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Introduction Chronic diseases are rapidly escalating and place tremendous burden on health care systems in the developing world. The effectiveness of post-physical examination communication with patients is as crucial as their physical observations. Mobile phones, as one of the innovative technological intervention in the 21st century, have become part of people’s lives. Their widespread availability has given them the potential to revolutionise health care communication and improve health services. The purpose of the present research report was to explore the feasibility of using text messages (SMS) by patients in managing their chronic illnesses in a rural setting in three Bushbuckridge clinics. Methodology A cross sectional descriptive study using quantitative methodology was carried out at three intervention clinics, where the electronic Patient Health Information System (PatHIS) was to be installed in the Bushbuck Area, Mpumalanga. A questionnaire was administered by the researcher at a specific clinic situated in rural setting to solicit information from participants. The researcher also used the method of observation, that is, an SMS was sent by the researcher to the participants with cellphones during the interview. Participants were requested to open and read the message or open their phonebook while the researcher was observing them. Results A total of 74 participants were interviewed. 74% (55/74) of participants owned cellphones and indicated that they were for personal use. Seventy-eight percent (15/19) of participants who did not own cellphones had access to other people’s cellphones, and 87 % (13/15) indicated that they did not mind if other people received SMS on their behalf. Only 25% of cellphone owners were able to demonstrate how they opened their SMS and read it. Ninety-three percent of cellphone owners who were unable to read their own SMS indicated that their messages were read by either their children and/or grand children. Eighty-eight percent (62/70) of the participants indicated that they would prefer to receive SMS in their own home language. Ninety-one percent (68/70) indicated that they would like to receive SMS from the clinic in future. Seventy Percent of the participants would prefer to receive appointment reminders via SMS. Fifteen Percent and 13 % would like to receive test results and health information via SMS respectively. Participants also indicated that they would like to be informed about the unavailability of medication at the clinic pharmacy. Discussion The study indicated that the use of SMS in the management of chronic diseases is feasible based on the number of participants who would like to receive SMSes from the clinic. However participants were specific in terms of the type of text messages they preferred to, that is, they preferred to receive appointment reminders via SMS. It is recommended that before such an intervention is implemented a balance between privacy, confidentiality as well as comprehension of test messages be established. It is also crucial to focus on patients’ preferences in terms of the type of text messages, as well as the language used. This will determine whether patients accept the use of text messages in managing their chronic illnesses.

archives@tulane.edu / This dissertation includes three essays analyzing the socio-economic impacts of healthcare policies and a public health issue in the areas of healthcare price transparency, disease management, and water pollution. The first chapter, Price Transparency and Healthcare Costs: The Case of the New Hampshire Healthcare Market, analyzes the effect of price transparency on supply side changes to healthcare spending. It finds New Hampshire Healthcare Cost reduced negotiated prices by 1.3%, due to responses of insurances and healthcare facilities. The effect was heterogenous across insurers depending on how much they paid to a facility relative to those their competitors paid before the price transparency. The second chapter, Can Chronic Diseases Be Managed to Cost Less? The Case of A Diabetes Disease Management Program, evaluates the effect of a private diabetes disease management program on healthcare costs. It finds disease management programs could reduce allowance by $127 per person per month on average. This reduction was contributed by lower costs for inpatient services, outpatient services, physician visits, and emergency room visits. The third chapter, Something in the Pipe: Flint Water Crisis and Health at Birth, estimates the effect of in utero exposure to water pollutions on birth outcomes. Using the Flint water crisis as a natural experiment, it finds the water crisis modestly increased the probability of low birth weight by 1.8 percentage points but had little effect on the length of gestation or prematurity. / 1 / Rui Wang

Regensburg, Universiẗat, Diss., 2009.

Thesis (M.S.)--Montana State University--Bozeman, 2007. / Typescript. Chairperson, Graduate Committee: Barry J. Jacobsen. Includes bibliographical references (leaves 115-128).

Ulm, Univ., Diss., 2007.

Thesis (M.S.)--West Virginia University, 2000. / Title from document title page. Document formatted into pages; contains ix, 154 p. : ill. Includes abstract. Includes bibliographical references (p. 137-143).

Thesis advisor: Sara Moorman / Improved survival for medical conditions that were previously fatal in infancy has led to more individuals living longer with chronic illnesses. These individuals, some of whom have largely unapparent, unpredictable, and yet severe symptoms from birth, may experience a unique set of physical, social, and emotional impacts associated with their condition as compared to youth with less severe, treatable pediatric conditions or individuals with adult-onset conditions. This dissertation explores these challenges using the case of youth with Barth Syndrome (BTHS), a rare, severe, genetic condition in males associated with life-limiting and life-threatening symptoms. Research questions explored: (1) how symptom severity, visibility, and controllability informed individuals’ social management and legitimization of BTHS; (2) how awareness regarding their limited, uncertain prognosis impacted life planning for youth with BTHS; and (3) which coping strategies individuals with BTHS used to manage the physical, social, and emotional impacts associated with their incurable, life-limiting condition. Thirty-three sixty-minute interviews were conducted in two groups: individuals with BTHS ≤15 years of age (n=18) and/or their caregivers, and individuals with BTHS ≥16 years of age (n=15). Interview transcripts were analyzed using Atlas.ti. Results demonstrated that (1) the severity, visibility, and lack of control over BTHS symptoms was associated with individuals needing to seek social support for their condition, rather than attempting to pass as healthy as other males with chronic conditions have been found to do; (2) individuals opted to forgo socially “on-time” goals (i.e., long-term, knowledge-based goals) based on their perceptions of their limited, uncertain time horizons and struggled to identify alternative goals; and (3) individuals used secondary coping strategies (i.e., regulating their emotional responses to their external stressor rather than controlling the stressor itself) to cope with the impacts associated with having an incurable, severe, and chronic health condition. These results can be used to inform practices for providing increased social and institutional support to chronically ill youth, including promoting positive coping strategies and facilitating meaningful, attainable, goal selection. These interventions may alleviate some of the challenges faced by the growing number of youth living with chronic illnesses seeking to safely and meaningfully engage in the realms of work, family, education, and social life. / Thesis (PhD) — Boston College, 2019. / Submitted to: Boston College. Graduate School of Arts and Sciences. / Discipline: Sociology.

Introduction: At the core of UK policy for improving outcomes in cancer are goals for a healthcare where patients are empowered through information enabling engagement in shared care decisions with clinicians. Interventions to support patients’ engagement in shared decision making are lacking within colorectal cancer and high grade glioma care despite intensive treatment regimens with uncertain outcomes. Navigation, a communication and decision support intervention, has been successfully piloted with prostate and breast cancer patients who demonstrated significantly more confidence and less uncertainty in their treatment decisions. With healthcare policy advocating patients be educated and engaged in their care, the applicability of this intervention to other cancer settings is required. The Navigation intervention includes: consultation planning with a Navigator, formulation of a consultation plan and recording (summary and CD) of the medical consultation. Objectives: To determine the effectiveness of the Navigation intervention in enhancing decision-making quality over time when compared with usual care, in patients with colorectal cancer. To explore repeated experiences of the Navigation intervention from the perspective of colorectal cancer (CRC) patients, patients with high grade glioma (HGG), and consulting clinicians. Design and Studies: A mixed methods study using a pragmatic randomised controlled trial and qualitative evaluation was undertaken during November 2010 – December 2013. The intervention was trialled separately with two cohorts of cancer patients (CRC and HGG). A longitudinal parallel-group pragmatic randomised controlled trial was conducted. Study 1 consisted of a longitudinal parallel-group pragmatic randomised control trial. Participants with colorectal cancer were openly randomised after completion of baseline measures to receive the intervention or usual care (no intervention). The intervention was administered to patients at three particular time points during first line cancer treatment. Participants completed tools collecting primary outcome (decision self-efficacy) and secondary outcomes (decision conflict, decision regret, anxiety and depression) measured prior to baseline, post consultation and at follow-up. Mean change in scores overtime and between groups were compared using Mixed ANOVAS. Study two was a prospective qualitative study undertaking serial in-depth semi-structured evaluation interviews with patients with High Grade Glioma. Study three undertook interviews with the consulting HGG and CRC clinicians. Framework analysis was undertaken. Setting: Two oncology settings within a tertiary cancer centre in Scotland. Participants: 132 patients with colorectal cancer (65 intervention, 67 control) participated in the randomised controlled trial. For the qualitative study, 17 colorectal trial participants (8 intervention, 9 control), 11 high grade glioma patients and 7 clinicians were interviewed. Evaluation Results: No significant difference was found between the control and Navigation intervention participants over time in the primary outcome of decision self-efficacy, or in the following secondary outcomes; decision conflict or anxiety and depression scores. At follow-up, the intervention group reported significantly less decision regret than the controls (p=0.039). In the qualitative data, Navigated participants reported being well prepared for medical consultations, able to actively engage in information exchange during consultation and enabled to recall and understand information provided. This was in contrast to participants receiving usual care who described being less prepared for medical consultations and experienced barriers to gathering information, such as time pressures, forgetting questions, and gaps in understanding. Clinicians identified that patients benefitted from preparing for, and having a written summary of, the consultation. Whereas neuro-oncology clinicians were supportive of Navigation as a tool to tailor information to patients; colorectal clinicians felt Navigation was a disruption to their normal consultation routine. Concern was expressed regarding the extra resource required by Navigated patients and therefore about the feasibility and sustainability of the intervention. Conclusions: Whilst models of shared decision making remain highly profiled in cancer strategies, information exchange and use of interventions in context is problematic. This evaluation of Navigation has demonstrated more impact on the process of decision making, rather than outcome per se, and has raised questions about its sustainability in clinical practice. A more nuanced understanding of different cancer pathways and the specific decisions to be made, may inform a more targeted use of decision support in cancer care.

Thesis (M.B.A.)--University of Nevada, Reno, 2005. / "May, 2005." Includes bibliographical references (leaves 92-97). Online version available on the World Wide Web. Library also has microfilm. Ann Arbor, Mich. : ProQuest Information and Learning Company, [2005]. 1 microfilm reel ; 35 mm.