Global ETD Search

341	Adversité socioéconomique, fréquentation d’un service d’éducation préscolaire, et développement de l’enfant : investigations expérimentales et longitudinales populationnelles Larose, Marie-Pier 11 1900 (has links) Problématique : L’exposition à l’adversité socioéconomique pendant les premières années de vie peut avoir des conséquences à long terme sur la santé physique et mentale de l’enfant. La fréquentation des services d’éducation préscolaire (SEP) a été proposée comme un moyen de promouvoir le développement des enfants de familles plus défavorisées permettant ainsi de contrecarrer les conséquences négatives associées aux contextes de vie adverses auxquels ils sont exposés. Les SEP sont désormais accessibles à la population et largement utilisés par les parents pour leurs enfants d’âge préscolaire. Cependant, des processus de sélection sociale font en sorte que les enfants plus défavorisés sont moins nombreux à fréquenter les SEP. De plus, bien que les SEP soient généralement des milieux de vie cognitivement et socialement stimulants, il existe des variations importantes dans la qualité de ces services. De surcroît, ces milieux sont propices à des situations pouvant susciter du stress et l’expression de comportements perturbateurs. Objectifs : L’objectif principal de cette thèse est d’examiner les associations entre l’adversité socioéconomique, la fréquentation des SEP et le développement de l’enfant selon une approche des parcours de vie, en prêtant une attention particulière aux effets de sélection sociale connus pour être présents dans les SEP. Quatre articles composent cette thèse. Les deux premiers articles examinent l’effet d’un programme d’entraînement aux habiletés sociales implanté dans des SEP de quartiers défavorisés sur la fréquence des comportements perturbateurs et les indicateurs neurophysiologiques du stress vécu par les enfants. De plus, nous avons investigué si l’adversité socioéconomique de la famille modifiait la magnitude des impacts attendus du programme. Dans le troisième article, nous examinons le rôle de la fréquentation des SEP dans la relation entre l’exposition à l’adversité au début de la vie, les habiletés cognitives de l’enfant et l’expression de comportements perturbateurs à l’adolescence. Avec le quatrième article de la thèse, nous étudions l’association entre la fréquentation des SEP et le taux de diplomation de l’école secondaire, et nous examinons si cette association est magnifiée auprès des enfants issus de mères avec un plus faible niveau d’éducation. Nous réalisons également une analyse bénéfice-coût afin d’évaluer si la subvention publique des SEP est une solution économiquement rentable. Méthodes : Les données utilisées pour les deux premiers articles proviennent d’un essai randomisé en grappes où 19 SEP (n = 362 enfants) de quartiers économiquement défavorisés ont été randomisés à la condition expérimentale : recevoir un programme d’entraînement aux habiletés sociales, ou à la condition contrôle de type liste d’attente. Dans le projet « Brindami », les comportements perturbateurs ont été mesurés par le biais de questionnaires répondus par les éducatrices alors que le stress a été quantifié par la sécrétion cortisolaire diurne mesurée dans la salive. Ces mesures ont été effectuées à deux reprises, avant et après l’intervention. Afin d’étudier l’impact du programme, des analyses multiniveaux et à mesures répétées ont été utilisées. Les effets de sélection sociale ont été considérés par l’application de critères de sélection stricts en regard de la défavorisation des SEP. Les données des troisième et quatrième articles proviennent de l’Avon Longitudinal Study of Parents and Children (ALSPAC), où 14 451 familles ont été suivis de 1991-2020. La fréquentation des SEP et l’exposition à l’adversité socioéconomique ont été mesurées par questionnaire au cours des quatre premières années de vie de l’enfant. Les habiletés cognitives de l’enfant ont été mesurées lors d’une visite en laboratoire lorsque l’enfant était âgé de huit ans. Les comportements perturbateurs de l’enfant ont été évalués par la mère à trois reprises au cours de l’adolescence à l’aide d’un questionnaire validé. Les informations sur la diplomation de l’école obligatoire ont été obtenues grâce à l’établissement d’un lien entre la base administrative du National Pupil Database du Royaume-Uni et de l’étude ALSPAC. Des analyses de médiation modérées et des analyses de régression multinomiale ont été utilisées. Les effets de sélection ont été estimés et minimisés par le biais de l’utilisation de coefficients de propension. Résultats : Dans les deux premiers articles, nous avons montré que l’implantation d’un programme d’entraînement aux habiletés sociales était associée à 1) une diminution des comportements perturbateurs, mais seulement chez les filles, et 2) à des patrons de sécrétion cortisolaire diurnes plus normatifs, et ce, particulièrement chez les enfants de familles plus économiquement défavorisés. Les résultats issus du troisième article suggèrent que, pour les enfants exposés à de l’adversité socioéconomique, la fréquentation des SEP est associée à une diminution des comportements perturbateurs à l’adolescence via l’augmentation des habiletés cognitives de ces derniers à l’enfance. Enfin, le quatrième article présente une association entre la fréquentation des SEP et la diplomation scolaire pour les enfants de mères ayant un plus faible niveau d’éducation, et suggère que les politiques publiques visant à subventionner la fréquentation des SEP pour ces enfants sont des stratégies économiquement rentables. Implications : Cette thèse souligne l’importance de la fréquentation des SEP pour les enfants exposés à de l’adversité socioéconomique. Afin que les SEP deviennent une stratégie de réduction des iniquités de santé pour un plus grand nombre d’enfants, les futures initiatives de santé publique devront chercher à minimiser les effets de sélection sociale dans l’élaboration de leur politique. / Background: Early life adversity is associated with life-long consequences on children's physical and mental health. Early childhood education and care (ECEC) attendance has been proposed as a solution to promote the development of children from vulnerable families and thus diminishing the negative consequences associated with their early exposure to adversity. ECEC is widely available to the general population and used by working parents for their preschool children. However, because of social selection processes, vulnerable children are less likely to attend ECEC than their more advantaged counterparts. In addition, although ECEC is generally a cognitively and socially stimulating environment, there are significant variations in the quality of these services. Moreover, ECEC are conducive to situations that can be a stressful and associated with the expression of disruptive behaviors. Objectives: The main objective of this thesis is to examine the associations between exposure to socioeconomic adversity, ECEC attendance, and children development while using a life-course approach and paying particular attention to social selection processes into ECEC. This thesis is divided into four papers. The first two articles examine the impact of a social skills training program implemented in ECEC facilities of low-income neighborhoods on children's levels of disruptive behaviour and stress. In addition, these papers investigate the moderating role of family socioeconomic adversity on the impact of the program. The third paper examines the moderating effect of ECEC attendance on the association between exposure to early life adversity and disruptive behaviours during adolescence via children's cognitive abilities. The fourth paper investigates whether ECEC attendance is associated with higher rates of compulsory school graduation, and whether this association is stronger among children of mothers with lower levels of education. Finally, this paper provides a benefit-cost ratio analysis to assess whether subsidising ECEC is an economically viable option. Methods: The first two papers used data from the Brindami cluster randomized trial in which 19 ECEC facilities (n = 362 children) from low-income neighborhoods were randomized to the experimental condition: receiving a social skills training program, or to the waiting list control condition. Levels of disruptive behaviours and stress levels assess with salivary cortisol were measured at pre- and post-intervention. Multi-level analysis with repeated measures were used to study the impact of the program. Social selection effects were considered through the application of strict ECEC selection criteria. For the third and fourth thesis paper, data were drawn from the Avon Longitudinal Study of Parents and Children (ALSPAC) where 14,451 families were followed from 1991-2020. ECEC attendance and exposure to early life adversity were measured by questionnaires during the child's first four years of life. Children’s cognitive abilities were measured during a laboratory visit when the child was eight years old. Children’s disruptive behaviours were assessed by the mother on three occasions during adolescence using a validated questionnaire. Information on compulsory school graduation was obtained via a linkage between the United Kingdom National Pupil Database and the children from the ALSPAC study. Moderated mediation and multinomial regression analyses were used. Social selection effects were controlled through the use of propensity scores. Results: The first two papers showed that the implementation of a social skills training program was associated with 1) a decrease in disruptive behaviours, but only among girls, and 2) with more normative diurnal cortisol secretion patterns, particularly for children of economically disadvantaged families. The third paper suggests that for children exposed to early life adversity, ECEC attendance is associated with a decrease in disruptive behaviours during adolescence via an increase in children’s cognitive abilities. Finally, the fourth paper presents a significant association between ECEC attendance and school graduation for children of mothers with lower levels of education and suggests that subsidising ECEC for these children is a cost-effective measure. Implications: This thesis highlights the importance of ECEC attendance for children exposed to socioeconomic adversity. To achieve ECEC social equalizing effect, stakeholders need to consider social selection processes into ECEC in the elaboration of their policy. Adversité socioéconomique Services d’éducation préscolaire Stress Habiletés cognitives Comportements perturbateurs Diplomation Parcours de vie Sélection sociale Iniquités de santé Déterminants sociaux de la santé Socioeconomic adversity Early childhood education and care Social skills training Cognitive skills Disruptive behaviors High school graduation Life course approach Social selection Iniquities Social determinants of health
342	Health capabilities, public policies and the determinants of infant mortality in Brazil Bugelli, Alexandre 12 1900 (has links) Résumé Le taux de mortalité infantile est un indicateur de santé des populations et de l'efficacité des systèmes de santé. Il est également capable d'estimer l'ampleur des inégalités sociales et en matière de santé entre populations. Au cours des 30 dernières années, le Brésil a enregistré des réductions significatives des taux de mortalité infantile. Entre 1990 et 2017, le taux de mortalité des moins de cinq ans est passé de 53,7 décès pour mille naissances vivantes à 15,6. Une réduction de 71% sur la période. La moyenne nationale de réduction était de 6% par an dans les années 90, passant à 4,8% dans les années 2000 et à 3,2% par an entre 2011 et 2015. De nombreux facteurs ont été signalés comme la cause de ces améliorations. Malgré la mise en œuvre de politiques sociales et de santé qui ont eu un impact positif sur la santé des populations brésiliennes au cours des dernières décennies, depuis 2009 le pays a connu une lente diminution de la baisse de la mortalité infantile qui est restée à des niveaux élevés, enregistrant de grandes disparités régionales. Après une crise économique qui a évolué vers une période troublée de crise politique, le pays a enregistré en 2016 une augmentation de la mortalité infantile chez les moins d'un an et de cinq ans, qui est passé de 12,43 à 12,72 décès pour mille naissances vivantes et de 14,28 décès à 14,89 décès pour mille naissances vivantes, respectivement. Ces éléments attirent l'attention sur l'impact possible des déterminants sociaux de la santé sur les taux de mortalité infantile au Brésil après la mise en œuvre de ces politiques sociales et de santé. Cette anomalie observée dans la tendance de la mortalité infantile, combinée aux disparités régionales et à une lente diminution de la baisse des taux de mortalité infantile est préoccupante. Elle soulève des questions sur l'impact de ces politiques sociales et de santé, sur la capacité du pays à maintenir une réduction du taux de mortalité infantile à long terme, et sa capacité à rejoindre les taux des pays développés, ainsi quels sont les déterminants de la mortalité infantile au Brésil après la mise en œuvre de ces politiques publiques? L'objectif premier de cette thèse était d'identifier les déterminants de la mortalité infantile au Brésil après la mise en œuvre du programme Stratégie Santé Famille et du Programme Bolsa Família afin de formuler des hypothèses plausibles, relatives au ralentissement du taux de mortalité chez les moins d’un an et de cinq ans, aux disparités régionales et à l’anomalie observée dans la tendance à la baisse du taux de mortalité infantile au Brésil. Pour atteindre cet objectif, nous avons effectué trois études: 1) un examen de la portée qui visait à identifier et à résumer les déterminants de la mortalité infantile au Brésil sous l'influence de ces programmes, en vue de formuler des hypothèses relativement à l’évolution récente des taux de mortalité infantile au Brésil et d’identifier les lacunes, en termes de recherche, concernant les déterminants de la mortalité infantile dans le pays; 2) une analyse descriptive rétrospective, dans une optique de santé publique et des inégalités en matière de santé, en adoptant le cadre analytique proposé par la Commission de l'OMS sur les déterminants sociaux de la santé, en utilisant les données du taux de mortalité chez les enfants de moins d'un an et des possibles déterminants de la mortalité infantile au Brésil selon les conclusions de notre examen de la portée (article 1); 3) une proposition de méthodologie pour faire face aux défis liés au développement d'un modèle de données de panel en utilisant des données agrégées des 26 états brésiliens et des différentes sous-régions, selon le « Conceptual Model of Health Capability » , afin d'inférer des associations possibles entre nos variables indépendantes et les taux de mortalité infantile au Brésil et pour vérifier l'hypothèse soulevée dans l'examen de cadrage sur les récents changements des indicateurs de mortalité infantile du pays. Les résultats globaux de ces études ont démontré qu'à la lumière du « Conceptual Model of Health Capability » et des déterminants sociaux de la santé, les disparités régionales liées aux inégalités, notamment aux niveaux du revenu, de l'éducation, de l'emploi, du taux de fécondité, de l'accès et de la qualité des services de santé, expliquent les inégalités en termes de taux de mortalité infantile, en particulier dans les macro-régions du nord et du nord-est du pays, ce qui freine probablement la baisse du taux de mortalité infantile. Ces inégalités expliqueraient à la fois la lenteur de la réduction du taux de mortalité infantile et sa tendance à demeurer à des niveaux relativement élevés. Les résultats ont également montré que les variations de ces facteurs, pour des raisons liées à la crise économique et politique, ont probablement perturbé la tendance à la baisse des taux de mortalité infantile. À cet égard, les résultats suggèrent qu'une forte réduction du taux d'emploi, observée entre 2014 et 2015 entre autres facteurs, pourrait avoir eu un impact différé sur le TMI en 2016. Les résultats ont également permis d’établir une association entre l'emploi et différents indicateurs de mortalité infantile, le taux d'emploi pouvant avoir un impact sur la mortalité infantile jusqu'à trois ans. Enfin, les études ont démontré qu'il existe un seuil de revenu des ménages, qui agit comme facteur de protection contre la mortalité infantile, en dessous duquel plus la proportion de ménages est élevée, plus le risque d'augmentation de la mortalité infantile est élevé. / Abstract The infant mortality rate is an indicator of population health and the effectiveness of health systems that is also capable of estimating the extent of social and health inequalities between populations. Over the last 30 years, Brazil has recorded significant reductions in child mortality rates. Between 1990 and 2017, the under-five mortality rate dropped from 53.7 to 15.6 deaths per thousand live births, a 71% reduction over the period. The national reduction average was 6% per year in the 1990s, decreasing to 4.8% in the 2000s and to 3.2% per year between 2011 and 2015, and many factors have been reported as the cause of these improvements. Even after the implementation of health and social policies that positively affected the health of the populations in Brazil in the last decades, since 2009 the country has experienced a slow decrease in the decline in infant mortality that remained at high levels, registering great regional disparities. After an economic crisis that evolved into a troubled period of political crisis, in 2016 the country recorded increases in under-one-year infant mortality and under-five-year infant mortality rates, that raised from 12.43 deaths to 12.72 deaths per thousand live births and from 14.28 deaths to 14.89 deaths per thousand live births, respectively. These facts call attention to the possible impact of social determinants of health on infant mortality rates in Brazil after the implementation of these health and social policies. This anomaly in the trend of child mortality, particularly when combined with regional disparities and a slow decrease in the decline in infant mortality rates is of great concern and raise questions about what is the extent of these health and social policies on the country’s ability to maintain a longer-term decline in the infant mortality rate, is it capable of placing this rate at the level of developed countries and what are the determinants of infant mortality in Brazil after the implementation of these public policies. The overarching goal of this thesis was to identify the determinants of infant mortality in Brazil after the implementation of the Family Health Strategy and the Bolsa Família programs in order to raise plausible hypotheses for the slowdown, the regional disparities, and the anomaly observed in the trend of declines in the infant mortality rate in Brazil. To attain this objective, we conducted three research papers: 1. a scoping review that aimed at identifying and summarizing the determinants of infant mortality in Brazil under the influence of Family Health Strategy and Bolsa Família programs, with a view of raising hypothesis for the recent changes in the infant mortality rates in Brazil and identifying gaps in terms of research concerning the determinants of infant mortality in the country, 2. a descriptive retrospective analysis according to the perspective of Public Health and health inequalities by adopting the analytical framework proposed by the World Health Organization’s Commission on Social Determinants of Health, using data from under-one-year old infant mortality rate and from possible determinants of infant mortality in Brazil according to the findings of our scoping review (article 1), and 3. a methodological proposal in order to overcome the challenges to developing a panel data model using aggregated data from the 26 Brazilian states and different subregions according to the Conceptual Model of Health Capability, with a view of inferring possible associations between our independent variables and infant mortality rates in Brazil, aiming at reviewing the hypothesis raised in the scoping review about the recent changes in the country's infant mortality indicators. The global results of these studies demonstrated that in the light of the Conceptual Model of Health Capability and the social determinants of health, regional disparities related to inequalities in factors such as income, education, employment, fertility rate, access, and quality of health services, account for inequalities in infant mortality rates, especially in the north and Northeast macro-regions of the country, which likely hamper further reductions of infant mortality. Those inequalities would explain both the slowdown in the reduction and the tendency of the infant mortality rate to remain at relatively high levels. Results also demonstrated that variations in those factors for reasons relating to the economic and political crisis, likely have interrupted the secular trend of declining infant mortality rates. In this regard, results suggest that a sharp reduction in employment rate observed between 2014 and 2015, among other factors, may have had a delayed impact on infant mortality rates in 2016. The results also identified an association between employment and different infant mortality indicators, with employment rate possibly impacting child mortality up to three years. Finally, the studies have shown that a household income threshold acts as a protective factor against child mortality, the bigger the proportion of households below this income bracket, the greater the risk of an increase in child mortality. Mortalité infantile Capabilités en santé Politiques publiques Déterminants sociaux de la santé Programme Bolsa Familia Données de panel Économie de la santé Brésil Infant mortality Health capabilities Capabilities approach Public policies Social determinants of health Conditional cash transfer program Bolsa Família Health Economics Brazil
343	Assessing And Modeling Quality Measures for Healthcare Systems Li, Nien-Chen 06 November 2021 (has links) Background: Shifting the healthcare payment system from a volume-based to a value-based model has been a significant effort to improve the quality of care and reduce healthcare costs in the US. In 2018, Massachusetts Medicaid launched Accountable Care Organizations (ACOs) as part of the effort. Constructing, assessing, and risk-adjusting quality measures are integral parts of the reform process. Methods: Using data from the MassHealth Data Warehouse (2016-2019), we assessed the loss of community tenure (CTloss) as a potential quality measure for patients with bipolar, schizophrenia, or other psychotic disorders (BSP). We evaluated various statistical models for predicting CTloss using deviance, Akaike information criterion, Vuong test, squared correlation and observed vs. expected (O/E) ratios. We also used logistic regression to investigate risk factors that impacted medication nonadherence, another quality measure for patients with bipolar disorders (BD). Results: Mean CTloss was 12.1 (±31.0 SD) days in the study population; it varied greatly across ACOs. For risk adjustment modeling, we recommended the zero-inflated Poisson or doubly augmented beta model. The O/E ratio ranged from 0.4 to 1.2, suggesting variation in quality, after adjusting for differences in patient characteristics for which ACOs served as reflected in E. Almost half (47.7%) of BD patients were nonadherent to second-generation antipsychotics. Patient demographics, medical and mental comorbidities, receiving institutional services like those from the Department of Mental Health, homelessness, and neighborhood socioeconomic stress impacted medication nonadherence. Conclusions: Valid quality measures are essential to value-based payment. Heterogeneity implies the need for risk adjustment. The search for a model type is driven by the non-standard distribution of CTloss. quality measure community tenure risk adjustment zero-inflated regression models doubly augmented beta model deviance Vuong test r-square O/E ratio predictive probability bipolar disorder second-generation antipsychotics medication possession ratio risk factors social determinants of health Biostatistics Medicine and Health Sciences Mental and Social Health Statistical Models
344	<b>Digital Health And Improvement Of Healthcare Access</b> Mateus Schmitt (18445557) 26 April 2024 (has links) <p dir="ltr">Digital Health technologies have revolutionized healthcare delivery, offering innovative solutions that enhance access, improve patient outcomes, and optimize the use of resources. Despite this advancement, health outcomes remain disparate across different social groups, with underprivileged populations at an increased risk of poor health outcomes due to inadequate access to care. Digital Health technologies serve as a critical intervention in mitigating these disparities, particularly for groups affected by geographical, economic, and infrastructural barriers.<br><br>The purpose of this study was to conduct a review of the current state of Digital Health technologies, including Software as a Medical Device (SaMD), Wearable Health, Portable Diagnostic Devices, and remote care platforms, and their impact on healthcare accessibility. Employing qualitative methodology, this metasynthesis emphasized an important discovery: the need for a paradigm shift among stakeholders in healthcare towards integrated and digitally-driven patient care. This shift requires more than just an understanding of new technologies. It demands a fundamental re-evaluation of patient care methods and the orchestration of the entire healthcare system towards integrated digital practices. Importantly, this study found that the pace of digitalization must be carefully managed and cultural factors must be considered and signals the urgency for a balanced approach to digital integration in healthcare.</p> Digital electronic devices Digital health Rural and remote health services Health equity Preventative health care Social determinants of health Applications in health Digital Health Technology Healthcare Healthcare Access Digital Integration Medical Devices
345	Uncovering the Role of Community Health Worker/Lay Health Worker Programs in Addressing Health Equity for Immigrant and Refugee Women in Canada: An Instrumental and Embedded Qualitative Case Study Torres Ospina, Sara 29 January 2013 (has links) “Why do immigrants and refugees need community health workers/lay health workers (CHWs) if Canada already has a universal health care system?” Abundant evidence demonstrates that despite the universality of our health care system marginalized populations, including immigrants and refugees, experience barriers to accessing the health system. Evidence on the role of CHWs facilitating access is both lacking and urgently needed. This dissertation contributes to this evidence by providing a thick description and thorough analytical exploration of a CHW model, in Edmonton, Canada. Specifically, I examine the activities of the Multicultural Health Brokers Co-operative (MCHB Co-op) and its Multicultural Health Brokers from 1992 to 2011 as well as the relationship they have with Alberta Health Services (AHS) Edmonton Zone Public Health. The research for this study is based on an instrumental and embedded qualitative case study design. The case is the MCHB Co-op, an independently-run multicultural health worker co-operative, which contracts with health and social services providers in Edmonton to offer linguistically- and culturally-appropriate services to marginalized immigrant and refugee women and their families. The two embedded mini-cases are two programs of the MCHB Co-op: Perinatal Outreach and Health for Two, which are the raison d’être for a sustained partnership between the MCHB Co-op and AHS. The phenomenon under study is the Multicultural Health Brokers’ practice. I triangulate multiple methods (research strategies and data sources), including 46 days of participant and direct observation, 44 in-depth interviews (with Multicultural Health Brokers, mentors, women using the programs, health professionals and outsiders who knew of the work of the MCHB Co-op and Multicultural Health Brokers), and document review and analysis of policy documents, yearly reports, training manuals, educational materials as well as quantitative analysis of the Health Brokers’ 3,442 client caseload database. In addition, data include my field notes of both descriptive and analytical reflections taken throughout the onsite research. I also triangulate various theoretical frameworks to explore how historically specific social structures, economic relationships, and ideological assumptions serve to create and reinforce the conditions that give rise to the need for CHWs, and the factors that aid or hinder their ability to facilitate marginalized populations’ access to health and social services. Findings reveal that Multicultural Health Brokers facilitate access to health and social services as well as foster community capacity building in order to address settlement, adaptation, and integration of immigrant and refugee women and their families into Canadian society. Findings also demonstrate that the Multicultural Health Broker model is an example of collaboration between community-based organizations and local systems in targeting health equity for marginalized populations; in particular, in perinatal health and violence against women. A major problem these workers face is they provide important services as part of Canada’s health human resources workforce, but their contributions are often not recognized as such. The triangulation of methods and theory provides empirical and theoretical understanding of the Multicultural Health Brokers’ contribution to immigrant and refugee women and their families’ feminist urban citizenship. Canada Case Study Inequity Immigrants Refugees Community Capacity Building Alberta Health Services Multicultural Health Brokers Health Human Resources Workforce Health Brokers Lay Health Promoters Lay Health Workers Authoritative Knowledge Experiential Knowledge Feminist Families Qualitative Research Child Welfare Cultural Brokering Community Health Workers Models Co-operatives Women Women's Urban Citizenship Empowerment Embedded Case Study Research Social Determinants of Health Social Change Social Work Urban Citizenship Universal Programs Unregulated Health Care Workers Theory Typology Perinatal Health Racialized Gender Race Class Discrimination Diversity Health Worker Co-operatives Policy Makers Urban Citizenship Universal Programs Access to Health Services Equity Access to Social Services Cultural Competence Racism Canada Prenatal Nutrition Program Public Health Primary Care Health Promotion Violence Prevention Immigrant Health Care Workers Immigrant Community Health Workers
346	Uncovering the Role of Community Health Worker/Lay Health Worker Programs in Addressing Health Equity for Immigrant and Refugee Women in Canada: An Instrumental and Embedded Qualitative Case Study Torres Ospina, Sara 29 January 2013 (has links) “Why do immigrants and refugees need community health workers/lay health workers (CHWs) if Canada already has a universal health care system?” Abundant evidence demonstrates that despite the universality of our health care system marginalized populations, including immigrants and refugees, experience barriers to accessing the health system. Evidence on the role of CHWs facilitating access is both lacking and urgently needed. This dissertation contributes to this evidence by providing a thick description and thorough analytical exploration of a CHW model, in Edmonton, Canada. Specifically, I examine the activities of the Multicultural Health Brokers Co-operative (MCHB Co-op) and its Multicultural Health Brokers from 1992 to 2011 as well as the relationship they have with Alberta Health Services (AHS) Edmonton Zone Public Health. The research for this study is based on an instrumental and embedded qualitative case study design. The case is the MCHB Co-op, an independently-run multicultural health worker co-operative, which contracts with health and social services providers in Edmonton to offer linguistically- and culturally-appropriate services to marginalized immigrant and refugee women and their families. The two embedded mini-cases are two programs of the MCHB Co-op: Perinatal Outreach and Health for Two, which are the raison d’être for a sustained partnership between the MCHB Co-op and AHS. The phenomenon under study is the Multicultural Health Brokers’ practice. I triangulate multiple methods (research strategies and data sources), including 46 days of participant and direct observation, 44 in-depth interviews (with Multicultural Health Brokers, mentors, women using the programs, health professionals and outsiders who knew of the work of the MCHB Co-op and Multicultural Health Brokers), and document review and analysis of policy documents, yearly reports, training manuals, educational materials as well as quantitative analysis of the Health Brokers’ 3,442 client caseload database. In addition, data include my field notes of both descriptive and analytical reflections taken throughout the onsite research. I also triangulate various theoretical frameworks to explore how historically specific social structures, economic relationships, and ideological assumptions serve to create and reinforce the conditions that give rise to the need for CHWs, and the factors that aid or hinder their ability to facilitate marginalized populations’ access to health and social services. Findings reveal that Multicultural Health Brokers facilitate access to health and social services as well as foster community capacity building in order to address settlement, adaptation, and integration of immigrant and refugee women and their families into Canadian society. Findings also demonstrate that the Multicultural Health Broker model is an example of collaboration between community-based organizations and local systems in targeting health equity for marginalized populations; in particular, in perinatal health and violence against women. A major problem these workers face is they provide important services as part of Canada’s health human resources workforce, but their contributions are often not recognized as such. The triangulation of methods and theory provides empirical and theoretical understanding of the Multicultural Health Brokers’ contribution to immigrant and refugee women and their families’ feminist urban citizenship. Canada Case Study Inequity Immigrants Refugees Community Capacity Building Alberta Health Services Multicultural Health Brokers Health Human Resources Workforce Health Brokers Lay Health Promoters Lay Health Workers Authoritative Knowledge Experiential Knowledge Feminist Families Qualitative Research Child Welfare Cultural Brokering Community Health Workers Models Co-operatives Women Women's Urban Citizenship Empowerment Embedded Case Study Research Social Determinants of Health Social Change Social Work Urban Citizenship Universal Programs Unregulated Health Care Workers Theory Typology Perinatal Health Racialized Gender Race Class Discrimination Diversity Health Worker Co-operatives Policy Makers Urban Citizenship Universal Programs Access to Health Services Equity Access to Social Services Cultural Competence Racism Canada Prenatal Nutrition Program Public Health Primary Care Health Promotion Violence Prevention Immigrant Health Care Workers Immigrant Community Health Workers
347	Uncovering the Role of Community Health Worker/Lay Health Worker Programs in Addressing Health Equity for Immigrant and Refugee Women in Canada: An Instrumental and Embedded Qualitative Case Study Torres Ospina, Sara January 2013 (has links) “Why do immigrants and refugees need community health workers/lay health workers (CHWs) if Canada already has a universal health care system?” Abundant evidence demonstrates that despite the universality of our health care system marginalized populations, including immigrants and refugees, experience barriers to accessing the health system. Evidence on the role of CHWs facilitating access is both lacking and urgently needed. This dissertation contributes to this evidence by providing a thick description and thorough analytical exploration of a CHW model, in Edmonton, Canada. Specifically, I examine the activities of the Multicultural Health Brokers Co-operative (MCHB Co-op) and its Multicultural Health Brokers from 1992 to 2011 as well as the relationship they have with Alberta Health Services (AHS) Edmonton Zone Public Health. The research for this study is based on an instrumental and embedded qualitative case study design. The case is the MCHB Co-op, an independently-run multicultural health worker co-operative, which contracts with health and social services providers in Edmonton to offer linguistically- and culturally-appropriate services to marginalized immigrant and refugee women and their families. The two embedded mini-cases are two programs of the MCHB Co-op: Perinatal Outreach and Health for Two, which are the raison d’être for a sustained partnership between the MCHB Co-op and AHS. The phenomenon under study is the Multicultural Health Brokers’ practice. I triangulate multiple methods (research strategies and data sources), including 46 days of participant and direct observation, 44 in-depth interviews (with Multicultural Health Brokers, mentors, women using the programs, health professionals and outsiders who knew of the work of the MCHB Co-op and Multicultural Health Brokers), and document review and analysis of policy documents, yearly reports, training manuals, educational materials as well as quantitative analysis of the Health Brokers’ 3,442 client caseload database. In addition, data include my field notes of both descriptive and analytical reflections taken throughout the onsite research. I also triangulate various theoretical frameworks to explore how historically specific social structures, economic relationships, and ideological assumptions serve to create and reinforce the conditions that give rise to the need for CHWs, and the factors that aid or hinder their ability to facilitate marginalized populations’ access to health and social services. Findings reveal that Multicultural Health Brokers facilitate access to health and social services as well as foster community capacity building in order to address settlement, adaptation, and integration of immigrant and refugee women and their families into Canadian society. Findings also demonstrate that the Multicultural Health Broker model is an example of collaboration between community-based organizations and local systems in targeting health equity for marginalized populations; in particular, in perinatal health and violence against women. A major problem these workers face is they provide important services as part of Canada’s health human resources workforce, but their contributions are often not recognized as such. The triangulation of methods and theory provides empirical and theoretical understanding of the Multicultural Health Brokers’ contribution to immigrant and refugee women and their families’ feminist urban citizenship. Canada Case Study Inequity Immigrants Refugees Community Capacity Building Alberta Health Services Multicultural Health Brokers Health Human Resources Workforce Health Brokers Lay Health Promoters Lay Health Workers Authoritative Knowledge Experiential Knowledge Feminist Families Qualitative Research Child Welfare Cultural Brokering Community Health Workers Models Co-operatives Women Women's Urban Citizenship Empowerment Embedded Case Study Research Social Determinants of Health Social Change Social Work Urban Citizenship Universal Programs Unregulated Health Care Workers Theory Typology Perinatal Health Racialized Gender Race Class Discrimination Diversity Health Worker Co-operatives Policy Makers Urban Citizenship Universal Programs Access to Health Services Equity Access to Social Services Cultural Competence Racism Canada Prenatal Nutrition Program Public Health Primary Care Health Promotion Violence Prevention Immigrant Health Care Workers Immigrant Community Health Workers
348	From the "rising tide" to solidarity: disrupting dominant crisis discourses in dementia social policy in neoliberal times MacLeod, Suzanne 26 March 2014 (has links) As a social worker practising in long-term residential care for people living with dementia, I am alarmed by discourses in the media and health policy that construct persons living with dementia and their health care needs as a threatening “rising tide” or crisis. I am particularly concerned about the material effects such dominant discourses, and the values they uphold, might have on the collective provision of care and support for our elderly citizens in the present neoliberal economic and political context of health care. To better understand how dominant discourses about dementia work at this time when Canada’s population is aging and the number of persons living with dementia is anticipated to increase, I have rooted my thesis in poststructural methodology. My research method is a discourse analysis, which draws on Foucault’s archaeological and genealogical concepts, to examine two contemporary health policy documents related to dementia care – one national and one provincial. I also incorporate some poetic representation – or found poetry – to write up my findings. While deconstructing and disrupting taken for granted dominant crisis discourses on dementia in health policy, my research also makes space for alternative constructions to support discursive and health policy possibilities in solidarity with persons living with dementia so that they may thrive. / Graduate / 0452 / 0680 / 0351 / macsuz@shaw.ca social determinants of health social exclusion crisis discourse Alzheimer's Alzheimer Society of Canada Suzanne MacLeod Susan Strega Donna Jeffery poststructural poststructuralism admission to long-term care funding for long-term care acute care aging demographic BC Psychogeriatric Association biomedical British Columbia Canada Health Act collective social responsibility competition corporate profit corporatization deresponsibilization elder friendly elderly citizens family caregivers Foucault found poetry genealogy of power knowledge incompetent Ministry of Health moral economics pharmaceutical bed blocker stigmatized tsunami absent-person action plan aging population alternative discourse apocalyptic demography appropriate archaeology archaeology of knowledge archaeological British Columbia burden Canada caregiver charity charitable collective collective car community community care condition of possibility conditions of possibility corporate counter-discourse dementia dementia care dementia policy dementia social policy dependent depoliticize discourse discourse analysis disruptive discourse economic burden economics economy elder emergency epidemic exclusion fear-monger Foucauldian found poem genealogy genealogical health authority health care health care staff health care system health policy document healthy lifestyle home and community care homogenization homogenize hospital imaginaries imaginary incapable individual responsibility individualism knowledge long-term care material effect materiality of discourse media moral panic national strategy neoliberal neoliberalism neoliberal rationality not prepared object objectification other person-centered people living with dementia person living with dementia persons living with dementia person with dementia poem poetic representation poetry policy policies political politics power power knowledge power relations private privatize privatization productivity of dominant discourse public health care residential care resistance responsibility responsibilization rising tide safety net shift costs to caregivers responsibility social policy imaginary social well-being social work social worker solidarity specialized stakeholder state stigma subject matter expert taxpayer threat unprepared unproductive voluntary volunteer wait time wave social policy
349	From the "rising tide" to solidarity: disrupting dominant crisis discourses in dementia social policy in neoliberal times MacLeod, Suzanne 26 March 2014 (has links) As a social worker practising in long-term residential care for people living with dementia, I am alarmed by discourses in the media and health policy that construct persons living with dementia and their health care needs as a threatening “rising tide” or crisis. I am particularly concerned about the material effects such dominant discourses, and the values they uphold, might have on the collective provision of care and support for our elderly citizens in the present neoliberal economic and political context of health care. To better understand how dominant discourses about dementia work at this time when Canada’s population is aging and the number of persons living with dementia is anticipated to increase, I have rooted my thesis in poststructural methodology. My research method is a discourse analysis, which draws on Foucault’s archaeological and genealogical concepts, to examine two contemporary health policy documents related to dementia care – one national and one provincial. I also incorporate some poetic representation – or found poetry – to write up my findings. While deconstructing and disrupting taken for granted dominant crisis discourses on dementia in health policy, my research also makes space for alternative constructions to support discursive and health policy possibilities in solidarity with persons living with dementia so that they may thrive. / Graduate / 0452 / 0680 / 0351 / macsuz@shaw.ca social determinants of health social exclusion crisis discourse Alzheimer's Alzheimer Society of Canada Suzanne MacLeod Susan Strega Donna Jeffery poststructural poststructuralism admission to long-term care funding for long-term care acute care aging demographic BC Psychogeriatric Association biomedical British Columbia Canada Health Act collective social responsibility competition corporate profit corporatization deresponsibilization elder friendly elderly citizens family caregivers Foucault found poetry genealogy of power knowledge incompetent Ministry of Health moral economics pharmaceutical bed blocker stigmatized tsunami absent-person action plan aging population alternative discourse apocalyptic demography appropriate archaeology archaeology of knowledge archaeological British Columbia burden Canada caregiver charity charitable collective collective car community community care condition of possibility conditions of possibility corporate counter-discourse dementia dementia care dementia policy dementia social policy dependent depoliticize discourse discourse analysis disruptive discourse economic burden economics economy elder emergency epidemic exclusion fear-monger Foucauldian found poem genealogy genealogical health authority health care health care staff health care system health policy document healthy lifestyle home and community care homogenization homogenize hospital imaginaries imaginary incapable individual responsibility individualism knowledge long-term care material effect materiality of discourse media moral panic national strategy neoliberal neoliberalism neoliberal rationality not prepared object objectification other person-centered people living with dementia person living with dementia persons living with dementia person with dementia poem poetic representation poetry policy policies political politics power power knowledge power relations private privatize privatization productivity of dominant discourse public health care residential care resistance responsibility responsibilization rising tide safety net shift costs to caregivers responsibility social policy imaginary social well-being social work social worker solidarity specialized stakeholder state stigma subject matter expert taxpayer threat unprepared unproductive voluntary volunteer wait time wave social policy

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