Home Based Childcare (HBC) workers have demanding work conditions, enjoy no or few social benefits, are paid less than the national average wage, and many of them intend to leave this occupation (Doherty, Lero, Goelman, Tougas, Lagrange, 2000). The available studies on early childcare workers in Canada have often excluded HBC workers from their analyses or grouped them with other types of early childcare workers in their analyses, which make it difficult to tackle the particularities of this specific subgroup of workers. In light of the limited studies on regulated HBC workers in the Canadian context, this thesis aimed to provide insight on these workers' health and broader social determinants of health in two Canadian provinces where they are the most concentrated. The overall purpose of this thesis is to document the perceived health and chronic conditions of HBC workers, highlighting the broader social determinants of their health (e.g. work, lifestyle). This thesis had four objectives: 1. Assess regulated HBC workers' health-related quality of life and investigate the relationships with socio-demographic characteristics. 2. Examine chronic health conditions affecting regulated HBC workers and identify the social determinants of health factors associated with chronic conditions. 3. Draw an overview on broader social determinants of health factors among regulated HBC workers using the Dahlgren and Whitehead model. 4. Undertake a job analysis of regulated HBC workers In the first Manuscript, the perceived health-related quality of life of home-based childcare workers in two Canadian provinces, Quebec and Ontario, was assessed using survey methods. Results show that HBC workers in Quebec positively perceive their overall physical health and negatively perceive their overall mental health. Those working in Ontario report both good overall physical and mental health-related quality of life and also report better mental and physical health-related quality of life compared to those in Quebec. That is, they have fewer problems with work or other daily activities due to their health, feel less physical pain, less fatigue, less nervousness, and are less depressed than workers in Quebec. HBC workers experience more pain, more fatigue, more interference of health problems with social activities, and more psychosocial distress compared to Canadian women in general. Finally, our study supports that being over 40 years old, being married or in a common-law union, and working in Ontario were factors relating positively to the perceived health-related quality of life among HBC workers when controlling for the level of education and the annual gross income. In the second manuscript, chronic health conditions affecting regulated HBC workers in Quebec and in Ontario and the broader social determinants of health factors associated with these were examined using survey methods. The study revealed that one out of two HBC workers had a chronic condition. Chronic back pain, asthma, hypertension, skin diseases, and arthritis are the main five chronic conditions among HBC workers. Also, five out of ten HBC workers with a chronic condition report chronic back pain as their main health condition. Finally, workers over 40 years of age, those who were somewhat physically active or inactive, having poor relationships with their supervisors or parents of children, and working for five years or more reported more chronic conditions as diagnosed by a health professional. In the third manuscript, the broader social determinants of health among regulated HBC workers in Quebec and in Ontario were examined using a mixed methods approach. Results showed significant differences in social determinants of health between HBC workers in Quebec and in Ontario in terms of age and factors related to individual lifestyles, social and community networks, structural factors, and general socio-economic conditions. In the fourth manuscript, HBC workers’ job content, context, and requirements were described and factors that affect their health and well-being were identified using qualitative methods and emphasizing the workers’ perspectives. Results showed that HBC workers’ job differs from centre-based childcare workers. They perform business administration tasks and more housekeeping and domestic work than workers in the centre-based childcare, which affect their health and well-being. They are paid on a per child basis but their level of education, experience or input into care is not taken into consideration. In addition, HBC workers reported factors related to the context and the content of their job such as the high physical and mental efforts, the absence of contact with other adults during working hours, the lack of external help during working hours, the difficulty of filling available spots, the exposure to noise and bad odours, the interference of work with personal and family life, the low and precarious remuneration and the lack of benefits as potential factors that may affect their health. Finally, the thesis conclusion provides an overview of HBC workers’ health and determinants of their health identifying remaining gaps in our knowledge of HBC workers’ health and determinants of health where future research is required. Future studies are encouraged to consider using multiple approaches (e.g. online surveys, paper survey, etc.) and multiple languages (e.g. Chinese) to reach a larger number of participants. Stakeholders and decision makers are encouraged to consider provincial differences in social determinants of health to implement interventions to reduce disparities and health inequities among HBC workers.

Master of Public Health - MPH / BACKGROUND: The Zambian anti-retroviral therapy (ART) program has successfully enrolled over 770, 000 people living with HIV (PLWH), out of a population of 1.2 million PLWH. This tremendous success has overburdened the clinic system resulting in many challenges for both patients and healthcare staff. To promote ART initiation, adherence, and retention and at the same time relieve pressure on the health system, a home-based ART delivery model (HBM) was piloted in two urban communities of Lusaka. This study explored levels of acceptability of the model and factors influencing this among PLWH living in the two communities. Acceptability was defined as degree of fit between the patient’s expectations and circumstances and the home-based delivery model of ART, taking into consideration all the contextual elements surrounding the patient. METHODOLOGY: A qualitative study of HBM acceptability was nested within a clusterrandomized trial comparing outcomes in patients receiving HBM intervention compared to the standard of care in two communities in Lusaka, Zambia. Using an exploratory qualitative study design and a purposive sampling technique, qualitative data were collected using observations of HBM delivery (n=12), in-depth interviews with PLWH (n=15) and Focus Group Discussions with a cadre of community health workers called community HIV care providers (CHiPs) administering the HBM (n=2). Data were managed and coded using Atlas.ti 7 and analysed thematically. RESULTS: Overall, the HBM was found to be a good fit with the lives and expectations of PLWH and therefore highly acceptable to them. This acceptability was influenced by a combination of cross cutting clinic based, program design and socio-economic factors that have been categorized into push and pull factors. Push factors were those related to the challenges that PLWH faced when accessing ART from the clinic and included congestion, long waiting times, confidentiality breaches and stigma arising from attending a dedicated clinic. These factors resulted in considerable direct and indirect livelihood opportunity costs. The HBM as an alternative had a number of ‘pull factors’. PLHW described services offered through the model as convenient, confidential, trusted, personalized, less stigmatizing, comprehensive, client centred, responsive, and respectful. Disclosure of client’s HIV status to people they lived with was found to be critical for the acceptability of the model. CONCLUSIONS AND RECOMMENDATIONS: The HBM is highly acceptable and this acceptability is influenced by a combination of crosscutting push and pull factors. Key to the HBM’s acceptability was its delivery design that was responsive to individual patient needs and the steps CHiPs took to minimize the ever-present threat of disclosure and stigma. Future adoption and scaling up of HBM should recognize the importance of these design features.

Magister Public Health - MPH / Background: The Zambian anti-retroviral therapy (ART) program has successfully enrolled over 770, 000 people living with HIV (PLWH), out of a population of 1.2 million PLWH. This tremendous success has overburdened the clinic system resulting in many challenges for both patients and healthcare staff. To promote ART initiation, adherence, and retention and at the same time relieve pressure on the health system, a home-based ART delivery model (HBM) was piloted in two urban communities of Lusaka. This study explored levels of acceptability of the model and factors influencing this among PLWH living in the two communities. Acceptability was defined as degree of fit between the patient’s expectations and circumstances and the home-based delivery model of ART, taking into consideration all the contextual elements surrounding the patient. Methodology: A qualitative study of HBM acceptability was nested within a clusterrandomized trial comparing outcomes in patients receiving HBM intervention compared to the standard of care in two communities in Lusaka, Zambia. Using an exploratory qualitative study design and a purposive sampling technique, qualitative data were collected using observations of HBM delivery (n=12), in-depth interviews with PLWH (n=15) and Focus Group Discussions with a cadre of community health workers called community HIV care providers (CHiPs) administering the HBM (n=2). Data were managed and coded using Atlas.ti 7 and analysed thematically. Results: Overall, the HBM was found to be a good fit with the lives and expectations of PLWH and therefore highly acceptable to them. This acceptability was influenced by a combination of cross cutting clinic based, program design and socio-economic factors that have been categorized into push and pull factors. Push factors were those related to the challenges that PLWH faced when accessing ART from the clinic and included congestion, long waiting times, confidentiality breaches and stigma arising from attending a dedicated clinic. These factors resulted in considerable direct and indirect livelihood opportunity costs. The HBM as an alternative had a number of ‘pull factors’. PLHW described services offered through the model as convenient, confidential, trusted, personalized, less stigmatizing, comprehensive, client centred, responsive, and respectful. Disclosure of client’s HIV status to people they lived with was found to be critical for the acceptability of the model. Conclusions and recommendations: The HBM is highly acceptable and this acceptability is influenced by a combination of crosscutting push and pull factors. Key to the HBM’s acceptability was its delivery design that was responsive to individual patient needs and the steps CHiPs took to minimize the ever-present threat of disclosure and stigma. Future adoption and scaling up of HBM should recognize the importance of these design features.

In 2012, research suggested that 21% to 67% of mental health professionals experience burnout. Burnout is described as a negative experience resulting in workplace stress that produces psychological, emotional, physical, and somatic symptoms. The purpose of this study was to examine a quantitative, correlational relationship between self-care practices and therapist beliefs in relation to burnout among home-based mental health therapists. The research question concerned whether there is a relationship between therapist beliefs, self-care, and burnout among home-based therapists. Equity theory was the base theory used for this project, indicating that reciprocity between therapist and client or therapist and supervisor may be a factor of burnout. While burnout has been researched extensively in the helping professions, this research focused specifically on those working as home-based mental health therapists (N = 80) from local community-based mental health care centers. Results of the quantitative correlational analyses showed that rigid adherence to therapeutic model, low tolerance for distress, belief in responsibility, workplace or professional balance, and balance significantly predicted burnout. Positive social change may result from this study through improved knowledge of symptoms of burnout, therapist beliefs, and self-care methods, which may allow agencies to combat early signs of burnout and promote appropriate training on burnout and approaches to self-care. The early detection and prevention of burnout would allow clinicians to be more effective in making a difference in the lives of clients. In addition, better training and awareness would lead to improvement in the lives of the clinicians and their families.

Thesis (M.Sc) (Agriculture) --University of Limpopo, 2007. / It is beyond doubt that a large proportion of the population in the rural areas are experiencing great difficulty in securing adequate food in both amount and quality. Poverty alleviation programs are embarked in various countries with Makhuduthamaga being no exception. The study was designed to evaluate the home-based egg production projects. The study was conducted at Makhuduthamaga sub- District of Sekhukhune District of Limpopo province. Two instruments were used for data collection namely Delphi technique and two structured questionnaires. The Delphi technique was used for both the beneficiaries and the extension officers to identify, list and rank in order of importance the constraints which impacted negatively on egg production as well as the actions taken to address those constraints. Two separate questionnaires were also used to collect data from both the beneficiaries and the extension officers. Out of twenty villages a list of 231 beneficiaries of starter up packs was identified. Krecjcie and Morgan (1970) sample estimation required 144 randomly selected beneficiaries of starter up packs to participate in the study which reflected 0.6 margin of error. The two questionnaires with open ended and closed ended questions were piloted at Fetakgomo District in four villages with thirty one beneficiaries and ten extension officers. Reliability was found to be 0.81 skills, 0.80 for support from extension officers and 0.61 for government expectations. The Statistical Package for the Social Sciences was used for the entering data collected. Descriptive statistics were used to analyse data. The findings revealed that the majority of the beneficiaries fall within the prescribed selection criteria. Almost all except one village were given the starter up packs namely 18 layers, four bags of laying mash, cage, nipples, feeding trays and a cage as outlined in the policy. Training was considered by both the beneficiaries and the extension officers as inadequate for effective and efficient running of the home based egg production projects. The results revealed that the majority of beneficiaries did not meet government expectations. An acknowledgement was made that during the implementation of projects mistakes were committed by both beneficiaries and extension officers. Analysis of variance was also used to determine the relationship between the level of education and the extent to which government expectations were met. There was no significant relationship between skills such as technical, management, financial, administration and the extent to which government expectations were met. However there was a significant relation between marketing skills and levels of education. The majority of beneficiaries had a low level of education. Pearson correlation coefficient was used to determine whether there is a relationship between skills and support from the extension officers and the extent to which government expectation were met. Skills such as technical and marketing as well as the support from the extension officers attributed much to variations with regard to the extent to which government expectation were met. Constraints were also encountered which impacted negatively on egg production. Extension officers identified the following constraints such as survey not done prior to distribution, insufficient human resources, training, insufficient monitoring, inadequate transport, inability of beneficiaries to purchase feed, inadequate starter packs and failure to establish cooperatives. Beneficiaries identified constraints such as feed, training, diseases and unavailability of veterinarian, mortality of layers on arrival, theft and predation, inadequate starter packs, layers not of the same age and cages that are too small. Out the constraints mentioned only three namely insufficient transport, inadequate starter up packs `and one aspect on feed i.e. soft shelled eggs were addressed. Although the majority of beneficiaries considered home based egg production projects inadequate in providing access to adequate food, slightly over half of them favoured them as future household projects. / Kellog Foundation

The purpose of this study was to investigate the marketing strategies of custom clothing home-based business owners by identifying selected demographic characteristics, general business information, marketing strategies, and current and potential future marketing support from members who were custom clothier home-based business owners affiliated with the Professional Association of Custom Clothiers in the Oregon Chapter. The PACC is an organization developed to assist custom clothier home-based businesses and commercial businesses that are in fields associated with the sewing industry. There is limited research developed exploring areas focused on the marketing of custom clothier home-based businesses. The custom clothier home-based business owner acts as the research and development manager, production manager, and accountant as well as the marketer of the business Therefore, as concluded in previous studies the examination of the marketing strategies used by custom clothiers and any marketing support offered by professional organizations that assist home-based businesses, required further investigation. A self-administered mail survey questionnaire was mailed to all members of the PACC organization in order to collect data for this study. Only members who owned a custom clothier home-based business were asked to participate. The data from 45 of the returned questionnaires were identified as useable and analyzed using a Statistical Analysis System (SAS) version 7. Percents and frequencies were used to analyze the demographic characteristics, marketing strategies, and current and potential future marketing support from the PACC organization. Eighty percent of the respondents had been members of the PACC organization for three years or more. The greatest percentage of the respondents (13.33%) had owned their custom clothier business for 12 years. The majority of the respondents contribute fifty percent or less of the total household income. The respondents in the survey confirmed that word-of-mouth communication was the most effective method of promotion for the custom clothier home-based business owner. Networking was the most beneficial item of marketing support the respondents derive from membership in the PACC organization. A Likert Scale with the endpoints of "Very Beneficial and Not Very Beneficial" identified that the respondents also perceive product/service development at meetings as a very beneficial source of marketing support from the PACC organization. Future ideas for possible potential marketing support for the PACC organization included: 1) using the PACC referral service, 2) more publicity for the PACC organization, and 3) more exposure at the national level. Fisher's Exact Test was used to analyze data. Four separate two-by-two tables were developed to compare the respondents as two groups of 1) those respondents who had marketing experience and/or education to 2) those respondents who did not have marketing experience and/or education. Therefore, the column factor in the columns of the two-by-two tables was marketing experience and/or education and was indicated by the respondents on the questionnaire with a "yes" or "no" response. The row factors in each of the four separate two-by-two tables were: 1) geographic range of the clientele. 2) number of competitors in the local area. 3) requests for new fabrics, embellishments, or interfacings, and 4) satisfaction with the level of profits from the business. This investigation revealed that the proportion of the respondents who had marketing experience and/or education were inclined to have clientele outside the designated local area of a 50-mile radius within the location of the home-based business. The two-by-two table that compared the column factor of marketing experience and/or education and the row factor of satisfaction with the level of profits from the business revealed no significant differences between the two groups of respondents. Satisfaction of the business was not associated with either having marketing experience and/or education or not having marketing experience and/or education. Research investigating the marketing strategies of custom clothier home-based business owner is an important topic. The marketing of the custom clothier home-based business is often a complex process and is difficult to master and implement. / Graduation date: 2000

An integrated framework of Family Resource Management and Household Economic theory was utilized to develop a model of relationships between human capital, family characteristics and resources, number of income sources, hours spent in home production, total income and subjective well-being. This study utilized a sample of 129 women systematically selected from Machinga and Zomba Districts in Malawi. Results of Path analysis showed that place of residence, primary education and secondary education or above had positive direct relationships to number of income sources. Variables which had significant negative relationships with hours spent in home production were place of residence and age. Access to farm technologies had a positive relationship. The positive predictors of total income were: primary education, secondary education or above, number of income sources, place of residence, land holding size and access to farm technologies. Home production time and health status were negatively related to total income. Total income and hours spent in home production were significant and positively related to a well-being score, derived from four measures of well-being. Health status was negatively related to this score. Five variables: place of residence, age, primary education, secondary education or above and access to farm technologies had indirect effects on total income through number of income sources and home production. All independent variables entered had indirect effects on the well-being score through total income and hours spent in home production. Number of income sources only mediated the effects on the well-being score jointly with total income. On the whole, both intervening variables did a fair job of mediating the effects of independent variables on total income and subjective well-being (well-being score). Finally, household size, health status and subjective well-being significantly affected overall satisfaction with life. This study has implications for policy, education/training and research in order to enhance women's well-being. / Graduation date: 1996

This dissertation examines the effect of changes in the stock of human capital on the labor force participation decision of women aged 25-54. Without the option of homebased work, some women choose to leave the labor market and stay at home temporarily for family reasons. Working women realize that time out of the labor force could impose penalties on their work careers. This is because during the break, they do not accumulate any new human capital while the existing job skills continuously depreciate. Nowadays, home-based work becomes possible for many jobs because rapid development in personal computers and advances in information and communications technology have reduced employers’ cost of offering home-based work arrangements. Working women can resolve the time conflict between demand for paid work and family responsibility by working from home. In a previous study, the home-based work decision depends on the fixed cost of working and potential home production. Women who are disabled, have small children, or live in rural areas are likely to work from home because they have high fixed costs of working and high potential home production. However, none of the existing studies applies the human capital theory of labor supply to the home-based work decision. Using data on the female labor force from the Integrated Public Use Microdata Series (IPUMS) of housing units from the 2000 U.S. Census, I estimate a nested logit model to examine the effects of expected costs of non-participation, in terms of forgone earnings, forgone human capital accumulation and human capital depreciation, on women’s labor force participation decision. I find that, other things being equal, women aged 25 to 44 who have potentially high human capital accumulation and high human capital depreciation are likely to stay in the labor force. In the case that the value of their home time is so high that they choose to stay at home, they prefer to work for pay at home than to be out of the labor force.

Thesis (M.A.)--Marshall University, 2001. / Title from document title page. Document formatted into pages; contains iv, 52 p. Includes bibliographical references (p. 51-52).

Thesis (MTech (Entrepreneurship))--Peninsula Technikon, 2002. / Word processed copy. Summary in English. Includes bibliographical references (leaves 53-55). Also available online.