Health disparities among rural African Americans include disproportionately higher morbidity and mortality rates associated with cardiovascular disease. Interventions designed to decrease cardiovascular risk can potentially improve health outcomes among rural, underserved communities. The purpose of this study was to test the effect of a cardiovascular health promotion intervention among rural African Americans. An experimental study randomized by church clusters was done in two rural counties in northern Florida. A total of 229 participants, 114 in the intervention group and 115 in the control group, were recruited from twelve rural African American churches. The pretest-posttest design included instruments chosen to measure cardiovascular health habits and knowledge as well as changes in produce consumption, dietary fat intake, and exercise using the major components of the Integrated Model of Behavioral Prediction: intentions, norms, attitudes, and self-efficacy. Linear mixed model was the statistical test used to detect the program effects. Participants who received the intervention had significant increases in scores for the cardiovascular health habits (p < .01) and health knowledge (p < .01) variables compared with the control group. There were also significant group differences regarding intentions to increase produce consumption (p < .01) and reduce dietary fat intake (p < .01). The cardiovascular health program was associated with other statistically significant results including produce consumption attitudes (p = .01) and norms (p < .01), dietary fat attitudes (p = .04) and norms (p < .01), and exercise attitudes (p < .01). There were also significant results found for perceived behavioral control/self-efficacy regarding increasing produce consumption (p < .01), reducing dietary fat intake (p = .03), and increasing exercise (p = .01). Compared to the control group, the cardiovascular health promotion intervention was effective in fostering positive health effects for most of the variables measured. The findings supported the theoretical framework used for guiding the study, the Integrative Model of Behavioral Prediction Nurse-led health promotion interventions within church settings can be effective means for reducing overall cardiovascular risk and health disparities among rural African American populations. / Includes bibliography. / Dissertation (Ph.D.)--Florida Atlantic University, 2015. / FAU Electronic Theses and Dissertations Collection

At a government hospital in the town of Dajabon, in the northwestern Dominican Republic, doctors and nurses must make decisions on whether or not to treat Haitian patients who have crossed the border in search of health care. This thesis examines the discourses and practices of Haitian patients and Dominican health care providers in the context of two co-existing but contrasting rhetorics: health as a human right, and medical humanitarianism. Using data collected through semi-structured interviews and participant observation, I examine how social, political, and economic forces shape medical encounters on the Haitian-Dominican border.

Thesis (M. A.)--University of Canterbury, 2007. / Typescript (photocopy). Includes bibliographical references (leaves 156-165). Also available via the World Wide Web

Thesis (M.P.H.)--University of Texas Health Science Center at Houston, School of Public Health, 2007. / Source: Masters Abstracts International, Volume: 45-04, page: 1936. Adviser: Corinne C. Aragaki. Includes bibliographical references.

Thesis (Ph. D.)--University of Texas Health Science Center at Houston, School of Public Health, 1994. / Typescript. Includes bibliographical references (leaves 143-154).

No description available.

Decentralization of health services in Uganda, driven by the structural adjustment programme of the World Bank, was embraced by government as a means to change the health institutional structure and process delivery of health services in the country. Arising from the decentralization process, the transfer of power concerning functions from the top administrative hierachy in health service provision to lower levels, constitutes a major shift in management, philosophy, infrastructure development, communication as well as other functional roles by actors at various levels of health care. This study focused its investigation on ways and levels to which the process of decentralization of health service delivery has attained efficient and effective provision of health services. The study also examined the extent to which the shift of health service provision has influenced the role of local jurisdictions and communities. Challenges faced by local government leaders in planning and raising funds in response to decentralized health serdelivery were examined.

Millions of people are infected with the Hepatitis C Virus (HCV) worldwide. In the UK, many individuals continue to live with undiagnosed HCV infection and are increasingly at risk of developing life-threatening cirrhosis and liver cancer. Of those that are diagnosed, only some are referred to an HCV specialist centre where vital treatment could cure their infection. Of those that are referred, only a proportion have actually attended and stayed in follow-up with a specialist centre. Geographic access to healthcare may be an important factor in these trends, but has so far received little attention in the context of HCV. This thesis examines the influence of geographic access to primary and specialist healthcare on HCV detection, trends of referral, chances of specialist centre utilisation and the odds of staying in follow-up. It also explores association between geographic access and the type of location in which diagnoses were made with the risk of mortality from liver-related causes. HCV detection was lower amongst those with poorer geographic access to primary healthcare, but further analyses suggest this trend is due to selection, not causation. Individuals with the furthest to travel were less likely to be referred to an HCV specialist centre, compared to those who lived closer. Travel-time was not a significant predictor of utilisation of HCV specialist centres, but with patients in more remote areas less likely to be referred, it is probable that the utilisation result is biased due to selection. Liver-related mortality was higher for patients diagnosed in hospitals, but the risk of death was not associated with a lack of geographic access to healthcare.

With aging populations and rising health care costs, many high-income countries are exploring mobile computing technologies to improve the efficiency and effectiveness of health care provision. These technologies, which underpin the field of pervasive computing, introduce a new model of human–computer interaction. Instead of the scenario where a single user interacts with a desk-bound “personal” computer, pervasive computing envisions a world embedded with small, inexpensive, portable networked devices able to communicate seamlessly with each other. In common with resource-rich countries, the field of pervasive computing has the potential to promote and support healthy population development in middle and low-income countries, and this, therefore, has relevance for South Africa. Current estimates suggest that there are between 28 and 32 million mobile phones in South Africa. This means that around 60% of all South Africans own, or have access to, mobile telecommunication. Over 900 000 km2 of the country is covered by the GSM (Global System for Mobile Communication) network of Vodacom, the largest telecommunications company in the country. Over 90% of South Africa is provided with access to mobile connectivity through shared agreements between the country’s major telecommunications networks. Aims The ubiquity of mobile phones has resulted in their receiving increasing attention from public health researchers. Yet a better understanding of how mobile phones could support health research in South Africa is still an emerging field with many unanswered questions. This thesis attempts to fill some of these gaps in our current knowledge. In particular, the primary aim of this work is to implement and evaluate the use of mobile phones as instruments with which to collect and analyse information for monitoring, evaluation and research in low-resource rural African settings. Methods To investigate this aim, data were gathered from the development, implementation and evaluation of four health surveys in South Africa. Two surveys were conducted with Birth to Twenty, a birth cohort of South African young adults living in Greater Johannesburg. These data were used to better understand the feasibility and data-quality implications of using mobile phones as a tool for the administration of ‘self-administered’ surveys. Two additional surveys, completed in KwaZulu-Natal province, evaluated the same themes of feasibility, acceptability and impact of data quality in mobile-phone-assisted personal (face-to-face) interviews (MPAPI). The first, conducted with 500 HIV-positive pregnant women in eight primary health clinics and 12 interviewers trained to use the mobile-phone survey software, was used to assess the feasibility and acceptability of MPAPI. The final survey compared the difference in data quality achieved by 100 interviewers using either pen and paper, or mobile phones to conduct a short health survey. De Leeuw's conceptual model was used to frame how mode characteristics influence data quality. Results Mobile-phone-assisted interviewing was found to have an impact on the data quality, feasibility and acceptability of health surveys. MPAPI was found to be similar in terms of accuracy and cost to small-scale paper-and-pen interviewing (PAPI) surveys. Time lines and accessibility were improved by the use of MPAPI. Mobile-phone-assisted self-interviewing (MPASI) surveys were found to have a lower survey response but a higher item-completion rate. Acceptability was found to be moderated by technological familiarity and the use patterns of mobile-phone features. Finally, conducting health research using mobile-phone interviews in South Africa was found to be feasible; to reduce the loss of questionnaires, and photocopying and data-entry costs; and to improve the speed at which data becomes available for analysis. Factors that mediated feasibility included the technical expertise of the project management and field staff, the technological know-how of participants, the comprehensiveness of the interviewer training, the mobile communication channel used (e.g., handset-agnostic SMS) and the presence or absence of an interviewer. Conclusion Under the right conditions, mobile-phone-assisted interviewing appears to be a feasible and practical tool for the rapid collection of health information, with data accuracy being the same or better than pen-and-paper interviews. It is argued that these benefits increase as the scale of the survey increases. Improved data can positively influence population health by providing decision makers with more rapid access to accurate data with which to monitor large-scale health systems. Small projects that do not require the rapid availability of data or where staff do not have the appropriate technical proficiencies would be better suited at present to more traditional survey data-collection techniques. Keywords: mobile phones; pervasive computing; mHealth; data collection; survey error

O processo de obtenção diagnóstica da tuberculose (TB) é permeado por aspectos relacionados à acessibilidade aos serviços de saúde, que interferem diretamente na conduta do doente em buscar por atendimento após perceber o início dos sintomas da doença. Reconhecer esses aspectos pode contribuir na elaboração de medidas que levem à identificação precoce dos casos, diminuição do tempo diagnóstico e disseminação do agravo na comunidade. O presente estudo teve como objetivo, analisar o tempo do doente na busca por serviço de saúde para o diagnóstico da tuberculose no município de Ribeirão Preto - SP, 2009. Estudo descritivo do tipo transversal, realizado em Ribeirão Preto. De 113 doentes de TB, que estavam em tratamento no período de julho a novembro de 2009, foram entrevistados 94, que atenderam os critérios de seleção. Utilizou-se um questionário estruturado baseado no Primary Care Assessment Tool (PCAT) adaptado para o enfoque no diagnóstico da TB. Para a análise dos dados, medidas de tendência central (mediana e intervalos interquartis) foram utilizadas para analisar a variável: \"tempo decorrido entre sentir-se doente e a primeira procura pelo serviço de saúde\". Estabeleceu-se a mediana como valor mais adequado para a caracterização dos dois grupos de doentes (atraso e não atraso). Considerou-se atraso ao diagnóstico, doentes que demoraram mais de 15 dias para buscar pelo primeiro atendimento em um serviço de saúde. Em seguida, por meio do cálculo da Razão de Prevalência identificaram-se as variáveis sócio-demográficas, clínicas e da dimensão porta de entrada de maior atraso na busca por atendimento. O primeiro serviço de saúde procurado foram os Serviços de Pronto Atendimento (SPA) (57,4%), seguidos pelas Unidades de Atenção Básica (UAB) (24,5%) e Serviços Especializados (SE) (18,1%). Já o acesso ao diagnóstico ocorreu nos SE (60,6%), seguidos dos SPA (26,6%) e das UAB (12,8%). Quanto ao tempo de atraso ao diagnóstico, em relação às informações sócio-demográficos, o perfil dos doentes que mais demoraram para buscar pelos SPA foram: idade entre 50 a 59 anos (30 dias); SE: gênero masculino (30 dias), com escolaridade (21dias); renda acima de cinco salários mínimos (30 dias). Informações clínicas: SE: forma clínica pulmonar, caso novo e com co-infecção TB/HIV, (20 dias). Dimensão porta de entrada (primeiro serviço de saúde pocurado): UAB: sintomas moderados da doença (30 dias); SPA: não consumiam bebidas alcoólicas (25 dias) e com conhecimento satisfatório sobre a TB (26 dias); SE: não realizavam controle preventivo de saúde (30 dias), fumavam (20 dias), com conhecimento satisfatório sobre a TB (26 dias), não procuravam o serviço de saúde mais próximo do domicílio (30 dias). O serviço de saúde de maior acessibilidade foram os SPA, (funcionamento de 24h, demanda livre). É necessário capacitar as equipes de saúde, para identificarem os doentes de TB que tiveram maior atraso na busca por atendimento, favorecendo a acessibilidade ao diagnóstico precoce e contribuindo no controle da doença. / The process of obtaining diagnosis for tuberculosis (TB) is permeated by aspects relating to the accessibility of health services, which impact directly on the conduct of patients in search of medical attention after noticing the first symptoms of the disease. Recognising these aspects can contribute to the development of measures that lead to the early diagnosis of cases, reduction in the overall time taken in the diagnostic process and alleviation of the impacts of TB on the community. The aim of the present study was to analyse the patient time in the search in first health service for the diagnosis of tuberculosis in city of Ribeirao Preto, SP, 2009. Descriptive study, cross sectional conducted in Ribeirao Preto. Of 113 TB patients that were in treatment during the period between June and November of 2009, 94 were interviewed that fulfilled the selection criteria. A questionnaire was used based on the Primary Care Assessment tool (PCAT), which was adapted for focus on the diagnosis of TB. For the analysis of data, measures of central tendency (median and interquartile intervals) were utilised to analyse the variable: ,,time elapsed between the appearance of symptoms and the first search for health services\". The median was established as the most appropriate value for the characterisation of two groups of patients (timely and delay). Patients were considered ,,delay\" if the time between the first signs of illness and the search for health sercices was greater than 15 days. Next, through calculation of the prevalence ratios, socioeconomic, demographic, clinical and gateway dimension were identified for the greatest delay in the search in first health service. The emergency services (ES) room was the most common health service first sought by patients (57.4%), followed by primary health care (PHC) (24.5%), and finally specialists services (SS) (18.1%). The leading service with regard to obtaining a diagnosis was that of SS (60.1%), followed by ES (26.6%), and PHC (12.8%). Regarding the delay in obtaining a diagnosis, and with relation to socio-demographic information, patients that took the longest to seek health services through ES rooms were: between 50-59 years of age (30 days); SS: masculine (30 days), educated (21 days), receive a salary greater than five times the minimum wage (30 days). Clinical Information: SS: lung clinics, new cases and with co-infection TB/HIV (20 days). Gateway dimension (the search in first health service): PHC: moderate symptoms of the disease (30 days); ES: non-drinkers (30 days), and with a satisfactory knowledge of TB (26 days); SS: not practicing preventative health control (30 days), smokers (20 days), satisfactory knowledge of TB (26 days), didn\"t seek the health service closest to residence (30 days). The most accessible health service proved to be ES (functioning 24 hours, on demand). It is necessary to properly equip health care professionals so as to facilitate the identification of patients from TB that delayed in the search in first health service, facilitating the health service accessibility thus enabling the early diagnosis of the disease and contributing to its control.