Thesis (M.S.W.)--Smith College School for Social Work, Northampton, Mass., 2007 / Typescript. Thesis submitted in partial fulfillment for the degree of Master of Social Work. Includes bibliographical references (leaf 58).

Thesis (Ph.D.)--Yale University, 2004. / Presented to the Faculty of the Graduate School of Yale University in candidacy for the degree of Doctor of Philosophy. Includes bibliography. Preview available online at: http://proquest.umi.com/pqdlink?did=765029031&Fmt=7&clientId%20=43258&RQT=309&VName=PQD.

Thesis (M.S.P.H.)--University of Michigan, 1940.

Thesis (M.S.P.H.)--University of Michigan, 1940.

<p>Postpartum depression (PPD) is a mental health condition present in 13% of new mothers. It is a serious public health issue that profoundly impacts the health of mothers, their children, and their partners. While the short- and long-term implications of maternal mental health for children’s growth and development have been well documented, little has been written about the impact of maternal PPD on partners. In particular, the effects of PPD on new fathers have received little attention. This qualitative descriptive study examined, through the sharing of photographs by participants and in-depth interviews (n = 10), the experience of the transition to parenthood for first-time fathers whose partners have PPD. It also compared their expectations of fatherhood with the lived reality of the experience and explored fathers’ perceptions of, and access to, health services and supports. The main themes that emerged from the data analysis were: From two to three, Connecting with baby, PPD and the partner relationship, Heightened involvement with baby, and Available and desired supports. Sub-themes that captured more specific patterns in the data also were identified. The study findings have implications for establishing best practices that are inclusive of support and education for partners.</p> / Master of Science (MSc)

<p>Introduction</p> <p>Canadian health and social service systems need to adapt to new challenges posed by the unique primary health care (PHC) needs of recent immigrant families. Community-based service providers are the first to experience changing responsibilities. Providers in communities with limited experience in working with immigrants may benefit from shared skills and modeled cultural competencies when working with new arrivals.</p> <p>Purpose</p> <p>This case study describes how a set of community-based service organizations addressed the PHC needs of recent immigrant families with young children living within a mid-sized urban centre in Atlantic Canada. The roles of organizational brokers and of <em>competence trust</em> among service providers were examined to determine their influence on the capacities of the service network overall.</p> <p>Methods</p> <p>Methods from social network analysis and descriptive qualitative inquiry were applied in this study. Organizational ecology contructs framed the research questions and propositions. An intersectoral approach to PHC was adopted to define the services network. Results derived from the network survey and key informant interviews were triangulated to develop a final interpretation.</p> <p>Results</p> <p>The study network constituted a relatively cohesive group of service providers. Network participation became more selective depending on the issue experienced by families. Network interactions were facilitated by broker organizations; some brokers actively engaged in the development of cultural competency capacities among network members. Trust in the other provider organization’s cultural competencies (<em>competence trust</em>) with recent immigrant families positively influenced the quality of working relationships.</p> <p>Conclusions</p> <p>Broker organizations can play a significant role in network capacity development through the promotion of cultural competencies in partnering organizations and by making connections across service sectors. The cultural competence of partnering organizations is an important pre-condition of trust for service providers committed to the needs of recent immigrant families. Having trusting relationships among providers can facilitate exchange and enable access to services. Nurses have the potential to participate in the advancement of culturally competent service systems.</p> / Doctor of Philosophy (PhD)

In 1998 World Health Organisation Europe outlined a vision of a new community-based nurse called the Family Health Nurse (FHN) who would help individuals, families and communities to cope with illness and to improve their health. Scotland was the first European country to develop this idea through policy, education and practice. The two phase national pilot project (2001-2006) primarily involved remote and rural regions. Despite its vanguard position, Scottish family health nursing has been subject to little in-depth critical analysis. This thesis addresses this deficit by analysing why and how family health nursing developed in Scotland. The research methods used are: critical review of textual sources; empirical research into policy, education and practice; and critical review and application of relevant theoretical perspectives to enable interpretation. Grounded primarily in constructivism, this approach builds explanation of the development of family health nursing in Scotland as a phenomenon in contemporary nursing history. This explanation highlights the importance of key factors and processes, particularly: agency at policy formulation level; use of the piloting mechanism to mediate knowledge production, containment and expansion; tensions between generalism and specialism as manifest within the promulgated FHN concept, the educational programme, and the FHN role as it was variously enacted in practice; related difficulty in engaging substantially with families; and the strong influence of local context on the nature and scope of FHN role development, especially in terms of situated power and embedded culture of place. The explanation is summarised as a synoptic story. A new integrative, explanatory model of the development of family health nursing in Scotland is also posited. This knowledge is then examined in relation to contemporary community nursing and primary care in order to understand influence and implications. This highlights the importance of the development of family health nursing in shaping the new Community Health Nurse (CHN) role which emerged from the Review of Nursing in the Community in Scotland 2006. The new explanatory model constructed within the thesis is then applied in its more generic MAPPED format (Model for Analysing Policy to Practice Executive Developments) to analyse the new policy formulation advancing the CHN role and to anticipate key developmental factors and processes. On this basis, the thesis argues that the MAPPED model is potentially valuable for the analysis of developments that require purview from policy through to practice. The thesis concludes by summarising its contributions to understandings of community nursing policy, practice, research and theory, and makes a number of related recommendations.

Cigarette smoking is the leading cause of preventable disease and is the cause of nearly 1 in 5 deaths in the United States. The prevalence of smoking has had a leveling off effect after many years of significant decline. Certain subgroups of the population, such as those with low income and certain illnesses, continue to smoke at disproportionately high rates. Reasons for these disparities in smoking rates are complex. Developing a better understanding of the issues related to persistent smoking particularly for those with medical illness and limited access to cessation resources can help focus interventions to help these high risk smokers quit. This dissertation includes a systematic review of the literature associated with hardcore smoking; an analysis of the reliability and validity of a self-efficacy instrument in a sample of low-SES, medically ill smokers; and the results of a cross-sectional, non-experimental study exploring the relationship between smoking-related factors and planning to quit in a sample of medically ill smokers. A sample of 70 current and recent smokers was surveyed at a free clinic. Quitting self-efficacy was measured using an instrument not previously tested in a rural, medically ill sample. Modifications to the survey were made based on qualitative interviews with smokers and a single question measuring self-efficacy was also tested. There was a high correlation among the self-efficacy measures (Spearman’s rho .99, p < .001) and between the longer instrument and the single question (Spearman’s rho .65, p < .001). Each measure demonstrated acceptable reliability and validity. In the study exploring potential factors associated with planning to quit, the number of prior quit attempts and confidence to quit explained 43% of the variance in those planning versus not planning to quit. Providing interventions focused on increasing confidence and experience with quit attempts can be effective in promoting a plan to quit in this group of smokers who, because of their medical illness, can benefit significantly from cessation. Research is needed to explore cessation outcomes when employing these targeted interventions with medically ill smokers in rural areas.

Background: Arab Americans, a growing population in the U.S., tend to have high rates of smoking and low rates of smoking cessation. Arab Americans and their families are at a high risk for poor health outcomes related to smoking. Objective: The purpose of this study is to better understand the smoking behaviors of Arabs in the U.S., using the two publishable manuscripts format. The first manuscript is a systematic review of the literature exploring the smoking behavior, prevalence and use among Arab Americans and examining studies addressing the effect of acculturation on this behavior. The second manuscript is a cross-sectional quantitative study investigating factors influencing desire to quit smoking among Arab Americans, and their association with acculturation and health beliefs. Results: The majority of the studies included in the first manuscript focused on smoking prevalence and cessation. Some discussed the impact of acculturation and health beliefs only two smoking cessation programs have been developed. Thus a cross-sectional descriptive study among adult Arab American smokers was conducted to measure tobacco use, nicotine dependence, desire to quit smoking, acculturation, and health beliefs. The desire to quit smoking was positively associated with perceived severity and susceptibility to cancer, perceived benefits of quitting smoking; and negatively associated with smoking barriers and nicotine dependence. Being female, having lower level of nicotine dependence, and higher perception of cancer severity predicted higher desire to quit smoking. Conclusion: Smoking cessation intervention studies need to target appropriate health beliefs, especially cancer severity of smoking among male Arab Americans.

The purpose of this dissertation was to explore the mechanism of association between social determinants of health (SDH), particularly limited health literacy, and disparate outcomes related to cardiovascular disease in vulnerable populations. Specific aims were to 1) compare quality of life (QOL), anxiety, and depressive symptoms between genders in implantable cardioverter defibrillator (ICD) recipients; 2) examine the association between multi-morbidity burden and QOL; 3) determine whether health literacy levels independently predict CVD risk in the male prison population; 4) examine the relationship between health literacy and decisiveness regarding end of life (EOL) choices, and 5) examine SDH as predictors of perceived poor health status in ICD recipients. Specific aim one was addressed by analysis of data collected from individuals in the Swedish ICD and Pacemaker Registry. Multiple linear regression was used to determine predictors of anxiety, depression, and quality of life in men and women. A higher prevalence of anxiety symptoms in women was noted with no differences in depressive symptoms noted between the genders. The majority of the variance in the predictive models for QOL was explained by the addition of the psychosocial variables for both genders. Specific aim two was addressed by analysis of data collected from individuals in the Swedish ICD and Pacemaker Registry. Logistic regression was used to determine predictors of QOL. Greater multi-morbidity burden was associated with lower QOL in ICD recipients. Specific aim three was addressed by analysis of data collected from male inmates enrolled in a bio-behavioral educational and counselling intervention program to reduce CVD risk. Nonlinear regression was used to determine whether health literacy was an independent predictor of CVD risk while controlling for social and clinical variables. Inmates with adequate levels of health literacy had lower ten year CVD risk profiles than those inmates with inadequate health literacy. Specific aim four was addressed by analysis of data collected from ICD recipients. Multinomial regression was used to determine predictors of decisiveness regarding EOL choices. Within the context of terminal illness, health literacy and race were found to be predictors of decisiveness regrading generator replacement while gender was found to be a predictor of decisiveness regarding the withdrawal of defibrillation therapy. Specific aim five was addressed by analysis of data collected from ICD recipients. Logistic regression was used to determine predictors of perceived poor health status. Residential status in the Central Appalachian region of Kentucky, not working outside the home, higher levels of health literacy, and comorbid depression were predictors of perceived poor/very poor health status.