Health can be described as both a product and a process of life, and is necessary for human wellbeing, overall quality of life and productivity. While health is generally desirable, many factors affect health and health outcomes of individuals and populations the world over. Virtually all individuals will be faced with one health problem or another during their lifetime, that requires some form of health care intervention. Whatever their reasons for seeking care, all health care consumers share a common interest – a desire to get better. In a pluralistic health care environment where different avenues exist for seeking and receiving health care, differential choice of care may be influenced by sociodemographic and related factors. To the extent that the available avenues for seeking and receiving health care do not offer the same opportunities for improving health, significantly different health outcomes may be realized for comparable conditions for which different types and volume of health care are sought and received. Understanding the factors that influence health-seeking behaviors among various populations may therefore, be an important first step in designing intervention programs that nudge health consumers toward better health-seeking behaviors with the goal to improving health and health outcomes among these populations. The purpose of this research was to develop a research instrument for studying health-seeking behaviors based on the Health Belief Model, and to use the instrument to study the factors that influence/predict health-seeking behaviors among Ghanaians. Using a convenience sample of 504 participants recruited from the Greater Accra, Ashanti, Volta and Northern Regions, analyses of the data showed that different sociodemographic characteristics such as age group, gender and health insurance status as well as selected modified constructs of the Health Belief Model such as Perceived Barriers to mainstream care, variously and collectively influence health-seeking behaviors at government and private health facilities, self-medication with herbal and pharmaceutical drugs, faith healing and care from traditional/herbal practitioners. Based on the findings of this study, the author concludes that health-seeking behaviors in Ghana are influenced by a multiplicity of factors including sociodemographic characteristics. Subsequently, recommendations for a more extensive study with a complementary qualitative enquiry are made in order to gain a more wholistic insight of the drivers of health-seeking behaviors in Ghana.

Nearly 50% of Americans will meet the diagnostic criteria of some form of mental illness in their lifetime (Mehta & Edwards, 2018). However, only 40% of these individuals will seek treatment for them. Patients with mental illness have a lifespan that is, on average, 25 years shorter than individuals without mental illness and are at 2-3 times the risk of diabetes, heart, and lung disease than the average population but do not receive adequate treatment at a proportionate rate. As a country, there are very negative stereotypes held towards individuals struggling with mental illness and substance use disorders even though they are among the most common conditions in the population. This stigma against mental illness often prevents individuals from seeking care for their symptoms and causes medical providers to treat patients with mental illness differently than those without them. Stigma can be seen in the way providers speak about patients with mental illness, the way the medical record labels patients with mental illness, and even how health care providers themselves fail to seek treatment when suffering from mental illness themselves. This thesis examines the types of stigmas that exist, describes how it interferes with clinical care and causes adverse clinical outcomes for patients with mental illness and substance use disorders and provides recommendations for improving the treatment of individuals with mental illness and the importance of normalizing talking about mental illness. / Urban Bioethics

Twenty years ago, a seminal study on adverse childhood experiences (ACEs) and subsequent increased health risks catapulted ACEs into the zeitgeist of research and application. Though a validated construct, the questionnaire, particularly the child sexual abuse (CSA) item is not without limitation and yet is used by the Centers for Disease Control and state agencies to quantify need and allocate resources to services accordingly. Currently, CSA is counted only when the perpetrator is 5-years or older than the victim. This requirement makes neglect of sibling and peer assault very likely. Accordingly, this study aimed to assess whether individuals with CSA experiences within an age gap smaller than 5 years are missed by the 5-year modifier embedded in CSA assessment wording and whether this missed group would otherwise qualify for services if detected. The study also aimed to assess whether this missed group has equivalently poor health outcomes to CSA groups currently captured by the 5-year modifier and whether outcomes for all CSA groups were higher than those who did not have a CSA history. An international sample of 974 women aged 18 to 50 completed an online survey hosted by Reddit regarding their substance use, multiple domains of current health, and CSA history using the original ACEs questionnaire and an experimental version of the CSA item without the 5-year modifier. All statistical analyses were completed in R. Results indicated there was a group of survivors with CSA experiences missed by the 5-year modifier and this had implications for reducing their total ACE scores. This group was nearly equal in size to CSA groups captured by the 5-year modifier and demonstrated equivalently poor health and substance use outcomes. On nearly all variables, CSA groups demonstrated poorer health outcomes than those who had never experienced CSA. These findings suggest the language of how CSA is assessed must be thoughtfully revised to include all CSA experiences as all are equally at risk for adverse outcomes and thus all warrant consideration for services currently afforded those with CSA histories and high ACE scores.

In 1998, a seminal study on adverse childhood experiences (ACEs) and subsequent health risks catapulted ACEs and the study questionnaire into the zeitgeist. However, its childhood sexual abuse (CSA) item is problematic as it requires the perpetrator have been 5-years or older than the victim. To assess whether some survivors’ CSA is not identified by the current item, whether their exclusion prevents access to services requiring a four-threshold ACE score, and how their health outcomes compared to other CSA groups and controls, an international sample of 974 women completed an online survey assessing their current health and CSA history using the original item and an experimental item without the 5-year modifier. Results indicated many CSA survivors are not identified by a 5-year modifier, exclusion has service implications for some, and on most variables, they had increased adverse health outcomes compared to controls. Means of assessing CSA must be thoughtfully revised.

Given the substantial monetary and nonmonetary costs that both employees and organizations can incur as a result of perceived workplace discrimination, it is important to understand the outcomes of perceived workplace discrimination as well as what moderates the discrimination-outcome relationship. While other meta-analyses of perceived discrimination have been published, the current meta-analysis expands prior meta-analytic databases by 81%, increasing the stability of the estimated effects. In addition, several prior meta-analyses have not focused exclusively on workplace discrimination. Consequently, the purpose of this meta-analysis is to provide a comprehensive quantitative review of perceived workplace discrimination, its consequences, and potential moderators of these relationships. Results showed that perceived workplace discrimination was related to decreased job satisfaction, reduced organizational commitment, greater withdrawal, and more perceived organizational injustice. Further, perceived workplace discrimination was associated with decreased mental health and physical health, lower ratings of life satisfaction, and increased work stress. Moderator analyses provided some evidence that perceiving the general presence of discrimination in one's organization may be more detrimental than perceiving oneself to be personally targeted by discrimination at work. Additionally, moderator analyses provided some support that interpersonal discrimination may be more detrimental than formal discrimination for some outcomes and that there may be differences in the perceived workplace discrimination-outcome relationships across different countries. The implications for workplace discrimination research and practice are discussed.

<p>  </p> <p>Maternal and infant health continues to be a compelling and urgent topic in the United States with prenatal care at its forefront for prevention of adverse outcomes. This study explored differences in adverse infant birth outcomes (i.e., preterm birth, low birthweight, and NICU stays) and postpartum maternal wellbeing outcomes (i.e., social support, depression, and confidence) related to the sociodemographic and baseline factors of mothers and their prenatal care experiences. </p> <p>Data was analyzed from the publicly available <em>Listening to Mothers III </em>dataset. Comprised of 2400 online-survey participants who gave birth to singleton infants in U.S. hospitals between 2011 and 2012. Structural equation modeling was employed with FIML to account for missing data. The model examined mediators of prenatal care (i.e., responsive provider behavior, week of first visit, duration of visits, group prenatal care; GPC) between maternal predictors and outcomes.</p> <p>Of infants in the sample, 8% were born preterm, 8% were born low birthweight, and 18% were admitted into the NICU. Depression and smoking during pregnancy, as well as participating in GPC, resulted in 15%, 20% and 18% greater proportions of infant NICU stays, respectively. For postpartum maternal wellbeing, participating in GPC increased the proportion of maternal confidence by 18%. Mothers who received responsive provider behavior had higher rates of social support (<em>b </em>= 0.28, <em>p </em>< .001), reported less depression (<em>b </em>= -0.19, <em>p </em>< .001), and felt more confident (<em>b </em>= 0.07, <em>p </em>= .02). </p> <p>Findings from this study suggest that the most impactful actions for prenatal care providers to take would be to provide increased support to mothers who identify as needing treatment for depression or smoking during pregnancy to best improve infant health through fewer admissions into the NICU, and to continue to bolster the responsiveness in which providers interact with patients to improve overall postpartum maternal wellbeing. </p>

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<p><strong>Objective: </strong>The objective of this thesis is to identify the approaches to patient-centered care provision currently employed by clinicians and to identify patient perspectives of patient-centeredness in relation to pain and disability following distal radius fracture. This thesis includes a scoping review of patient-centered care frameworks and models, as well as a prospective cohort study.</p> <p><strong>Rationale: </strong>Patient-centered care provision has been linked with positive health outcomes, improved patient satisfaction, and reduced health costs. A uniform approach to patient-centered care in rehabilitation has yet to be developed primarily due to the breadth and scope of practice. Understanding current approaches to patient-centered care and patient perspectives on this care can serve as a foundation to future discussions on the development of a rehabilitation-specific approach to patient-centered care provision.</p> <p><strong>Data sources: </strong>Frameworks and models of patient-centered care provision were located via electronic database searches. The extracted frameworks and models were compared based on how they described strategies on achieving the three tenets of patient-centered care: communication, partnership, and health promotion. A prospective cohort study provided patient perspectives on patient-centeredness, pain, and disability following distal radius fracture at baseline and at three months post distal radius fracture in 129 patients.</p> <p><strong>Methods: </strong>Frameworks and models on patient-centered care provision were extracted from articles and placed in data summary tables for comparison and review. Information on how these frameworks and models described strategies for communication, partnership, and health promotion was collated and reviewed. The patients’ perceptions of patient-centeredness, pain, and disability were determined from responses to the Patient Perceptions of Patient-Centeredness Questionnaire and the Patient Rated Wrist Evaluation. Outcome measure responses were analyzed to measure change over time (Wilcoxon Rank Sum and T-Test analyses) and to identify relationships (Pearson correlations).</p> <p><strong>Results: </strong>The scoping review found 19 articles, from which 25 patient-centered care frameworks or models were identified. All frameworks and models reported strategies on achieving effective communication, partnership, and health promotion. The prospective cohort study revealed significant correlations between patient perspectives of patient-centeredness and pain and disability following distal radius fracture. This suggests that positive experiences with patient-centered care provision are correlated with reduction in pain and improvement in function following an acute orthopaedic injury.</p> <p><strong>Implications: </strong>Until a rehabilitation-specific approach to patient-centered care provision is developed, rehabilitation clinicians can be confident that selection of one of the currently employed frameworks or models of patient-centered care will reflect the three tenets of patient-centered care provision. Adopting one of these patient-centered approaches to care provision likely will result in positive health outcomes.</p> / Master of Science Rehabilitation Science (MSc)

The goal of this investigation was to assess service use, self-management strategies, and health status of older adults (60+ years) with perceived need who sought assistance from the Virginia Medicaid Elderly and Disabled Consumer-Direction (EDCD) waiver services. A sequential explanatory mixed method design was used to address the overall research question: How do older adults manage unmet needs? Using health services data from two independent State agencies, regression techniques were used to examine predictors of service use, hospitalization, and mortality among 1,008 individuals. A purposive subsample of eight rural-dwelling waiver-ineligible individuals was identified for follow-up semi-structured telephone interviews to explore self-management strategies for confronting functional care needs. Waiver-ineligible individuals were at risk for hospitalization and mortality; rural-dwelling individuals were more likely to be waiver-ineligible and had increased risk of mortality. Analysis of interviews revealed individuals had ongoing unmet needs and relied on family and community services and used internal and external strategies to manage them; plans were not in place should their health continued to decline. For this group of near-risk older adults who are waiver-ineligible and do not have financial means to pay for more help, accessible preventive services are necessary to reduce risk of adverse health outcomes. Policymakers are encouraged to advocate for preventive services that assist individuals before care needs become unmanageable. Agencies responsible for service delivery need to target efforts toward this group, particularly those residing in rural areas. Researchers must continue forging partnerships that permit use of health services data to identify when and how older adults use services, and explore how self-management strategies influence health and functioning over time. / Ph. D.