Nonadherence to medications for chronic illnesses is a public health problem that requires education related to its illnesses and medications in order to reduce morbidity, mortality, and health care costs, and to improve quality of life. Scholars have identified that morbidity and mortality are much higher among African Americans due to poor medication adherence when compared to Euro-Americans. This study focused on African Americans to increase their medication adherence with chronic illnesses. The purpose of this study was to analyze the effectiveness of using different educational methods to enhance medication adherence. The social cognitive theory and the theory of planned behavior were used as a foundation to develop this quantitative study. Three validated tools were used to assess the effectiveness of educational methods to see if there would be any increase in knowledge, self-efficacy, and change in health beliefs. A sample size of 144 African Americans in Chicago with chronic illnesses was randomized to an experimental group that received education on medication adherence for a period of 8 weeks through lecture, video presentation, roleplaying, and group discussion. A control group received regular education for the same 8 weeks. ANOVA, ANCOVA, and MANOVA statistical methods were used to analyze the findings that reported no statistical significance in the knowledge difference scores F(1,261) = 0.17, p = 0.678, self-efficacy difference scores F(1,259) = 0.96, p = 0.328, and health beliefs difference scores F(4,258) = 0.46, p = 0.765. This study contributes to social change by identifying a public health problem which can be improved by adding and testing other variables such as fatigue and cognitive and sensory deficits associated with chronic illnesses, which could yield a more valuable in-depth understanding.

This dissertation is divided into five chapters consisting of three short essays that concentrate on economic analysis of health, savings and labor. The first essay is aimed at investigating the influence of increased work hours on individuals’ health and how this may differ between males and females. It is expected that increased hours of work will have a negative impact on health but this impact may be stronger for females. In the second essay, the relationship between individuals’ health and savings behavior is analyzed. Healthy individuals are expected to be more productive, earn higher incomes, and have lower medical expenditures compared to unhealthy individuals. It is therefore expected that individuals’ health will have a positive influence on their saving behavior. The third paper analyzes the effect of increased work, as proxied by labor force participation, on health, as proxied by life expectancy, at the macro level. The main aim of the analysis in the third essay is to investigate whether or not increased female labor force participation is a contributing factor to the narrowing gap between the life expectancy of females and males. In the final chapter of this dissertation, I provide a summary of my findings on the relationships between work, health, and savings. I also provide directions for future research.

Indiana University-Purdue University Indianapolis (IUPUI) / There is a lack of existing research that investigates the feasibility of using consumers to evaluate the fidelity of evidence-based practices, including supported employment which is an intervention that helps people with severe mental illnesses to obtain competitive employment. Fidelity refers to the extent that the SE program adheres to the Individual Placement and Support (IPS) model of supported employment. The present study was a concordance study that investigated whether or not consumers’ self reports of IPS fidelity information agreed with administrative charts and employment specialists. Additionally, it was hypothesized that consumers’ program satisfaction ratings would be positively correlated with their self reported IPS fidelity scores. An additional purpose of this study was to examine what types of supported employment fidelity items consumers were able to report on. Participants included a volunteer sample of 30 consumers and 5 employment specialists from one IPS program in Indiana. Consumers in the IPS program were interviewed by telephone using a survey that included questions related to their program’s fidelity as well as their satisfaction with the program. Questions were based off of items from the IPS Fidelity Scale and were categorized into the following subscales: work incentives counseling, job search, engagement, organization, staffing, and job support. Similar questions were asked in an employment specialist survey and a chart review. All three sources (consumers, charts, and employment specialists) indicated high IPS fidelity responses on the researcher developed surveys. However, there was a low level of agreement between the sources at both the subscale level and item level. Although there was an overall low level of agreement between sources, there were several items that had a moderate or higher degree of agreement. Additionally, the present study did find a positive correlation between the consumer fidelity score percentage and consumer IPS program satisfaction ratings, supporting the researcher’s hypothesis. Among the items that consumers had difficulty answering were several tapping program level policies such as zero exclusion. Reasons for the discrepancy in agreement between sources as well as clinical implications of the findings are discussed.

This non-experimental, descriptive, quantitative survey attempted to evaluate IMCI implementation in the eThekwini district of KwaZulu -Natal. The study focused on IMCI implementation by IMCI trained registered nurses, health facility support and follow-up and supervision. The research population comprised of all IMCI trained registered nurses working in health facilities in the eThekwini district. The convenient sample consisted of 40 research subjects. Data was collected by means of an interview schedule and a checklist, and analysed using Microsoft Excel 2007. Findings of the study revealed that many of the IMCI trained registered nurses were unable to assess, classify and treat the sick child comprehensively and consistently. The recommended follow-up visit at six weeks after completion of IMCI training, and lack of on-going supervision remains an area of concern. Recommendations were that district or clinic supervisors can enhance the skills of IMCI trained registered nurses through recommended follow-up visits and on-going supervision and the provision of updated IMCI chart booklets. / Health Studies / M.A. (Health Studies)

<p>Background: Globally, neonatal mortality (i.e. deaths occurring during the first month of life) accounts for 44% of the 11 million infants that die every year (Lawn, Cousens &amp / Zupan, 2005). Early&nbsp / detection of illness and referral of mothers and infants during the peri-natal period to higher levels of care can lead to substantial reductions in maternal and child mortality in developing&nbsp / countries. Establishing effective referral systems from the community to health facilities can be achieved through greater utilization of community health workers and improved health seeking&nbsp / behaviour. Study design: The Good Start Saving Newborn Lives study being conducted in Umlazi, KwaZulu-Natal, is a community randomized trial to assess the effect of an integrated home&nbsp / visit package delivered to mothers during pregnancy and post delivery on uptake of PMTCT interventions and appropriate newborn care practices. The home visit package is delivered by community health workers in fifteen intervention clusters. Control clusters receive routine health facility antenatal and postpartum care. For any identified danger signs during a home visit,&nbsp / community health workers write a referral and if necessary refer infants to a local clinic or hospital. The aim of this study was to assess the effectiveness of this referral system by describing&nbsp / community health worker referral completion rates as well as health-care seeking practices and perceptions of mothers. A cross- sectional survey was undertaken using a structured&nbsp / questionnaire with all mothers who had been referred to a clinic or hospital by a community health worker since the start of the Good Start Saving Newborn Lives Trial. Data collection: Informed consent was obtained from willing participants. Interviews were conducted by a trained research assistant in the mothers&rsquo / home or at the study&nbsp / offices. Road to Health Cards were reviewed to confirm referral completion. Data was collected by means of a cell phone (mobile researcher software) and the database was later transferred to Epi-info and STATA IC 11 for analysis.&nbsp / Descriptive analysis was&nbsp / conducted so as to establish associations between explanatory factors and referral completion and to describe referral processes experienced by caregivers. Significant&nbsp / associations between categorical variables were assessed using chi square tests and continuous variables using analysis of variance. Results: A total of 2423 women were&nbsp / enrolled in the SNL study and 148 had received a referral for a sick infant by a CHW by June 2010. The majority (95%) of infants were referred only once during the time of enrolment, the&nbsp / highest number of which occurred within&nbsp / the first 4 weeks of life (62%) with 22% of these being between birth and 2 weeks of age. Almost all mothers (95%) completed the referral by taking&nbsp / their child to a health facility. Difficulty in breathing and rash accounted for the highest number of referrals (26% and 19% respectively). None of the six mothers who did not complete referral recognised any danger signs in their infants. In only 16% of cases did a health worker give written feedback on the outcome of the referral to the referring CHW.&nbsp / Conclusion: This study found&nbsp / high compliance with referrals for sick infants by community health workers in Umlazi. This supports the current primary health care re-engineering process being undertaken by the South&nbsp / African National Department of Health (SANDOH) which will involve the establishment of family health worker teams&nbsp / including community health workers. A key function of these workers will&nbsp / be to conduct antenatal and postnatal visits to women in their homes and to identify and refer ill children. Failure of mothers to identify danger signs in the infant was associated with&nbsp / non-completion of referral. This highlights the need for thorough counseling of mothers during the antenatal and early postnatal period on neonatal danger signs which can be reinforced by&nbsp / community health workers. Most of the referrals in this study were&nbsp / neonates which strengthens the need for home visit packages delivered by community health workers during the antenatal&nbsp / and post-natal period as currently planned by the South African National Department of Health.Recommendations: This study supports the current plans of the Department of Health for greater involvement of CHWs in Primary Health Care. Attention should be given to improving communication between health facilities and CHWs to ensure continuity of care and greater&nbsp / realization of a team approach to PHC.</p>

<p>Background: Globally, neonatal mortality (i.e. deaths occurring during the first month of life) accounts for 44% of the 11 million infants that die every year (Lawn, Cousens &amp / Zupan, 2005). Early&nbsp / detection of illness and referral of mothers and infants during the peri-natal period to higher levels of care can lead to substantial reductions in maternal and child mortality in developing&nbsp / countries. Establishing effective referral systems from the community to health facilities can be achieved through greater utilization of community health workers and improved health seeking&nbsp / behaviour. Study design: The Good Start Saving Newborn Lives study being conducted in Umlazi, KwaZulu-Natal, is a community randomized trial to assess the effect of an integrated home&nbsp / visit package delivered to mothers during pregnancy and post delivery on uptake of PMTCT interventions and appropriate newborn care practices. The home visit package is delivered by community health workers in fifteen intervention clusters. Control clusters receive routine health facility antenatal and postpartum care. For any identified danger signs during a home visit,&nbsp / community health workers write a referral and if necessary refer infants to a local clinic or hospital. The aim of this study was to assess the effectiveness of this referral system by describing&nbsp / community health worker referral completion rates as well as health-care seeking practices and perceptions of mothers. A cross- sectional survey was undertaken using a structured&nbsp / questionnaire with all mothers who had been referred to a clinic or hospital by a community health worker since the start of the Good Start Saving Newborn Lives Trial. Data collection: Informed consent was obtained from willing participants. Interviews were conducted by a trained research assistant in the mothers&rsquo / home or at the study&nbsp / offices. Road to Health Cards were reviewed to confirm referral completion. Data was collected by means of a cell phone (mobile researcher software) and the database was later transferred to Epi-info and STATA IC 11 for analysis.&nbsp / Descriptive analysis was&nbsp / conducted so as to establish associations between explanatory factors and referral completion and to describe referral processes experienced by caregivers. Significant&nbsp / associations between categorical variables were assessed using chi square tests and continuous variables using analysis of variance. Results: A total of 2423 women were&nbsp / enrolled in the SNL study and 148 had received a referral for a sick infant by a CHW by June 2010. The majority (95%) of infants were referred only once during the time of enrolment, the&nbsp / highest number of which occurred within&nbsp / the first 4 weeks of life (62%) with 22% of these being between birth and 2 weeks of age. Almost all mothers (95%) completed the referral by taking&nbsp / their child to a health facility. Difficulty in breathing and rash accounted for the highest number of referrals (26% and 19% respectively). None of the six mothers who did not complete referral recognised any danger signs in their infants. In only 16% of cases did a health worker give written feedback on the outcome of the referral to the referring CHW.&nbsp / Conclusion: This study found&nbsp / high compliance with referrals for sick infants by community health workers in Umlazi. This supports the current primary health care re-engineering process being undertaken by the South&nbsp / African National Department of Health (SANDOH) which will involve the establishment of family health worker teams&nbsp / including community health workers. A key function of these workers will&nbsp / be to conduct antenatal and postnatal visits to women in their homes and to identify and refer ill children. Failure of mothers to identify danger signs in the infant was associated with&nbsp / non-completion of referral. This highlights the need for thorough counseling of mothers during the antenatal and early postnatal period on neonatal danger signs which can be reinforced by&nbsp / community health workers. Most of the referrals in this study were&nbsp / neonates which strengthens the need for home visit packages delivered by community health workers during the antenatal&nbsp / and post-natal period as currently planned by the South African National Department of Health.Recommendations: This study supports the current plans of the Department of Health for greater involvement of CHWs in Primary Health Care. Attention should be given to improving communication between health facilities and CHWs to ensure continuity of care and greater&nbsp / realization of a team approach to PHC.</p>

The purpose of this study was to explore and describe the experiences of adolescents living with a diagnosed chronic auto-immune Illness (CAI) due to the fact that there is a wider increase in the prevalence and incidence of auto-immune illnesses among adolescents. The researcher applied one primary scientific paradigm and two theories in this study, namely the Gestalt paradigm, Field theory and Erikson’s Theory of Adolescent Development, pertaining to adolescents living with a CAI. A qualitative, explorative and descriptive case study approach was followed. Purposive sampling was used to select six adolescents with a diagnosed CAI. Data was collected through individual semi-structured interviews and observations. Qualitative data analysis using Creswell’s “data analysis spiral” was used to analyse data and identify themes. It was clear that the adolescents” environments, as well as their intra- and interpersonal resources and outlook on life have an influence on the way they experience their illness. They experienced a continuum of feelings which ranged from support and encouragement from family and community members, to a lack of understanding from community members, and ridicule and isolation by peers. Sharing success stories and exploring a multidisciplinary, more holistic treatment plan that focuses on mind, body and soul, may benefit adolescents living with a CAI. / Thesis (MA (Psychology))--North-West University, Potchefstroom Campus, 2013

Integrated Management of Childhood Illnesses (IMCI) is a strategy that was developed by the World Health Organisation (WHO) and the United Nations Children’s Fund (UNICEF) to reduce the mortality and morbidity rate of children younger than 5 years and to improve the quality of life of these children. The reduction of child mortality and morbidity is one of the Millennium Developmental Goals (MDGs) as sub-Saharan Africa has a high child mortality and morbidity prevalence. The IMCI strategy has three components namely case management, the health system and the household and community component. This strategy was implemented internationally, including South Africa, where it is implemented within Primary Health Care (PHC) facilities. The implementation of the IMCI strategy was introduced to the PHC environment of South Africa and aims to enhance the equity, accessibility, affordability and availability of health care to all South African citizens, with the focus in this study on the child younger than 5 years. The North West province started training the professional nurses and implemented IMCI in 1998. The Dr. Kenneth Kaunda district (one of the districts in North West Province) and with specific focus on the Matlosana sub-district identified challenges in the implementation of the IMCI strategy by professional nurses. Challenges such as a lack of trained staff, the short time frame available for consultation amidst an already overburdened clinic and the physical infrastructure of the PHC facilities are such examples. The main aim of this research was to explore and gain insight and understanding in the challenges professional nurses working in PHC facilities face regarding the implementation of the IMCI strategy. A qualitative research design was used to conduct this study on daily work-life experiences of the professional nurses. Individual, semi-structured interviews were used as the method of data collection. The main question asked was: “What are the challenges faced by professional nurses in PHC facilities regarding the implementation of the IMCI strategy?” Data saturation was reached after 18 professional nurses were interviewed (N=18). Digitally voice recorded interviews were transcribed and content analysis was conducted. The findings of this research suggest that the professional nurses in the PHC facilities indeed experienced challenges regarding IMCI implementation. The main themes that emerged were challenges regarding the organisation and service delivery; challenges specific to the implementation of the IMCI strategy and also challenges external to the clinic that impacted directly on the IMCI strategy implementation. The findings were discussed with literature integration. From the research results and conclusions, the researcher compiled recommendations for nursing education, nursing research, and community health practice. / Thesis (MCur)--North-West University, Potchefstroom Campus, 2013.

The purpose of this study was to explore and describe the experiences of adolescents living with a diagnosed chronic auto-immune Illness (CAI) due to the fact that there is a wider increase in the prevalence and incidence of auto-immune illnesses among adolescents. The researcher applied one primary scientific paradigm and two theories in this study, namely the Gestalt paradigm, Field theory and Erikson’s Theory of Adolescent Development, pertaining to adolescents living with a CAI. A qualitative, explorative and descriptive case study approach was followed. Purposive sampling was used to select six adolescents with a diagnosed CAI. Data was collected through individual semi-structured interviews and observations. Qualitative data analysis using Creswell’s “data analysis spiral” was used to analyse data and identify themes. It was clear that the adolescents” environments, as well as their intra- and interpersonal resources and outlook on life have an influence on the way they experience their illness. They experienced a continuum of feelings which ranged from support and encouragement from family and community members, to a lack of understanding from community members, and ridicule and isolation by peers. Sharing success stories and exploring a multidisciplinary, more holistic treatment plan that focuses on mind, body and soul, may benefit adolescents living with a CAI. / Thesis (MA (Psychology))--North-West University, Potchefstroom Campus, 2013

Integrated Management of Childhood Illnesses (IMCI) is a strategy that was developed by the World Health Organisation (WHO) and the United Nations Children’s Fund (UNICEF) to reduce the mortality and morbidity rate of children younger than 5 years and to improve the quality of life of these children. The reduction of child mortality and morbidity is one of the Millennium Developmental Goals (MDGs) as sub-Saharan Africa has a high child mortality and morbidity prevalence. The IMCI strategy has three components namely case management, the health system and the household and community component. This strategy was implemented internationally, including South Africa, where it is implemented within Primary Health Care (PHC) facilities. The implementation of the IMCI strategy was introduced to the PHC environment of South Africa and aims to enhance the equity, accessibility, affordability and availability of health care to all South African citizens, with the focus in this study on the child younger than 5 years. The North West province started training the professional nurses and implemented IMCI in 1998. The Dr. Kenneth Kaunda district (one of the districts in North West Province) and with specific focus on the Matlosana sub-district identified challenges in the implementation of the IMCI strategy by professional nurses. Challenges such as a lack of trained staff, the short time frame available for consultation amidst an already overburdened clinic and the physical infrastructure of the PHC facilities are such examples. The main aim of this research was to explore and gain insight and understanding in the challenges professional nurses working in PHC facilities face regarding the implementation of the IMCI strategy. A qualitative research design was used to conduct this study on daily work-life experiences of the professional nurses. Individual, semi-structured interviews were used as the method of data collection. The main question asked was: “What are the challenges faced by professional nurses in PHC facilities regarding the implementation of the IMCI strategy?” Data saturation was reached after 18 professional nurses were interviewed (N=18). Digitally voice recorded interviews were transcribed and content analysis was conducted. The findings of this research suggest that the professional nurses in the PHC facilities indeed experienced challenges regarding IMCI implementation. The main themes that emerged were challenges regarding the organisation and service delivery; challenges specific to the implementation of the IMCI strategy and also challenges external to the clinic that impacted directly on the IMCI strategy implementation. The findings were discussed with literature integration. From the research results and conclusions, the researcher compiled recommendations for nursing education, nursing research, and community health practice. / Thesis (MCur)--North-West University, Potchefstroom Campus, 2013.