The complexity and lack of coordination of the U.S. health care system is especially challenging for older adults, many of whom have multiple chronic conditions. The faith community is a potential partner to assist them, due to strong religiosity of older adults and specific characteristics of faith communities. This study explores the knowledge and practices of faith community nurses (FCNs) in meeting care coordination needs of older adults and identifies a model of gap-filling by FCN practice. An approach combining both quantitative and qualitative approaches was used. A survey was distributed to all known FCNs in Kentucky. From the 60 respondents, 15 FCNs were selected for personal interviews, and six care recipients were also interviewed. Survey data revealed a relatively older workforce, M=57 years, with 73% in nursing for more than 20 years. All served as FCNs in their own congregations, mostly as volunteers. FCNs relied on informal rather than formal assessments, with little consistency in type of health-related information obtained from congregants. The combined interview data revealed themes including, strong grounding in faith, sense of congregational family, reliance on general nursing assessment skills, intentional empowerment, bridging expanses, trust, and continuity. Findings suggest that FCNs in Kentucky identify and fill significant gaps in health care for older adults. Spirituality and religious rituals were important for FCNs and those they served. Congregants sought out FCNs to answer questions, interpret medical information, and assist with health care interactions. The stability of the FCNs in the lives of congregations was regarded as important; congregants counted on FCNs presence through transitions in health. A model to explain FCN intervention was developed based on integration of a social ecological perspective with the WHO International Classification of Functioning, Disability, and Health. This model reflects contextual factors that occur throughout nested environments that surround each individual, including immediate family, congregational family, health and social care systems, and societal policies. FCNs serve as a bridge between and among these nested environments, connecting them and facilitating change within each level.

Hearing loss is considered a global health concern with 466 million people affected worldwide. Current hearing health care delivery models are based on several consecutive face-to-face consultations that occur in-person. Information and communications technology, and especially mobile technology, can be used to support or enhance health care delivery. This can be employed in addition, or as an alternative to, current patient treatment pathways. This project developed a hybrid hearing health care approach by combining online and face-to-face services. The services were offered using a five-step approach: (1) online hearing screening, (2) motivational engagement by voice/video calling, messaging, or emailing, (3) diagnostic hearing testing in a face-to-face appointment, (4) counseling, hearing aid trial and fitting using face-to-face and online methods, and (5) online aural rehabilitation, counseling and ongoing coaching using face-to-face and online methods. Three studies were conducted. Study I investigated the readiness, characteristics and behaviors of patients who sought hybrid hearing health care. Over three months (June–September 2017), 462 individuals completed the online hearing screening test: 59% (271/462) of those failed (age M = 60; SD = 12), indicating that further assessment and treatment might be required. These patients had been aware of their hearing loss for a period of between 5 to 16 years. A significant positive correlation was observed between age and speech reception threshold (r = 0.21; p < .001), where older participants presented with poorer scores. Five participants completed readiness measurement scales and attended a face-to-face diagnostic hearing evaluation during this time. Study II investigated patient uptake, experience and satisfaction with hybrid hearing health care using a process evaluation. The process evaluation study was conducted over a three-month period for patients who sought services from the clinic over a period of 19 months (June 2017–January 2019). A total of 46 patients seen at the clinic were invited to complete an online questionnaire regarding their experiences and satisfaction with the steps completed and services provided. Of those, 31 (67%) patients responded (age M = 66; SD = 16). Of the 61% of patients who had previously sought hearing services, 95% reported the hybrid clinic services as superior. Two main themes emerged from the patient’s comparison of their experience with the hybrid clinic versus previous experiences: clinician engagement (personal attention, patience, dedication, thorough explanations, professional behavior, exceeding expectations, friendliness and trust) and technology (latest technology, advanced equipment and hearing aid trial). Patients who completed all five steps, including acquiring hearing aids and taking part in an online aural rehabilitation program (continued with hearing health care), were significantly older and had significantly poorer speech reception thresholds compared to those who did not acquire hearing aids after the diagnostic hearing test and hearing aid trial (discontinued hearing health care). A significant positive correlation was found between age and the number of face-to-face appointments attended per patient (r = 0.37; p = .007). Study III investigated whether digital proficiency (proficiency with mobile devices and computers) was a predictor of the uptake of hybrid hearing health care. A total of 931 individuals failed the online hearing screening test and had submitted their details to the clinic for further care over a 24-month period (June 2017–June 2019). Of the 931 online test takers, 53 persons (age M = 64; SD = 15) who attended a face-to-face diagnostic hearing testing completed a mobile device and computer proficiency questionnaire. An exact regression model identified age as the factor associated with patients completing all five steps, including acquiring hearing aids and taking part in an online aural rehabilitation program (continued with hearing health care) from a hybrid model (β = .07; p = .018). Older patients were more likely to continue to seek hearing health care. Digital proficiency was not significantly associated with adults with hearing loss taking up services through a hybrid hearing health care model. The results from these three studies demonstrate that asynchronous internet-based services such as an online hearing screening test can be used to create awareness of hearing health care. It is possible to provide online support to patients during the initial stages of seeking hearing health care online prior to the first face-to-face visit. Patient uptake, satisfaction and experience of using hybrid hearing health care services are positive when compared to traditional methods of service delivery. Hearing health care models that combine face-to-face and online methods hold promise for audiologists willing to incorporate online modalities into current treatment pathways. This research project highlights the opportunity for audiologists to provide services and personalized support to patients using a combination of face-to-face and online modalities. / Thesis (PhD)--University of Pretoria, 2020. / This work was supported by the National Research Foundation (NRF) of South Africa under the grant number 107728. / Speech-Language Pathology and Audiology / PhD (Audiology) / Unrestricted

A thesis submitted in partial fulfilment of the requirements for the degree of Masters of Arts in Clinical Psychology at the University of Zululand, South Africa, 2011. / South Africa is at a critical point in the debate about the future of health-care in the occupation-specific dispensation (OSD). It also faces the exodus of valuable human resources that was perceived as greener pastures, as medical practitioners become increasingly dissatisfied with governmental policy, wage negotiations, work-place disillusionment, lack of service delivery, expressions of corruptions, and lack of resources. This research aimed to thematically analyse the experiences, opinions and feelings of medical practitioners in both the public and private health-care sectors as well as explored international trends with the intention of drawing comparisons, highlighting problem areas, and discussion of possible solutions. It was hoped that this research would contribute towards understanding the dynamics that marked the exodus of medical practitioners from South Africa, at a time when change in the health-care system was imminent. In order for the medical practitioners to remain in the current health-care system, a new dialogue would have been opened in which their concerns could be raised and evaluated.

Indiana University-Purdue University Indianapolis (IUPUI) / Introduction: The U.S. is faced with a primary care (PC) workforce shortage; an estimated 43 percent of the population has unmet health care needs and 18.2 percent of the adult population lacks a usual source of care (USC) provider. The workforce shortage limits even those with a USC from receiving the full scope of recommended clinical services. One promising solution is reforming scope-of-practice (SOP) policies for PC nurse practitioners (NPs). Objectives: The primary objective of this dissertation was to assess the impact of NP SOP policy implementation on NP practice patterns and patient access to PC by evaluating NP time spent delivering patient care, NP role as USC providers, patient travel times, and appointment availability. Methods: The studies discussed in this dissertation leveraged cross-sectional data from the National Sample Survey of Nurse Practitioners (NSSNP), time-series data from the Medical Expenditure Panel Survey (MEPS), and the Nurse Practitioner Professional Practice Index (NPPPI) to quantify variations in state policy environments. We used generalized mixed effects models to examine relationships in the cross-sectional data analyses and two-way fixed effect models to evaluate longitudinal data. Results: Our analyses revealed several key findings: NP SOP policies do impact the percentage of time NPs spend providing direct patient care; the NP workforce role as USC providers has increased as SOP policies have changed; states with supportive reimbursement policies have more NPs working as USC providers; and states with fewer NP supervision requirements have shorter patient travel times to USC providers. Conclusion: The U.S. health care system must continue to evolve to address the growing demand for PC services. While strategies to increase the supply of PC providers may be an effective long-term solution, our findings suggest that NP SOP reform may be a viable and complementary strategy to increasing the capacity of the PC workforce, providing more immediate relief. / 2 years

No description available.

Thesis (Ph.D. (Nursing))--North-West University, Potchefstroom Campus, 2006.

The process for the incorporation, integration or collaboration of traditional healers into the National Health Care Delivery System of South Africa was marred by an array of mixed attitudes from all the parties concerned, namely traditional healers, patients, biomedical personnel, and the policy makers. The variety of approaches for inclusion of the traditional healers into the National Health Care System of South Africa was a further indication of the complexity of the situation. The possibility of functioning together between traditional healers and biomedical personnel existed before 1990 when the two groups met in Johannesburg in 1986 to discuss ways by which functioning together can be established. A series of meetings and discussions followed after which came the promulgation of the Chiropractors Homeopaths and Allied Health Services Professionals Act of 1996, which gives traditional healers their due recognition but does not include them as part of health care providers. The process of functioning together is a recommendation made by the World Health Organization and the most used terms for this functioning together is, incorporation, integration and collaboration. The process of incorporation can be realised by ensuring that both biomedical personnel and traditional healers remain autonomous, not controlling each other, respecting the existence of one another, as well as each other's own methods of healing. Integration was another method whereby the two health care systems can function together, even though integration differs in context from incorporation. Integration means that the traditional healers will have to function within the health care system under the directions of the biomedical personnel, whereby the patient receives a combination of both treatment methods depending on the problem or diagnosis. The third modality of getting the two health care systems to function together could be by collaboration. Collaboration was seen as a two sided effort whereby the healing methods of one are brought to fore and the most effective one is chosen to cure the patient's identified problem at that time. For the process of functioning together to be meaningful, it was necessary to get the government to review licensing the traditional healer's practices, so as to identify the healing techniques that are of value and use these to treat the patients. It was not really possible to clearly separate the three approaches because they all addressed the issue of having the two health care systems function together to increase health care services and fulfil the patients' health needs. For the purpose of this research the word incorporation was used. In South Africa the traditional healer is identified as the health care choice of 80-9036 of the black population. If this large number of black people uses traditional healing, then it becomes necessary to investigate the manner in which the traditional healer can be utilized effectively in the National Health Care Delivery System of South Africa to render the services that the patient needs for his/her health needs. It is for this reason that the researcher aimed at investigating the existing models of incorporation of traditional healers, the perceptions and attitudes of the traditional healers, biomedical personnel, patients and the policy makers regarding incorporation, their views on how this incorporation should be achieved, as well as how the incorporation of traditional healers into the National Health Care Delivery System of South Africa could be realised. A qualitative research design and theory generating approach was followed, and the research was conducted in two stages. In stage one qualitative research, participants were traditional healers, biomedical personnel, patients and policy makers, selected by means of non-probable purposive voluntary sampling. Data was collected by means of conducting semi-structured interviews with all the participants in the three identified provinces of South Africa. Field notes were recorded after each interview session. Data analysis was achieved by open coding. A co-coder and the researcher analysed the data independently after which consensus discussions took place to finalise the analysed data. Ethical principles were applied according to the guidelines of the Democratic Nurses Organisation of South Africa and the Department of Health. The second stage which was a theory generation approach, was used to formulate a model for the incorporation of the traditional healers into the National Health Care Delivery System of South African. / Thesis (Ph.D. (Nursing))--North-West University, Potchefstroom Campus, 2006

The process for the incorporation, integration or collaboration of traditional healers into the National Health Care Delivery System of South Africa was marred by an array of mixed attitudes from all the parties concerned, namely traditional healers, patients, biomedical personnel, and the policy makers. The variety of approaches for inclusion of the traditional healers into the National Health Care System of South Africa was a further indication of the complexity of the situation. The possibility of functioning together between traditional healers and biomedical personnel existed before 1990 when the two groups met in Johannesburg in 1986 to discuss ways by which functioning together can be established. A series of meetings and discussions followed after which came the promulgation of the Chiropractors Homeopaths and Allied Health Services Professionals Act of 1996, which gives traditional healers their due recognition but does not include them as part of health care providers. The process of functioning together is a recommendation made by the World Health Organization and the most used terms for this functioning together is, incorporation, integration and collaboration. The process of incorporation can be realised by ensuring that both biomedical personnel and traditional healers remain autonomous, not controlling each other, respecting the existence of one another, as well as each other's own methods of healing. Integration was another method whereby the two health care systems can function together, even though integration differs in context from incorporation. Integration means that the traditional healers will have to function within the health care system under the directions of the biomedical personnel, whereby the patient receives a combination of both treatment methods depending on the problem or diagnosis. The third modality of getting the two health care systems to function together could be by collaboration. Collaboration was seen as a two sided effort whereby the healing methods of one are brought to fore and the most effective one is chosen to cure the patient's identified problem at that time. For the process of functioning together to be meaningful, it was necessary to get the government to review licensing the traditional healer's practices, so as to identify the healing techniques that are of value and use these to treat the patients. It was not really possible to clearly separate the three approaches because they all addressed the issue of having the two health care systems function together to increase health care services and fulfil the patients' health needs. For the purpose of this research the word incorporation was used. In South Africa the traditional healer is identified as the health care choice of 80-9036 of the black population. If this large number of black people uses traditional healing, then it becomes necessary to investigate the manner in which the traditional healer can be utilized effectively in the National Health Care Delivery System of South Africa to render the services that the patient needs for his/her health needs. It is for this reason that the researcher aimed at investigating the existing models of incorporation of traditional healers, the perceptions and attitudes of the traditional healers, biomedical personnel, patients and the policy makers regarding incorporation, their views on how this incorporation should be achieved, as well as how the incorporation of traditional healers into the National Health Care Delivery System of South Africa could be realised. A qualitative research design and theory generating approach was followed, and the research was conducted in two stages. In stage one qualitative research, participants were traditional healers, biomedical personnel, patients and policy makers, selected by means of non-probable purposive voluntary sampling. Data was collected by means of conducting semi-structured interviews with all the participants in the three identified provinces of South Africa. Field notes were recorded after each interview session. Data analysis was achieved by open coding. A co-coder and the researcher analysed the data independently after which consensus discussions took place to finalise the analysed data. Ethical principles were applied according to the guidelines of the Democratic Nurses Organisation of South Africa and the Department of Health. The second stage which was a theory generation approach, was used to formulate a model for the incorporation of the traditional healers into the National Health Care Delivery System of South African. / Thesis (Ph.D. (Nursing))--North-West University, Potchefstroom Campus, 2006

This thesis presents a challenge to policy initiatives that presume that patient-centered care will reduce racial disparities in health. Data from the Medical Expenditure Panel Survey were used to test patient assessment of provider behavior defined as patient-centered care according to the National Health Disparities Report of the Agency for Healthcare Research and Quality of the Department of Health and Human Services. Results indicated patient-centered care improves self-rated health status, but blacks still report worse health status than whites experiencing comparable patient-centered care. Further, black-white differences in patient-centered care had no affect on health status. Rival theories of black-white differences in health, including social class and health literacy, provided better explanations of disparities than assessment of provider behaviors. These findings suggest that policies designed to financially incentivize patient-centered care practices by providers should be considered with caution. While patient-centered care is better quality care, financial incentives could have a negative effect on minority health if providers are deterred from practices that serve disproportionate numbers of poor and less literate patients and their families. Measurement of the concept of patient-centered care in future health disparities research was also discussed.

The purpose of this phenomenological study was to describe the lived experiences of African American women with secondary infertility, defined as an inability to conceive or carry a baby to term after a previous conception. Research on secondary infertility has ignored the prevalence of the condition in African American women. The implications of secondary infertility in African American women have immediate and far-reaching health and psychosocial consequences. African American women rely on interconnectedness and social networks; therefore, social networks and social support served as the key concepts underwriting the study's conceptual framework. Social networks and social support underscore the connection between those needing and those rendering support during stressful life events. The study consisted of 10 African American women ages 18-75 years old, who met the inclusion criteria for the study. Participants completed screening questions, a brief demographic questionnaire, and an interview. Their experiences were captured through first person accounts during one-to-one semi-structured interviews developed through pilot testing. Qualitative analysis yielded four themes: (a) defining family and adjusting to the change in definition of a family; (b) experiences with secondary infertility; (c) psychosocial stressors and supports from friends and family; and (d) treatment and intervention. This research promotes social change by informing clinical practice through access to culturally competent resources, increased responsiveness and policy development promoting timely access to care.