Canada’s population is aging rapidly, and understanding living arrangements and their determinants plays a critical role in supporting healthy aging. This thesis examined, using a population-based longitudinal survey, the Canadian Multicentre Osteoporosis Study, the effects of clinically-significant change in physical and mental health on future living arrangements, employing generalized estimating equations logistic regression models. Clinically-significant decline in SF-36 Physical Component Score (PCS) increased likelihood of not remaining community-dwelling, or “aging in place” over stable or improved scores by 41%. SF-36 Mental Component Score (MCS) did not show a statistically significant effect on aging in place. Older age and employment status of retired or unemployed increased likelihood of not aging in place, whereas living with a partner, pursuing moderate or vigorous physical activity, and having children increased the likelihood of aging in place. Study findings will inform social and health policy development to support aging in place in Canada and elsewhere.

This presented diploma thesis deals with evaluation of the traffic noise influence on the health of the exposed population. The objectives of this thesis are based on the results of Environmental Health System in the Czech Republic (Subsystem III), which provides the long-term monitoring of the noise in the municipal environment of the chosen agglomerations. A part of the noisy location monitoring is also the questionnaire survey confirming hypothesis n.1: "At the traffic noise perceiving, there is an important psychosocial bound, which often stands in opposition to the results of the noise measurements". Furthermore, the thesis describes the results of the indicative measurement of the chosen noisy localities in comparison with same locality measurements in the technical accuracy class. The indicative gauge tests were made on the traffic-busy roads in Jihlava city. The measurement has proved the link between the intensity of the traffic flow and indicatively determined noise levels and practical applicability for the local planning or local controlling incentives solution. The results of the indicative measurements point out to breaking of the equivalent night noise levels for sleep disturbance in three chosen localities. Breaking of the equivalent day noise levels has a nature of the noise annoyance. The measured road-traffic-caused night and day noise levels may be compared to the recommendations for the risks of increased incidence of selected civilization diseases published by the World Health Organisation.

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / Systemic arterial hypertension is a chronic non-communicable disease considered an important public health problem both in the global and national levels. Its repercussions exceed the biological dimension, because, it involves the subjectivity and the social constructions of the person, family and community where they live. Thus, among the scenarios that have been focus of attention and care in health are the ones that comprehend the population that lives in the countryside. It is essential that in these places the care from the cultural perspective is identified and comprehended, allowing the professionals of health to act professionally and efficiently with the people of different cultures. So, it is essential to comprehend the practices of care of people with hypertension that live in the countryside. From this question, we outlined as objective of this study to analyze the way how the people with systemic arterial hypertension that live in the countryside understand and live the practices of care. It is a field research, qualitative, exploratory and descriptive, performed with 13 people with hypertension that live in the countryside, covering the period from May to June of 2015. The data collection was performed by means of participant observation of moderated kind and semi-structured interview. The data was worked by Guide of phases of Data Analysis from the method of etno-nursing suggested by Leininger and McFarland. The research followed the ethical principles of the Resolution number 466/2012 and obtained approval by the Research Ethics Committee with the Approval Certificate for Ethical Assessment number 41156015.7.0000.5346. The results were organized in two categories and three subcategories discussing from the beliefs and experiences in the disease process and the daily care practices. Regarding the experience of living with "high pressure" are revealed trajectories performed to diagnosis, the meanings attributed the etiology of the disease, the changes and the difficulties stemming from living with hypertension, as well as representations of illness resulting from that experience. Also, care practices were discussed from the aspects that concern the habits, uncertainties and possibilities in food, strategies were also identified from the replacement, reduction or elimination partial or total food with potential for worsening health. Another approached practice was the use of medicines and teas as medicines used to control blood pressure levels. Also addressed were the careful design combined with the care practices in general as protection against bad weather, hygiene, interaction with other people, games, leisure activities and social support network as forms of care and welfare. So to understand care practices is critical recognition and appreciation of different existing cultures and the elements present in everyday life. / A hipertensão arterial sistêmica é uma doença crônica não-transmissível considerada um importante problema de saúde pública, tanto em âmbito mundial como nacional. Suas repercussões ultrapassam a dimensão biológica, pois envolve a subjetividade e as construções sociais da pessoa, da família e da comunidade onde vivem. Sendo assim, dentre os cenários, que têm sido foco de atenção e cuidado em saúde, estão os que compreendem a população que vive no campo. Torna-se indispensável que no campo o cuidado, a partir da perspectiva cultural, seja identificado e compreendido, permitindo aos profissionais de saúde atuações diferenciadas e eficientes com pessoas de diferentes culturas. Logo, é importante compreender as práticas de cuidado de pessoas com hipertensão que vivem no campo. A partir dessa problemática, delineou-se como objetivo deste estudo analisar o modo como as pessoas com hipertensão arterial sistêmica que vivem no campo entendem e vivenciam as práticas de cuidado. Trata-se de uma pesquisa de campo, qualitativa, exploratória e descritiva, realizada com 13 pessoas com hipertensão que vivem no campo, no período de maio a junho de 2015. A coleta de dados realizou-se por meio de observação participante do tipo moderado e entrevista semiestruturada. Os dados foram trabalhados pelo Guia das Fases de Análise de Dados do método da etnoenfermagem sugerido por Leininger e McFarland. A pesquisa seguiu os princípios éticos da Resolução número 466/2012 e obteve aprovação do Comitê de Ética em Pesquisa com o Certificado de Apresentação para Apreciação Ética número 41156015.7.0000.5346. Os resultados foram organizados em duas categorias e três subcategorias que discutem desde as crenças e experiências no processo de adoecimento bem como as práticas cotidianas de cuidados. Em relação a experiência de viver com pressão alta são reveladas as trajetórias realizadas até o diagnóstico, os significados atribuídos a etiologia da doença, as mudanças e as dificuldades advindas do viver com hipertensão, bem como as representações da doença advindas dessa experiência. Também, foram discutidas as práticas de cuidado a partir dos aspectos que tangem a os hábitos, incertezas e possibilidades na alimentação, ainda foram apontadas estratégias a partir da substituição, redução ou eliminação parcial ou total de alimentos com potencial de agravamento para saúde. Outra prática abordada foi a utilização de medicamentos e chás como remédios utilizados para o controle dos níveis pressóricos. Ainda foram abordadas a concepção de cuidado aliada as práticas de cuidado em geral como proteção contra as intempéries climáticas, higienização, interação com outras pessoas, jogos, atividades de lazer e a rede social de apoio como formas de cuidado e bem-estar. Sendo assim, para entender as práticas de cuidado é fundamental o reconhecimento e valorização das diversas culturas existentes bem como dos elementos presentes no cotidiano.

O objeto deste estudo é a relação trabalho/saúde dos enfermeiros do Programa Saúde da Família (PSF), recortado diante do quadro teórico da Saúde do Trabalhador. O objetivo geral foi compreender as características do trabalho dos enfermeiros do PSF da subprefeitura de Vila Prudente – Sapopemba e a relação entre os processos de fortalecimento e de desgaste que neles se expressam. A coleta de dados se realizou através de entrevistas individuais com 16 enfermeiros das Unidades Básicas de Saúde dessa subprefeitura que contam com o PSF. As formas de trabalhar dos enfermeiros entrevistados foram analisadas de acordo com cinco categorias: processo de trabalho, exploração da subjetividade, polivalência, desgaste e fortalecimento, verificando-se, em cada uma delas, os potenciais de fortalecimento e de desgaste gerados. Os resultados são: os enfermeiros reconhecem o espaço territorial ocupado pela população adscrita e enfatizam a precariedade das condições de moradia, configurando-se o objeto de trabalho como uma população carente; o modelo assistencial tem como eixo orientador o planejamento por resultados, voltado à racionalização do trabalho da equipe; o médico é o profissional principal, o trabalho é organizado segundo os preceitos da divisão social e técnica do trabalho de tipo taylorista; os enfermeiros estão intensamente envolvidos com o trabalho, convivendo, de um lado, com a forte expectativa que se tem de suas potencialidades para solucionar os problemas e, de outro, com a impossibilidade de oferecer respostas para os problemas trazidos pela população; os trabalhadores acreditam que para trabalhar no PSF é necessário um perfil especial para o trabalho, o planejamento das atividades próprias dos enfermeiros é sufocado pelos imprevistos do dia-dia; os entrevistados assumem um pouco de tudo e diagnosticam a necessidade de se qualificar para a multifuncionalidade; consideram que devem ter habilidade para resolver todos os problemas do dia a dia. O fortalecimento advém principalmente da relação prazerosa e recompensatória com o objeto/finalidade do trabalho e com o trabalho em si, destacando-se a satisfação com a obtenção de resultados gratificadores, como o vínculo formado com as famílias, muitas vezes localizada nas situações de conquista individual. Com referência ao desgaste, pode-se concluir que: os territórios adscritos pelo PSF integram potenciais de desgaste do trabalhador, impotentes diante da complexidade que implica trabalhar na periferia do tecido social; problemas de alta complexidade trazidos pelos pacientes, bem como o contato direto com o sofrimento e as carências da população, a não adesão ao tratamento ou as reclamações sobre este ou aquele profissional integram as cargas psíquicas; os trabalhadores têm que lidar com situações de precariedade em que a falta de materiais para as atividades diárias representa transtorno no trabalho; a exigência de produtividade, as cobranças, as interrupções constantes nas tarefas em andamento, a realização de atividades que não são atribuições da categoria, os diferentes graus de compromisso e, por vezes, a falta de integração entre as enfermeiras constituem motivo de estresse, angústia e irritação; os enfermeiros se desesperam para dar conta da demanda e chamam a atenção para a necessidade de impor limites. O acolhimento é desgastante uma vez que a demanda é grande e os usuários querem ver seus problemas resolvidos rapidamente; o desgaste se concretiza em muito cansaço físico e mental, levando os enfermeiros a querer apenas descansar e a acumular problemas de saúde como hipertensão, alergias, dores de estômago, além de outros agravos como dormir no volante e sofrer acidentes de carro / The object of this study is nurses’ job/health relation in the Family Health Program (Programa Saúde da Família - PSF), represented within a theoretical framework of Worker’s Health. The general objective was comprehending the characteristics of PSF nurses\' job in Vila Prudente - Sapopemba sub prefecture and the relation between the process of strengthening and debility expressed in them. Data collecting was done through single interviews with 16 nurses who work in Basic Health Units which take part of PSF in this sub prefecture. The interviewed nurses\' ways of working were analyzed according to five categories: working process, subjectivity, polyvalence, debility and strengthening, having, in each of them the debility and strengthening potential fulfilled.. The results are: nurses recognize the area where adscript population live and highlight the precarious living conditions, turning the object of study to be a destitute population; the care pattern is guided by planning focused on results and the rationalization of team work; the doctor is the main worker, job is planned according social division precepts and taylorist working techniques; nurses are intensely involved in the job, handling, on one hand, with the strong expectation of their ability to solve problems and, on the other hand, with the impossibility of finding an answer for people’s problems; workers believe you need to have a special profile for working in order to work at PSF, nurses’ activities planning is canceled because of unforeseen happenings on day-by-day; the interviewees recognize most of it and diagnosed the need of getting themselves prepared for multifunctionality; they believe they must be able to solve all day-by-day problems. Strengthening results from the pleasant and rewarding relation between object/purpose of work and the work itself, highlighting contentment with compensating results gotten, as getting closer to families, which is, most of the time done individually. About debility, we can conclude that: adscript places by PSF are potentially debilitating for workers who are impotent in the face of complexity of working in poor areas; handling problems of great complexity arisen by patients, also, dealing directly to suffering and population’s destitution, patients who don’t undergo treatment or complain about this or that worker contribute to psychological pressure; workers must deal with precarious situations in which lack of material for daily activities is a trouble at work; production demand, pressing necessity, constant discontinuity of tasks in progress, developing activities they are not designated to, different sense of commitment and, at times, lack of interaction among nurses cause stress, agony and exacerbation; nurses get desperate to do what is in demand and it draws attention to the need of imposing limits. Approving reception is debilitating, once demand is great and users want their problems to be quickly solved; debility causes physical and mental weakness, then nurses just want to rest and they end up having several health problems such as hypertension, allergies, stomachaches, besides other injuries such as sleeping while driving, causing car accidents

Rapid and unplanned urbanization has ushered in a variety of public health challenges, including exposure to traffic pollution and greater dependence on automobiles. Moreover, vulnerable population groups often bear the brunt of negative outcomes and are subject to disproportionate exposure and health effects. This makes it imperative for urban transportation engineers, land use planners, and public health professionals to work synergistically to understand both the relationship between urban design and population exposure to traffic pollution, and its social distribution. Researchers have started to pay close attention to this connection, mainly by conducting observational studies on the relationship between transportation, urban form, and air quality. However, research on this topic is still nascent. Further, most studies do not predict exposures under alternative urban design scenarios. Hence, to understand the relationship between urban design and population exposures, there is a need to build and apply integrated modeling tools that can predict exposures under alternative urban design scenarios. Within this context, the overarching goal of this dissertation is to understand how the transportation infrastructure of cities can be designed for improved urban air quality and mitigation of population exposure to traffic pollution. The study area is Hillsborough County, Florida, a sprawling region with limited transit availability and a diverse population along with a mix of urban, suburban, and rural areas. The rank of the county for sprawl and congestion metrics (i.e., yearly delay and travel time index) fall in the mid-range in comparison with other US urban regions. Thus, the study area may be representative of other US urban regions with medium sprawl and above-average congestion levels. Oxides of nitrogen (NOx), a surrogate for traffic pollution, is the focus pollutant. The Health Effects Institute’s report on traffic-related air pollution identifies NOx as a potential surrogate due to its relative ease of measurement and the abundance of epidemiologic studies that characterize exposures to NOx. Because exposures are dependent on the spatial and temporal distributions of both people and pollution, this study first sought to understand the importance of activity and travel patterns of individuals for exposure estimation. To estimate exposures, the 2009 National Household Travel Survey (NHTS) data containing daily individual activity records, ArcGIS-estimated shortest-time travel route profiles, and the annual-average diurnal cycle of NOx derived from hourly CALPUFF dispersion model results from 2002, were combined. Two exposure measures were estimated: activity-based exposure that considers the daily activity and travel patterns of individuals, and residence-based exposure that considers only the pollutant concentrations at the residences. Exposure estimation without inclusion of activity and travel patterns was found to slightly underestimate activity-based exposures on average. Additionally, disproportionately-high exposures were found for blacks, Hispanics, below poverty groups, urban residents, and people whose daily travel time is greater than one hour. Finally, urbanicity and travel time variables were found to be the strongest predictors of daily exposure. Following this, a modeling framework was developed to predict population exposure by integrating activity-based travel demand modeling (DaySim), dynamic traffic assignment simulation (MATSim), mobile-source emission estimation (EPA MOVES), and pollutant dispersion modeling (R LINE). This modeling framework was used to predict daily population and subgroup exposures by estimating the high-resolution spatial and temporal distributions of both pollution and individual activities for the year 2010. Persistent exposure inequalities were found at the population-level; blacks, Hispanics, active age groups (19-65 years), below-poverty and middle-income groups, urban residents, and individuals with daily travel times above one hour had higher estimated exposures than the population mean. These inequalities for blacks, Hispanics, and below-poverty non-white groups worsened at higher exposure levels. Use of low-resolution activity and pollution data as opposed to high-resolution data led to underestimation of exposures (by 10% on average). Finally, the integrated modeling framework was employed to understand the relationship between urban transportation and land use design, air quality, and population exposure. Three scenarios that are based on a combination of diesel-bus transit services and residential distribution were simulated. Specifically, the low-transit scenario used the 2040 base residential distribution and the 2010 bus services. The enhanced-transit scenario applied the 2040 bus services proposed for the county instead. The compact-growth scenario added an increase of residential density to this latter scenario. Specifically, about 37% of total households were redistributed from locations with low accessibility to jobs and transit to locations near employment and bus stops. Results indicate slight higher non-car travel mode shares in the enhanced-transit and compact-growth scenarios compared to the low-transit scenario (with a 7.1% increase for walking, 0.2% for bicycle, and 1.8% for transit for the compact-growth scenario versus the low-transit scenario). The enhanced-transit scenario resulted in slightly lower daily total travel distances and times compared with the low-transit scenario, but daily total emissions and winter mean concentration of NOx were higher, i.e., the increase in bus transit services did not induce sufficient shifts in travel mode to overcome the concomitant increase in diesel-bus emissions. The compact-growth scenario resulted in lower daily total travel distance (9%) and travel time (2.1%) and daily total emissions of NOx (11%) and its winter mean concentration (9%), compared with both the low-transit and enhanced-transit scenarios. Although the compact-growth scenario improved the air quality of the region on average, daily population mean exposure was higher compared with both the low-transit (29%) and enhanced-transit scenarios (25%). This is largely due to the redistribution of population to urban core locations that had higher pollutant levels. Overall, neither the bus-transit improvements nor residential compaction strategies alone were sufficient to mitigate population exposures. Combining them with transit that services both origins and destinations, uses clean fuel technologies, and separates major roadways from dense residential pockets may be needed for greater exposure reductions. Overall, this dissertation has implications for population exposure to traffic pollution and public health through transportation and land use interventions. Results presented here may be applicable to other study regions that have similar composite sprawl scores as the Tampa Bay area. Future studies should exploit spatially-and temporally-resolved data on human activities and travel, vehicular activities, and air quality for better characterization of population exposure. Engineers and planners should pay greater attention to integrated land use and transport planning; lone, disjointed, and ill-planned design interventions may exacerbate population exposure to air pollution. The integrated modeling framework presented here may be applied in a wide variety of urban contexts to further explore the nexus between travel demand, air quality, and exposures. However, before such an exercise is undertaken, a preliminary analysis should be conducted to assess the transferability of the framework. Policies that could be studied include mixed land use design, urban compaction with controlled sociodemographic distributions (to assess exposure inequality), and inclusion of additional types of transit and fuel technologies.

HIV/AIDS continues to challenge prevention, care and treatment efforts and presents an increasingly urgent threat to population health. In the context of prevention, this fatal sexually transmitted infection (STI) underscores the importance of providing youth (the fastest growing risk group) with adequate information, motivation, behavioural skills, and access to resources that support the achievement and maintenance of sexual health across the lifespan. However, youth have proven to be a difficult audience to reach, particularly with educational programs that approach adolescent sexuality from an adult frame of reference, one that often stresses the negative aspects of human sexuality. Yet many of the tasks associated with a successful transition into adulthood and social integration depend upon the ability to initiate and maintain long-term, intimate sexual relationships. Using a case study methodology, this research—which was conducted in British Columbia, Canada—investigated the potential effects of an innovative theatre-based, peer-led HIV prevention/sexuality education program on four groups of high school students and the peer leaders. The potential of theatre-in-education was examined to determine if this format would engage youth audiences—and keep them engaged—and if it would have a positive impact on self-reported confidence in performing risk-reduction behaviours. The results from the four case studies strongly suggest that peer-led theatre presented in conjunction with peer-led discussion has the potential to not only engage youth between 12 and 17, but to also increase self-reported confidence in their ability reduce risk. In two of the cases, engagement was high and constant; while the two other cases demonstrated that the format has a strong potential for drawing more reluctant audiences into discussions over time. In all cases, confidence reportedly increased. Further to this, audiences reported gains in knowledge, improvements in behavioural and communication skills, and increased motivation to use condoms and to access sexual health care. In addition, and perhaps most importantly, there were reports of increased communication about sexual health issues, the development of greater compassion and tolerance, along with the desire to avoid stigmatizing HIV-positive individuals and sexual minorities. The peer leaders reported comparable effects. Given that stigma has been identified as the most persistent barrier to HIV/AIDS prevention, care and treatment, embedding peer-led theatre programs—focused on sexuality and HIV prevention—into currently existing theatre arts curricula within the public school system offers a powerful and cost-effective means of providing comprehensive sexual health education. It would be shrewd (from both a social and economic perspective) for education ministries and school districts to capitalize on the positive aspects of adolescent peer networks and youths’ natural tendency to learn from one another. This research, while based on informed judgment, adequacy and plausibility rather than on the gold standard of a randomized control trial, arguably provides initial evidence that the theatre-in-education format is worthy of implementation on a wider scale. Investing in the set-up, maintenance and rigorous evaluation of peer-led theatre-in-education programs which focus on sexuality has the potential to normalize safer sexual practices and improve population health, for this generation and generations to come.

Women’s mortality rate in the United States has increased in almost every age group in the past several years. However, more women in the United States are choosing yoga as a complementary health approach to improve general well-being. Thus, research on yoga and other factors that affect women’s health in the United States may inform public health initiatives to address the health disparities in women’s mortality rates. Grounded in the health belief model, the purpose of this study was to explore whether the factors of practicing the components of yoga, doctor’s recommendation for increased physical activity, body mass index (BMI) categories, hypertension, high cholesterol, age, and occupation predicted the self-rated health of women. This cross-sectional, secondary analysis of the 2017 National Health Interview Survey included 14,464 female respondents, and ordinal logistic regression analysis was used to examine the data. The results showed that self-reported participation in yoga, breathing as a part of yoga, and meditation as a part of yoga was associated with higher self-rated health. Additionally, participants with healthy weight BMI, teachers, and participants who did not receive recommendations for increased physical activity and did not have hypertension or high cholesterol were more likely to report better self-rated health. Based on the results of this study, public health researchers may continue to explore the effects of yoga on women and how a yoga-based population health intervention could help women in the United States live longer and healthier lives.

The purpose of this project was to design a chronic care plan using the chronic care management (CCM) framework to improve health services at lower healthcare costs. The practice-focused question explored whether the operationalization of the CCM model would impact progress toward the management of chronic illness for the target population of Medicare beneficiaries with 2 or more chronic illnesses in an urban acute care agency located in the western United States. The middle-range theory, logic rational plan model, Lewin’s change theory, and the CCM’s coordination care and collaborative care concepts were used to guide the project. Data were collected from nursing databases and government agencies. Nurses were significant to the CCM reform by supporting the elements for proactive care. Nurse practitioners can bill using the CCM codes, and clinical nurses can performed patient sensitive care. The social changes were patients with chronic illnesses realized a better quality of life at lower health costs.

Introduction: Education of physiotherapists still fails to meet the health and social needs of society. One instrument to steer change in health sciences education is a re-designed curriculum. The overall intent of this study was to develop standards of competencies, teaching and learning strategies, and assessment, for an undergraduate community physiotherapy curriculum in South Africa. The grounding for this research was pragmatism. The Six-step model for curriculum development and the Clinical Prevention and Population Health Curriculum framework guided the research process and main analysis. Methods : A sequential mixed method design was used. First, a two-phase parallel situation analysis was conducted which included a qualitative document analysis of community physiotherapy curricula of the eight physiotherapy university departments in South Africa and a review of health policy documents. The experience of 12 purposively selected physiotherapists who had completed a compulsory community service year was qualitatively explored through interviews within an appreciative inquiry stance. In phase 2, input was gained from physiotherapists, from all ecological levels, on the community physiotherapy curriculum through a Delphi study. Three rounds were used. Round 1 explored the roles of physiotherapy in community health, round 2 quantified consensus in overarching competency domains, and round 3 gathered learning and teaching, and assessment, strategies to gain these competencies. Results : All eight universities had gaps in their community physiotherapy curriculum and were variedly aligned with South African health policies and health profile. Graduates need to be able to provide physiotherapy over the lifespan, to conditions mirroring the quadruple burden of disease, in settings varying from hospitals to homes of clients, with emphasis on health education and promotion within an interprofessional team. They must be prepared for suboptimal practice environments and to utilise the compulsory community service year as a gateway in professional development. Graduates need resilience to cope during the year and awareness about the importance of identifying a mentor in the frequent absence of a profession-specific supervisor. Community physiotherapy needs three core knowledge and skill sets; i.e. clinical physiotherapy, population health and community development. Consensus of 70%+ was gained on competency criteria in the domains of the following professional roles: clinician, professional, communicator and collaborator, scholar, health promoter, public health practitioner, community developer (change agent), and manager/leader. Service-learning was identified as a strategy to develop these roles supported by learning and assessment portfolios. Reflection in different formats – essays, presentations, case analysis, projects such as community wellness programmes, diaries - is a core activity to facilitate learning. A range of complementary strategies were suggested that included direct observation, role-play, and journal clubs. Core to assessment for professional competencies is for the students to be able to give evidence of their own learning (e.g. in a portfolio or oral examination) and to get frequent formative feedback. Conclusion : The physiotherapy profession is important for improving the health status of the South African population. Physiotherapy students should be educated to take on relevant professional roles through the application of appropriate educational standards. The study recommends that the curriculum standards be implemented and evaluated and that the application of complex theory in the further development and implementation of the curriculum be investigated. Lastly, future research in the generic professional domains, such as public health and community development, should be interprofessional in nature. / Thesis (PhD)--University of Pretoria, 2013. / gm2013 / Physiology / Unrestricted

Background: Advances in information technology have paved the way to facilitate accessibility to population-level health data through web-based data query systems (WDQSs). Despite these advances in technology, US state agencies face many challenges related to the dissemination of their local health data. It is essential for the public to have access to high-quality data that are easy to interpret, reliable, and trusted. These challenges have been at the forefront throughout the COVID-19 pandemic. Objective: The purpose of this study is to identify the most significant challenges faced by state agencies, from the perspective of the Behavioral Risk Factor Surveillance System (BRFSS) coordinator from each state, and to assess if the coordinators from states with a WDQS perceive these challenges differently. Methods: We surveyed BRFSS coordinators (N=43) across all 50 US states and the District of Columbia. We surveyed the participants about contextual factors and asked them to rate system aspects and challenges they faced with their health data system on a Likert scale. We used two-sample t tests to compare the means of the ratings by participants from states with and without a WDQS. Results: Overall, 41/43 states (95%) make health data available over the internet, while 65% (28/43) employ a WDQS. States with a WDQS reported greater challenges (P=.01) related to the cost of hardware and software (mean score 3.44/4, 95% CI 3.09-3.78) than states without a WDQS (mean score 2.63/4, 95% CI 2.25-3.00). The system aspect of standardization of vocabulary scored more favorably (P=.01) in states with a WDQS (mean score 3.32/5, 95% CI 2.94-3.69) than in states without a WDQS (mean score 2.85/5, 95% CI 2.47-3.22). Conclusions: Securing of adequate resources and commitment to standardization are vital in the dissemination of local-level health data. Factors such as receiving data in a timely manner, privacy, and political opposition are less significant barriers than anticipated.