Thesis (M.S.)--University of Michigan, 1975.

Thesis (Ph. D.)--University of Chicago, School of Social Service Administration, June 2000. / Includes bibliographical references. Also available on the Internet.

A major component of the primary health care (PHC) system is the delivery of health services on a community level, at the core of which is the Home and Community Based Care (HCBC) programme. This study focuses on one element of the HCBC system, namely how those involved in the administration of the community-based health component of primary health care, understand their relationship from the perspective of both the government (WCG - DoH) and the NPO service providers in the Eden District of the Western Cape. Additionally, it analyses the nature and the extent of the collaboration between the two entities. A patient referral tool was facilitated in a collaborative process to assess the ability of the two entities to strengthen their relationship. The study methodology was undertaken utilising Insider Ethnography with the researcher as a participant observer. Ten semi-structured interviews of the key stakeholders and one focus group were conducted with the staff of four non-profit (NPO) service providers operating in the Eden District and with WCG - DoH staff managing the HCBC programme. The findings reflect a substantial disconnect and imbalance in the relationship between the two entities, highlighting a top-down, transactional process at higher levels of management, in contrast to the operational relationships at the local sub-district level which are more collaborative. This disjuncture often disempowers the NPO service providers involved in the implementation of the programme. A number of recommendations regarding communication, advocacy, and innovation are proposed. Regular meetings of government, from district to provincial levels, with the NPO service providers, to strengthen collaboration by all stakeholders, are crucial.

Introduction and Background Childhood obesity affects 17% of children in the United States (Whooten et al., 2018). It is well understood that many social determinants contribute to the manifestation and improvement of this disease. Purpose Statement I aim to compare the impact of increased health education through medical professional to families and obese/overweight children compared to implemented physical activity in social and personal settings on BMI improvement among the obese/overweight children. Literature Review Searches performed through the Sherrod Library data base at East Tennessee State University included the following key words: social determinants, long-term study, physical activity, clinical, community and family. Research was not limited to the United States population. Findings Review of these studies showed marked improvement in BMI for physical activity programs in association with schools. These activities resulted in BMI z-score improvements of -0.22, when 60 minutes of physical activity was implemented 3-day/week prior to school (Whooten et al., 2018). Studies surrounding medical counseling and education alone reported minimal improvements to BMI and limited sustainable of these results at follow-up. However, frequent routine meeting with medical profession and obese children and their family resulted in increased Pediatric Quality of Life scores. Conclusions While implantation of multiple discipline may be required to improved BMI in obese/overweight children, physical activity in the public social setting shows to be promising compared to increased education and counseling from medical professionals alone in reducing BMI.

Abstract Introduction and Background: Minority populations struggle to gain access to equitable healthcare due to cultural variations and language barriers. It is paramount for providers to accommodate to the differing needs of underserved minority groups. Purpose Statement: We analyzed information on the effects of community-based interventions aimed at improving healthcare access for minorities. Literature Review: We used PubMed as our main database. For our search, we looked up the keywords “Healthcare Access AND Minorities.” Next, we filtered articles that had been published since 2017 and sorted to include clinical trials, randomized control trials, and meta-analyses. After that, we came across ninety-eight total articles, and picked five of the most critical. Findings: From the first two articles, patient navigators have been shown to be effective in helping minorities navigating the information and decisions presented to them in healthcare. The researchers in the third study found that minority groups are at a greater risk for a health literacy deficit. Our next article found that African Americans treated with computerized cognitive behavioral therapy saw a significant decrease in anxiety and depression. Our final document found that lack of access to healthcare resources decreased dementia outcomes by missing the early onset of symptoms. Conclusions: It is evident that minorities face healthcare disparities that keep them from receiving access to equitable healthcare. As a nurse, it is important to identify gaps in access to healthcare in minority patients. Interventions aiming to increase health literacy and access in minorities have shown to be effective.

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No description available.

Unhoused Individuals and Access to Healthcare Introduction & Background: The unhoused, identified as those in shelters, transitional housing, and those who sleep in unhabitable places are prone to exposure to issues such as diabetes complications, tuberculosis, and lack of insurance. This U.S. population of over 560,000 may not prioritize health due to their focus on survival. Purpose Statement & Research Question: The purpose of researching homelessness is to determine if the unhoused population who use community health resources has a better quality of life than the unhoused who do not utilize resources. Literature Review: The literature review included search terms such as unhoused, hospital admissions, homeless programs, and scientific nursing research. A broad inclusion criterion with a focus on the use of local resources within the population was utilized. The CINAHL database was searched. Each source is peer reviewed, less than 5 years old, and authored by at least one registered nurse. Findings: Findings indicate that current systems and tools for the unhoused within healthcare facilities are deficient regarding patient-centered care. Over 50% of unhoused people are male, and 60% of the unhoused seek shelter in some capacity. Trends include region, climate, and available resources. Interviews yield that the unhoused have issues seeking proper care due to a lack of understanding of healthcare systems or referral pathways. Difficulties with transportation, insurance, or perceived negative authority from providers affect this population. Conclusions & Nursing Implications: Professional hypotheses and methodology are portrayed in the viewed research. Different identification strategies and accessible health programs are necessary for this population to improve the well-being of the unhoused and the efficiency of health facilities.

In response to the striking health and social inequalities existing across communities within a large Southern Ontario City the McMaster University School of Nursing has partnered with the local family health team, municipal government, and other community partners to evaluate a pilot program designed to enhance health and social outcomes within a specific priority neighbourhood. The innovative pilot program is a nursing-based system navigation role, grounded concurrently in the community and a local Primary Care Practice. The role is uniquely designed as the nurse provides navigation for individuals and families while functioning as a networker to facilitate improved service integration at a systems level. This study serves as a narrative person-centered evaluation of the program, emphasizing the impact on the lives of community members. This study employed the Three-Dimensional Narrative Inquiry Space method as described by Clandinin and Connelly (2000) to explore the experience of nine community residents utilizing navigation services through the Community Nurse Navigator/Networker (CNN). Programs tell a story; therefore, the collection and analysis of participants’ life stories, in conjunction with field notes, observations, and documents, created a common narrative of the experience of navigation in a community setting. A thematic analysis of participants’ life stories was conducted to present a common narrative of community members’ experience of navigation. The major finding of this study was the positive experience residents shared interacting with the CNN. Participants valued the development of a therapeutic relationship through social interactions, the significance of place on the impact of the CNN role, and the effect of the navigation role to address health disparities over time. Study findings have implications for continued development of the CNN role and other community-based nurse navigation roles in priority neighbourhoods to address health inequities. / Thesis / Master of Science in Nursing (MSN)

Background: There is limited research on the healthcare experience of Deferred Action for Childhood Arrivals (DACA) recipients both before and after enrollment in the program. DACA is a program designed to defer deportation to children and young adults in the United States for up to 2 years. The goal of this qualitative study is to explore the lived experiences of DACA students with regards to access to healthcare and perceptions of treatment. Method: This study is qualitative and uses a phenomenological approach. DACA Recipients (N = 5) were recruited from the UCF student population and 1:1 interviews were conducted. Interviews were transcribed and manually coded. Results: Thematic analysis revealed the following three themes (1) Meeting Needs (2) It Takes a Village and (3) Documentation­­ Over Insurance Conclusion: The fundamental structure of the findings shows the struggles of receiving healthcare as an undocumented immigrant, and the limitations of DACA as a solution. Health insurance is a more prominent and impactful factor than documentation status in the quality and quantity of healthcare access. The healthcare experience ranges from volunteer clinics to local pharmacies. Although, if DACA recipients have insurance, their healthcare experience is more consistent, regardless of documentation. Their day to day lives is composed of meeting basic needs, receiving only necessary doctor's visits as a child, and being prepared for all circumstances in terms of future citizenship.