Blindness is one of the most debilitating health disorders and avoidable blindness is a major international health problem. The World Health Organization has estimated that globally, there are 45 million persons who are blind - a figure that is expected to increase to approximately 76 million by the year 2020. Approximately 80% of blindness is avoidable and can be prevented or cured with appropriate service delivery efforts. Research suggests that the combined annual global GDP loss from blindness in 2000 was more than $40 billion. Yet blindness has received relatively little attention in worldwide efforts to promote health and it is not at present a high health priority in many countries. Consequently, unless there are alternative and more efficient and extended endeavours to address this situation and model an approach that will provide a long-term solution, avoidable blindness will continue. In recent years, eye care service delivery organisations have assumed a greater level of responsibility for addressing the problem of avoidable blindness. A number of successful approaches have been designed and implemented to expand the delivery of eye care services. The approaches have focused on the development of organisational capacity and on sustainability, and they have effectuated a reduction in avoidable blindness in particular target populations. However, despite their importance, contemporary eye care service delivery models have largely been neglected in the literature and few formal organisational approaches to eye care have been developed and documented. There are few definitive independent studies available that outline the bases of these approaches and no explicit and standardised methodologies that can assist service delivery organisations to replicate the approaches. Objective and comprehensive research is accordingly required to promote current and new approaches to eye care and to develop ways of facilitating their adoption. The thesis attempts to address this problem by developing a theory–based, case study–supported practical methodology to identify, support the progression of, and measure the strategic and operational objectives of eye care service delivery organisations. The research seeks to identify the issues relevant to the management of eye care service delivery organisations and subsequently evaluate whether they can be incorporated into a distinct and explicit management framework. It seeks to present the value of the process and the possibility that it can be accomplished elsewhere and in dissimilar organisations. By developing a widely applicable management framework, the research's primary contribution is that it extends eye care organisational management theory to assist in the facilitation of blindness reduction. A conceptual management framework is developed in the thesis which unifies contemporary eye care organisational approaches with the Balanced Scorecard management framework. The framework was devised for and evaluated by undertaking two case studies – one in India and one in South Africa. The significance of developing such a framework is demonstrated at various points throughout the thesis. The research process reveals the potential applicability of the framework – the Strategic Management Framework (SMF). The research concludes that the SMF is able to support and enhance organisational development, performance management, and scenario analyses in eye care service delivery organisations operating in developing countries. Although the framework developed in the thesis is specific to eye care organisations it is flexible enough to be transferable to other healthcare organisations in developed countries. The final conclusion of the thesis is that, while the SMF is not in itself a solution to the problem of avoidable blindness, it is an appropriate and practical management tool which will improve existing, and assist in the establishment of new, eye care service delivery organisations. In this context, the research makes a number of significant and original contributions to prevention of blindness literature and theory. / Thesis (Ph.D.)--School of History and Politics, 2004.

Among the health disparities affecting the U.S. Hispanic population today are those relating to risky behaviors such as substance abuse, intimate partner violence (IPV) and HIV/AIDS. However, few studies have examined how these conditions may impact this population. The purpose of this dissertation was to explore the experiences that Hispanic women in South Florida have with regard to substance abuse, IPV and risks for HIV/AIDS, to describe how these conditions may be related, and to develop a model that can be used to guide research and interventions targeting this population. This dissertation uses data collected in Project DYVA (Drogas y Violencia en las Americas- Drugs and Violence in the Americas), a pilot research study that utilized both qualitative (Phase I) and quantitative (Phase II) research methods to describe the experiences of Hispanic women in South Florida between the ages of 18 and 60 with regard to substance abuse, violence and risky sexual behaviors. Three studies were conducted as part of this dissertation. The first study utilizes data collected during the qualitative phase of Project DYVA. During this phase eight focus groups were conducted and analyzed using qualitative content analysis (N = 81). The second and third studies utilize data collected during the second phase of Project DYVA. In this phase cross-sectional questionnaires collecting information regarding demographics, acculturation, self-esteem, depression, substance abuse, IPV and risks for HIV, were administered to 82 Hispanic women. Univariate and multivariate statistics were used to explore the relationships between substance abuse, IPV and risk for HIV (study 2) and between resource availability, IPV and depression (study 3). The findings from this dissertation suggest that substance abuse, IPV and risk for HIV are closely related intersecting health issues. IPV, the condition that emerged as the most salient of the three, also appears to be closely associated with resource availability (i.e., self-esteem and income) and depression. Additional individual, cultural, relationship and socio-environmental factors that may play a significant role in shaping the experiences that Hispanic women have with regards to these intersecting conditions were also identified and organized into a model.

The purpose of this single case study was to describe community perspectives of a service learning (SL) partnership with a single university conferring a baccalaureate nursing degree. The longevity of the partnership extended the study purpose to explain why the partnership continued and worked well. A review of nursing literature revealed descriptive accounts of programs designed to meet needs of underserved populations and student learners. However, the review also revealed a knowledge gap in nursing education science regarding the community perspectives of successful SL partnerships. This study focused on relationships with the academe partner, interactions with students and faculty, and benefits of services rendered. Using a case study approach, the investigator sought disparate sources of information including interviews with 21 community members, the primary nursing professor, and the university administrator for rural health and community partnerships. The investigator reviewed relevant documents and made observations during nine days in the community. Triangulation of multiple data sources illuminated a relationship in which key players remained committed to mutual goals beyond immediate projects. Compelling findings were the a) immersed accessibility of the primary nursing professor who lived in the community, b) competency of community members to be expert teachers and set the agenda for the university’s involvement, and c) increased social connectedness that empowered a community to improve its health. The American Association of Critical Care Nurses Synergy Model (Hardin, 2009) was useful for understanding the synergistic relationship involving community partners, student learners, and nursing faculty. However, the broader themes of a community empowered through full integration into a partnership fit with social theories explaining interactions at the macro level as well as behaviors along a pathway of shared commitment. This case demonstrated that sustained interpersonal relationships were critical to developing the community’s integral role as full partner, and the primary nursing professor was a trusted link advocating judiciously for all parties. As SL pedagogy is integrated into nursing education with an emphasis on community-based education and health at the population level, findings of this study can assist nurse educators in the development and maintenance of successful community-academe partnerships.

Sleep disturbance is common in patients with heart failure (HF) and the family caregivers. Sleep disturbance is known as a predictor of poor quality of life (QoL) in individual level. The manner in which patients’ and caregivers’ sleep disturbances influence each other’s QoL has not been determined. The purpose of this dissertation was to investigate the associations of sleep disturbance and outcomes in patients with HF and their primary family caregivers. The specific aims were to: 1) examine whether sleep disturbance of patients and their family caregivers predict their own and their partners’ QoL; 2) examine the mediator effects of depressive symptoms on the association between sleep disturbance and QoL in patients and family caregivers; and 3) provide evidence of the psychometric priorities of the Zarit Burden Interview (ZBI) as a measure of caregiving burden in caregivers of patients with HF. The three specific aims were addressed using secondary analyses of cross-sectional data available from 143 patients with HF and their primary family caregivers. To accomplish Specific Aim One, multilevel dyadic analysis, actor-partner interdependence model was used for 78 patient- caregiver dyads. Individuals’ sleep disturbance predicted their own poor QoL. Caregivers’ sleep disturbance predicted patients’ mental aspect of QoL. For Specific Aim Two, a series of multiple regressions was used to examine the mediation effect in patients and caregivers separately. Depressive symptoms significantly mediated the relationship between sleep disturbance and mental aspect of QoL in patients. The mediation effect was similar in caregivers. For Specific Aim Three, the internal consistency and convergent and construct validity of the ZBI in 124 family caregivers of patients with HF were examined. The results showed that the ZBI is a reliable and valid measure of caregiving burden in this population. This dissertation has fulfilled important gaps in the evidence base for the QoL outcome in patients with HF and caregivers. The findings from this dissertation provided evidence of the importance of monitoring sleep disturbance for better QoL in both patients and caregivers and the importance of assessing caregivers’ sleep disturbance for improving patients’ QoL. It also provided evidence of the importance of managing depressive symptoms when targeting sleep disturbance to improve QoL in both patients and caregivers.

Thesis (Ph.D.) -- McMaster University, 1998. / Includes bibliographical references (leaves 143-147). Also available via World Wide Web.

Thesis (Ph.D.)--University of Melbourne, School of Social Work and Department of Psychiatry, 2001. / Typescript (photocopy). Includes bibliographical references (leaves 262-311).

Thesis (Ed.D.)--Teachers College, Columbia University, 1992. / Includes tables. Typescript; issued also on microfilm. Sponsor: Elizabeth Tucker. Dissertation Committee: Douglas S. Sloan. Includes bibliographical references (leaves 157-175).

Thesis (M.S.P.H.)--University of Michigan, 1942.

Thesis (Ph.D.)--Flinders University, Faculty of Health Sciences, Dept. of Public Health. / Typescript bound. Includes bibliographical references: (leaves 406-434) Also available online.

Thesis (Ph.D. (Economics)) - Rhodes University, 2009.