding of HIV stigma and coping with it. The relationships enriched by PLHA feeling more supported and CFM realizing how they stigmatized and that they should be more supportive. Leadership was activated through the project. Bringing PLHA and CFM together during an intervention, proved to be affective, Recommendations focus on the inclusion of HIV-related stigma reduction awareness interventions in the curriculum of student nurses and the implementation thereof in the community, through community based nursing. It would be of benefit if the programme could also be offered as a workshop to traditional healers in the community. Nurses in clinics working with PLHA should invite PLHA and CFM to participate in groups to support each other in reducing HIV-related stigma and share problem-solving coping strategies. The researcher believes that the results of the current study have important implications for further research in HIV-related stigma reduction interventions in other countries and demographic groups. It has the potential to be used for long-term monitoring studies of HIV stigma reduction interventions and the change over time. / Thesis (MCur)--North-West University, Potchefstroom Campus, 2013