Thesis (Ph. D.)--Syracuse University, 2009. / "Publication number: AAT 3381577."

Thesis (M.S.) University of Missouri-Columbia, 2006. / The entire dissertation/thesis text is included in the research.pdf file; the official abstract appears in the short.pdf file (which also appears in the research.pdf); a non-technical general description, or public abstract, appears in the public.pdf file. Title from title screen of research.pdf file viewed on (June 26, 2007) Includes bibliographical references.

No description available.

Primary health care is pivotal to the growth of a country’s economy by improving the health and social well-being of its people. Several efforts and structures have been put in place to ensure that all South Africans have access to health facilities as well as representation in the health facilities, just as community members are represented in schools and other boards. Health committees play an important and integral role to the community and health facilities by being mediators between the community and the health facility (Padarath &Friedman, 2008). The Eastern Cape is one of the provinces that has health committees that are fully functional and a number of factors including the collaboration of key stakeholders (facility managers, community members, clinic staff and ward councillors) contribute to why health committees have been operational in the Eastern Cape(Padarath &Friedman , 2008). It becomes critical to investigate factors that sustain health committees in Nelson Mandela Bay. This chapter introduces the research topic, purpose, rationale and background as well as the objectives of the study. The research focuses on investigating the sustainability of health committees in Nelson Mandela Bay therefore making it critical to define the term sustainability. Conceptualizing sustainability has been ongoing with various definitions from learners from different backgrounds. Sustainability as a concept emanates from different dimensions namely, scientific, political economic and indigenous dimension. Sustainability has been described by scholars as a state of well-being and as an evolutionary process (Dimitrov, 2010). Sustainability is regarded as a state of well being whereby humans can live in co-exist with the natural world, this definition takes into account issues to do with good health , cultural identity, personal security and freedom of choice. Sustainability- well being brings out a lot of questions and problems in identifying the fundamentals values of sustainability. It is continuously debated amoung scholars if sustainability of well being pertains only to the health conditions of human beings or it should be extended to others (Dimitrov, 2010) “Sustainability that is restricted to the well being of humans is related to Notions about security of individual/community health together with financial security together with financial security; the planet is regarded as a resource to further this end (Dimitrov, 2010:4) If however well-being definitions of sustainability are construed to preserving and protecting the environment as well as biodiversity of other species (plant and animals) then the normative definitions of sustainability from this viewpoint are tendered with notions of global Environmental stability, ecological considerations and security of ecosystems” (Dimitrov, 2010:4).

Background: The success of tuberculosis (TB) treatment largely depends on healthcare team factors within a healthcare system, as healthcare workers play a vital role in fostering patient adherence to TB treatment. Strengthening motivation amongst Kenya’s TB healthcare workers should thus be reinforced in order to improve on clinical outcomes of TB treatment in Kenya. Objectives: To determine motivational needs of TB healthcare staff at a district hospital in Kenya and to provide recommendations on how to enhance their motivation. Design: TB healthcare workers including nurses, doctors, pharmacists and community healthcare workers were purposively sampled from a district hospital in Kenya. Their motivational levels were measured using a questionnaire adapted from Bennet and colleagues (2000). Key Findings: A high level of job satisfaction was present in more than 50 percent of the employees, although the ‘extrinsic job satisfaction’ sub-scale stood out as scoring relatively poorly in comparison to the other ‘job satisfaction’ sub-scales. Cognitive motivation yielded mixed results with 44 percent of respondents rating themselves as being satisfied, and 56 percent between neutral and very dissatisfied. The overall organisational commitment was positive, with the majority (60 percent) of respondents rating themselves as being committed to their organisation. The majority (96 percent) of workers rated their performance at work as very high. Conclusion: Improvement in staff motivation can be attributed to how well a hospital's management organises and runs its hospital. It was recommended that hospitals should provide an environment where motivational strategies are continuously implemented and where change is positively rewarded. This may, in turn, have a positive impact on TB treatment outcomes. The study may be of interest to key decision makers in Kenya’s healthcare system as well as TB programme managers, hospital managers and health managers in general. Further investigations are needed in order to determine whether Kenya’s public healthcare system has a staff retention strategy that is up to date with the motivational needs of Kenya’s health workforce.

In Florida, Medicaid expenditures have grown more quickly than Medicaid caseloads. Since the Medicaid program comprises a large share of all state budgets, controlling Medicaid spending has been the first priority for state governments. To manage spending and improve access to healthcare, states have adopted a managed care approach to Medicaid services. When states pursue Medicaid managed care, they believe that managed care can control Medicaid spending and maintain budget predictability through a capitated payment system. Medicaid beneficiaries are also guaranteed access to care through contracts with managed care health plans and/or providers. Several studies that have investigated the impact of Medicaid managed care using nationally representative data have often yielded inconclusive or contradictory results. Despite the growing interest in Medicaid managed care in Florida, only a few studies have examined the impact of managed care programs on preventable hospitalization, length of stay, and cost of inpatient care for Florida's Medicaid enrollees. In addition, only a few studies have examined the impact of Medicaid managed care in the context of different market structures. The purpose of this dissertation is three-fold. First, this study examines the effects of a Medicaid managed care program on preventable hospitalization, length of stay, and cost of inpatient care for Medicaid patients. Second, the impact of market structure on preventable hospitalization, length of stay, and cost of inpatient care is a subject of interest. Finally, this dissertation extends the existing literature methodologically. This study uses multilevel modeling to estimate variables at different levels simultaneously. Agency theory and transaction cost economics provide a useful framework for understanding the effects of different insurance schemes on incentives that affect the behavior of both patients and providers. In addition, the model of market structure provides a theoretical framework for predicting the market behavior of Medicaid managed care organizations under market contexts ranging from monopoly to perfect competition. The study included 1,957,072 Medicaid patients aged 18 to 64 years who were discharged from a short-term general hospital in Florida from January 1, 2006 to December 31, 2012. The researcher used two-level hierarchal models to predict the probability of preventable hospitalization, length of stay, and inpatient cost in Medicaid patients. The results show that Medicaid managed care patients had a higher probability of preventable hospitalization than Medicaid fee-for-service patients. In addition, Medicaid managed care patients were more likely to have shorter lengths of stay and lower inpatient costs compared with fee-for-service Medicaid patients. This study found that market competition moderates the relationship between Medicaid insurance type and dependent variables. The study supports a spillover effect of Medicaid managed care on inpatient costs for Medicaid fee-for- service patients. In conclusion, the dissertation discusses several policy implications. / A Dissertation submitted to the Reubin O'D. Askew School of Public Administration and Policy in partial fulfillment of the requirements for the degree of Doctor of Philosophy. / Fall Semester, 2014. / November 3, 2014. / Competition, Inpatient Cost, Length of Stay, Managed Care, Medicaid, Preventable Hospitalization / Includes bibliographical references. / Keon-Hyung Lee, Professor Directing Dissertation; William G. Weissert, University Representative; Frances Berry, Committee Member; Lance deHaven-Smith, Committee Member.

With art programs becoming more prominent in medical environments, this research seeks to investigate the way art materials are being used and perceived in these settings. Through observation of one pediatric unit and information collected from parents and nurses at this location, this qualitative evaluation aims to promote the ways in which art practices are benefiting children within hospital environments, while also considering the effect art materials may have on health professionals’ ability to perform primary medical responsibilities. Through an analysis of the data collected through observation and surveys, this research proposes the need for four guidelines for the use of art materials in pediatric medical settings: 1) giving children options rather than beginning with specific directives, 2) providing options for the location of the use of art materials, 3) investing in traditional art materials rather than digital for this population, and 4) creating plans to inform patients of their opportunities to participate in art. These principles consider the combined needs of the patients, families, structure of the hospital, and nurses to inform the development of future art practices within pediatric medical settings. / A Thesis submitted to the Department of Art Education in partial fulfillment of the requirements for the degree of Master of Science. / Fall Semester 2016. / November 8, 2016. / art materials, arts in health, art therapy, healing arts, medical, pediatrics / Includes bibliographical references. / Theresa Van Lith, Professor Directing Thesis; David Gussak, Committee Member; Marcia Rosal, Committee Member.

As the need for multicultural awareness continues to grow, it becomes prevalent in a music therapist career to incorporate music interventions that address diverse culturally based populations. This research paper investigates music therapy with Hispanic immigrants within the United States. It gives information on the culture of this population, their experiences and perspectives of the health care profession, including music therapy, and genres of music that have originated from them. / A Thesis submitted to the College of Music in partial fulfillment of the requirements for the degree of Master of Music. / Spring Semester 2017. / April 7, 2017. / hispanic families and music therapy, hospice with hispanic immigrants, music therapy in hospice care / Includes bibliographical references. / Jayne Standley, Professor Directing Thesis; Dianne Gregory, Committee Member; Clifford Madsen, Committee Member.

Chinese immigrants (CIs) had low colorectal cancer (CRC) screening rates. Macro-level health determinants may affect CIs' CRC screening; however, this is not well established. Thus, this research looked at the macro-level social factors of CRC screening among CIs. The POET theoretical framework guided this study, which includes four components: population (P), organization (O), environment (E), and technology (T). A convergent mixed method was used to investigate whether sociodemographic, acculturation, religious social capital, and mobile media-based cancer information seeking may predict CIs' endoscopic screening, and how these variables impact it. A validated survey and an interview covering the same factors were utilized to collect quantitative and qualitative data from three local Chinese American churches. 101 church-going CIs completed questionnaires and 29 were interviewed. The three macro-level determinants of screening behavior were modeled using logistic regression. The interview data were analyzed using a framework analysis, which included familiarizing with the data, establishing a coding framework, coding, organizing categories and quotes, and mapping and interpretation. The majority of participants were over 50, employed, married, insured, well educated, and earning over $50,000/year. 54.46% of participants had Endoscopic screening. Doctor recommendation, higher Sunday worship attendance, and mobile media-based cancer information seeking were all significantly associated with endoscopic screening (p < .05). The qualitative investigation showed that a doctor's recommendation was essential. Mobile media eases endoscopic screening fear and empowers participants. The endoscopic screening was less impacted by high religious social capital among churchgoers. The findings show that improving endoscopic screening among CIs requires multilevel interventions. Doctors should provide culturally and linguistically appropriate screening recommendations. Chinese American churches may help by sharing endoscopic screening information and emotional support. Mobile media should be used to raise CI screening awareness and ease screening fears.

Avoidable hospital readmissions continue to be a concerning and costly healthcare issue. While the emphasis on reducing avoidable hospital readmissions persists, incentivization strategies are evolving. Initial strategies prioritized medical care delivery, but recent regulation highlights the value of effective transitional (discharge) care planning, and particularly, patient involvement in that process. This latter aspect of care has a clear indication for the application of shared decision-making. Shared decision-making (SDM) practice in the acute care setting largely represents a gap in the literature; yet understanding patient perceptions of SDM during hospitalization is an important and timely first step in exploring the effectiveness of newly implemented regulation-driven hospital initiatives. The purpose of this study is to examine the relationships between perceptions of SDM during hospitalization, patient experience, and readmissions. This study utilized a prospective cohort design, including participant recruitment and survey distribution upon day of hospital discharge followed by an observation period to monitor for 30-day readmission. The target population was adults who were hospitalized for general medical conditions at a single community hospital. The final sample size was 83. Patient perceptions of SDM were measured using the CollaboRATE Measure of Shared Decision-Making, which was validated as part of this study. Study findings indicated that patients perceive the occurrence of SDM and participation in both care decisions and transitional planning. Most also agreed with their discharge disposition. Perceptions of SDM: varied based on patient, provider, and organizational factors during care decisions; varied based only on nurse communication during transitional care planning; were significantly related to hospital patient experience, as measured by HCAHPS subscales; were not found to be related to 30-day readmissions; however, patient agreement with discharge disposition was predictive of readmission. These findings were largely consistent with the proposed conceptual model and establish a foundation for future related research.