Includes bibliographical references / Problem Statement: The use of mobile technology in health (mHealth) has been ascribed as transformative power in the health systems of the developing countries, especially for improving healthcare delivery in rural areas. However, the full potential of mHealth has not been realised and there is a dearth of evidence on effectiveness and impact. This has limited informed policy-making, affecting the buy-in from investors and policy makers, and limiting adoption and scaling up of mHealth interventions that could benefit rural communities. Purpose of the research: The main objective of this study was to examine how mHealth interventions contribute to maternal health outcomes in a developing country context, at a micro level. The specific aims were to examine how mHealth outcomes for maternal health consumers in rural communities are produced and how variations in outcomes can be explained. Design/methodology/approach: The study adopted a critical realism approach, and drew on Capability Approach as a theoretical lens, with the aim to explain how and why mHealth interventions work in maternal health, for whom, and in what circumstances; by analysing patterns between context, mechanisms and outcomes. Data for this research was obtained through semi-structured interviews with users of mHealth in maternal healthcare in Malawi, and various project stakeholders. Project documents were also used as secondary data. Findings: mHealth interventions may affect maternal health outcomes and service delivery through multiple mechanisms. Three different types of mechanisms were found to produce mHealth outcomes for women in maternal health. These were: Technology adoption mechanisms that led to the uptake and adoption of mHealth services in maternal health; agential mechanisms that facilitated agency of consumers in achieving health goals; and health system mechanisms for realisation of desired health outcomes. A myriad of personal, sociocultural, and environmental factors either activated or inhibited the mechanisms, resulting invaried outcomes for the women. Originality/contribution: mHealth as a complement to existing maternal health services can lead to improvement in consumer behaviour and experiences, and even clinical outcomes. This research has highlighted a pathway through which mHealth outcomes are produced for consumers in maternal health. This process starts from mHealth acceptance and adoption as a technology by the consumers; to women acting as agents of their own health by utilising the opportunities generated by mHealth; and finally health system efficiencies for provision of adequate care to the women. This understanding of how mHealth works in maternal health can improve design and operations of such interventions for effectiveness that may lead to the realisation of its full potential.

Magister Pharmaceuticae - MPharm / Antimicrobial resistance is a global concern associated with increased morbidity and mortality. It has been estimated that, by 2050, the continuous escalation of antimicrobial resistance, globally, will result in more deaths per year, compared to cancer and diabetes. The direct and indirect impact of ineffective antibiotics, and therefore, antimicrobial resistance, will be hardest felt by low and middle-income countries, as the financial burden will be too great to manage. Carbapenems are considered the last line of antimicrobials to treat multidrug-resistant bacterial infections. They are the preferred choice to treat infections, presenting with extended-spectrum beta-lactamases (ESBL) producing Enterobacteriacea. Various strains of bacteria that have become resistant, due to the selective pressure, as a result of carbapenem over use, are referred to as Carbapenem-resistant Enterobacteriaceae (CRE). / 2022

Health disparities between the western, central and eastern regions of rural China, and the impact of national health improvement policies and programming were assessed. A total of 400 counties were randomly sampled. ANOVA and Logistic regression modeling were employed to estimate differences in health outcomes and determinants. Significant differences were found between the western, central and eastern rural regions in community infrastructure and health outcomes. From 2000 to 2010, health indicators in rural China were improved significantly, and the infant mortality rate (IMR), maternal mortality rate (MMR) and under 5 mortality rate (U5MR) had fallen by 62.79%, 71.74% and 61.92%, respectively. Central rural China had the greatest decrease in IMR (65.05%); whereas, western rural China had the greatest reduction in MMR (72.99%) but smallest reduction in U5MR (57.36%). Despite these improvements, Logistic regression analysis showed regional differences in key health outcome indicators (odds ratios): IMR (central: 2.13; western: 5.31), U5MR (central: 2.25; western: 5.69), MMR (central: 1.94; western: 3.31), and prevalence of infectious diseases (central: 1.62; western: 3.58). The community infrastructure and health outcomes of the western and central rural regions of China have been improved markedly during the first decade of the 21st century. However, health disparities still exist across the three regions. National efforts to increase per capita income, community empowerment and mobilization, community infrastructure, capacity of rural health facilities, and health literacy would be effective policy options to attain health equity.

The disparity between survival rates for Black and White women with breast cancer is well documented and has been examined in terms socioeconomics, environment, tumor type, and genetics. However, there is little examination of the role of health care facilities in cancer disparities. Health care facilities are representative of societal norms and beliefs that include location, quality of care, finance, policies, and staffing; therefore, they are a proxy for social justice and social change. The purpose of this study was to examine correlations between health care facility type; social determinants of cancer such as poverty, culture, and social justice; and breast cancer survival rates. Using the social determinants of cancer theoretical framework, the breast cancer survival rate of 4,087 Black and White women in Georgia between the ages of 45 and 69 was studied. The relationship between breast cancer survival and predictors including race, income, health care facility type, grade, and tumor type (4 sub-variables) were examined using the Kaplan-Meier Method, log-rank test, and Cox proportional hazard model. The log-rank test suggested no statistically significant difference in the survival functions among patients in different health care facilities (Ï?2(2) = 0.0150, p = 0.9926). The Cox proportional hazard model suggested no statistically significant relationship between breast cancer survival and health care facility type, after controlling for other predictors (Ï?2(2) = 0.3647, p = 0.8333). This result indicates that healthcare facilities do not influence breast cancer survival rates, however, given the persistent health outcome disparities further research in the area is warranted.

Interprofessional collaboration is recognized as the innovative, evidence-based strategy that strengthens health systems and improves performance and health outcomes. While resource-rich countries have benefited much from the implementation of this initiative, literature is scarce regarding sub-Sahara Africa. This quantitative cross-sectional descriptive study described the extent of interprofessional collaborative practice at the tertiary care level in Nigeria and its implications on patient health outcomes, professionals' performance, satisfaction, and healthy practice environment. The relational coordination theory (RCT) provided the conceptual framework for the study. Key research questions were on the association between the extents of interprofessional practice and each of the outcome implications. Data were collected using a questionnaire survey and were analyzed using means, standard deviations, t tests, correlation and regression statistics, and Chi-square tests. Results showed that the health professionals rated the practice of interprofessional collaboration low and perceived that the extents of the practice negatively affected patient's mortality, professionals' work performance, job satisfaction, and the frequency of interprofessional conflicts and strike actions. Recommendations included policy formulation and implementation, commitment and willingness by the health professionals to teamwork and patient-centered care. The implications for positive social change is that these results could be used as a tool to advocate for policy formulation and policy change for effective implementation of interprofessional collaboration; and as a database for future training intervention on collaborative practices among health professionals.

Breast ironing (BI) practice is a common practice in Cameroon. Most villages and towns continue with BI because they believe it constitutes a positive cultural lifestyle. However, public health officials and other advocates have branded BI as a harmful traditional practice because of the traumatic impact it has on the women who experience it. The purpose of this quasi-experimental study was to examine the perceived long-term health-related outcomes of BI and the quality of life changes on these women. Underpinning this study was the betrayal theory of trauma. A survey was used to collect data from 230 women. Descriptive analysis of the data showed, BI was more prevalent in some regions of Cameroon and among some ethnic groups more than others. A chi-square test revealed a strong relationship that women who experienced BI perceived long-term physical, psycho-social, and emotional health-related outcomes and negative quality of life changes during and after the practice. A multiple logistic regression model was conducted to examine the relative odds of exposure of other independent predictors on the outcome variable. The chi-square test on severe pain and marital/ family health; breast scars and frequent pain; stress and feeling inferior; sadness and pain, revealed a P-value < .001. The odd ratio (OR) of the confounding predictors breast scars, frustration, shame, depression, self-esteem; burns; abscesses revealed an Exp(B)/ OR

Minority ethnic groups have disproportionately high rates of diabetes prevalence and complications. This study examined the degree, nature, and mediation of ethnic differences in changes over time in four health outcomes: functional limitations, emotional symptomatology, psychosomatic symptomatology, and self-reported health status. The theoretical context incorporated tenets from the social characteristics and the minority status perspectives. Data were drawn from two rounds (1992 and 1996) of the Health and Retirement Survey, a national plane survey of midlife Americans. The study focused on a subsample of 744 respondents who had been diagnosed with diabetes or high blood sugar by the time of the first round. Descriptive and lag-time regression analyses were employed. Five models were used to: (1) assess the independent effects of being Black and being Hispanic on changes over time in each of the outcome variables without and with the set of mediating variables; and (2) gauge the specific manner in which mediating variables affected initial statistically significant effects among Blacks and Hispanics. The mediating variables included five social position measures (education, income, net worth, gender, and a role integration index), health insurance coverage, and four health-related lifestyle measures (body mass index, drinking, smoking, and physical inactivity). The results pointed to a complex pattern of effects between Blacks and Hispanics and across outcomes. The social characteristics hypothesis was supported in two instances: increases in functional limitations over time for Blacks and poorer self-reported health over time for Hispanics. The minority status hypothesis was supported only for increases in emotional symptomatology among Hispanics. No support for either hypothesis was observed for psychosomatic symptomatology. Critical mediating variables also differed between Blacks and Hispanics across the outcomes. The two variables mediating the Black effort for functional limitations were body mass index and gender, whereas the two variables mediating the Hispanic effect for self-reported were smoking and education.

Background: The National Institute Mental Health (2015) estimated there were about 44.7 million people diagnosed with a serious mental illness and 62.9% of those diagnosed were without mental health services. The loss of services was due to unemployment, reoccurring hospitalization, inabilities to care for themselves, and lack of participation in societal norms (World Health Organization [WHO], 2014). According to Insel (2011/2015), the U.S. cost of mental healthcare was an estimated $57.5 billion in 2006. This cost was not due to actual care but associated with the economic burden of job loss and the excessive use of community resources. The Affordable Care Act (ACA) and the Mental Health Equality and Parity Act (MHEPA) has positively influenced access to mental healthcare, but healthcare coverage continues to be deficient. Insufficient clinical documentation practices decrease insurance reimbursement potential. Purpose: The purpose of this quality improvement project was to enhance the current clinical documentation practices and policies and increase insurance reimbursement in an adult psychiatric inpatient unit in a private, non-profit mental and behavioral health organization. Theoretical Framework: The Kurt Lewin’s 3 Step Change Management Theory Methods: A quantitative design guided this project utilized an investigator-developed tool modeled from the CMS Inpatient Unit Worksheet as a data collection tool from the clinical chart documentation reviews. Results: Fisher’s Exact and Chi square tests measured the cross tabulation of pre and post comparison sample frequency of staff’s integration of an evidence-based descriptive documentation method into practice. The results presented with statistical significance of the progress narrative notes. The declined chart claims a p <0.001, and the numbers related to case scenario utilization of the documentation method was p = 1.00. Conclusion: The relationship between descriptive clinical documentation and insurance reimbursement was evident in the usage of the Data, Assessment/Action, Response, and Plan (DARP) method in the clinical documentation progress narratives notes. There was a 24% improvement in insurance reimbursement claims and a 17% decrease in charts declined for the study period.

Indiana University-Purdue University Indianapolis (IUPUI) / Acute Myeloid Leukemia (AML) is the most common hematologic malignancy. Malglycemia is a disorder of glucose metabolism and includes hyperglycemia, hypoglycemia and the combination of hyperglycemia and hypoglycemia. Malglycemia has been shown to occur frequently during hospitalization among critical care patients and has been associated with increased risk of sepsis and mortality. Little is known, however, about the prevalence and role of malglycemia on the health outcomes of AML patients hospitalized for initial induction therapy. Malglycemia may be of particular importance to the patient with AML because, researchers have found that malglycemia may promote cellular changes which facilitate the progression of cancer, alter treatment response, and attenuate immune response. The purpose of this study was to determine the prevalence of malglycemia (hyperglycemia, hypoglycemia or the combination) and to examine its role on a comprehensive set of health outcomes (neutropenic days, infection, and septicemia, and sepsis, induction hospital length of stay, complete remission and mortality) in AML patients hospitalized for initial induction therapy. A retrospective cohort study design was used. Records of 103 AML patients, hospitalized for initial induction chemotherapy were reviewed. Results of the study showed that 98% of the AML patients had at least one episode of hyperglycemia, with a prevalence rate of 33% over the entire induction inpatient hospitalization for this population. All patients noted with hyperglycemia also had hypoglycemia and thus, the prevalence rate of hypoglycemia alone could not be determined. Prevalence of the combination of hyperglycemia and hypoglycemia was 1.4 %. Although not statistically significant, a trend was noted for AML patients with hyperglycemia to experience more days with neutropenia, greater numbers of infection, sepsis, septicemia and death (mortality) than patients without hyperglycemia during induction treatment. Patients with the combination of hyperglycemia and hypoglycemia also experienced an increased risk of developing septicemia (p = .025) and sepsis (p =.057). Future studies with larger sample sizes are needed to confirm these findings.

Indiana University-Purdue University Indianapolis (IUPUI) / Unmet social needs pose significant risk to both patients and healthcare organizations by increasing morbidity, mortality, utilization, and costs. Health care delivery organizations are increasingly employing social workers to address social needs, given the growing number of policies mandating them to identify and address their patients’ social needs. However, social workers largely document their activities using unstructured or semi-structured textual descriptions, which may not provide information that is useful for modeling, decision-making, and evaluation. Therefore, without the ability to convert these social work documentations into usable information, the utility of these textual descriptions may be limited. While manual reviews are costly, time-consuming, and require technical skills, text mining algorithms such as natural language processing (NLP) and machine learning (ML) offer cheap and scalable solutions to extracting meaningful information from large text data. Moreover, the ability to extract information on social needs and social work interventions from free-text data within electronic health records (EHR) offers the opportunity to comprehensively evaluate the outcomes specific social work interventions. However, the use of text mining tools to convert these text data into usable information has not been well explored. Furthermore, only few studies sought to comprehensively investigate the outcomes of specific social work interventions in a safety-net population. To investigate the role of social workers in addressing patients’ social needs, this dissertation: 1) utilizes NLP, to extract and categorize the social needs that lead to referral to social workers, and market basket analysis (MBA), to investigate the co-occurrence of these social needs; 2) applies NLP, ML, and deep learning techniques to extract and categorize the interventions instituted by social workers to address patients’ social needs; and 3) measures the effects of receiving a specific social work intervention type on healthcare utilization outcomes.