Background: Interpersonal communication is inherent in a majority of strategies seeking to engage prescriber and pharmacist health care professionals (HCPs) in the reduction and prevention of prescription drug abuse (PDA). However, research on HCP PDA communication behavioral engagement and factors that influence it is limited. Objectives This study quantitatively examined communication behaviors and trait-level communication metrics, and qualitatively described prescription drug abuse-related communication perceptions and behaviors among primary care prescribers and community pharmacists. Methods: Five focus groups (N = 35) were conducted within the Appalachian Research Network (AppNET), a rural primary care practice-based research network (PBRN) in South Central Appalachia between February and October, 2014. Focus groups were structured around the administration of three previously validated trait-level communication survey instruments, and one instrument developed by the investigators to gauge HCP prescription drug abuse communication engagement and perceived communication importance. Using a grounded theory approach, focus group themes were inductively derived and coded independently by study investigators. Member-checking interviews were conducted to validate derived themes. Results: Respondents' trait-level communication self-perceptions indicated low communication apprehension, high self-perceived communication competence, and average willingness to communicate as compared to instrument specific criteria and norms. Significant variation in HCP communication behavior engagement was noted specific to PDA. Two overarching themes were noted for HCP-patient communication: 1) influencers of HCP communication and prescribing/dispensing behaviors, and 2) communication behaviors. Multiple sub-themes were identified within each theme. Similarities were noted in perceptions and behaviors across both prescribers and pharmacists. Conclusions: Despite the perceived importance of engaging in PDA communication, HCPs reported that prescription drug abuse communication is uncomfortable, variable, multifactorial, and often avoided. The themes that emerged from this analysis support the utility of communication science and health behavior theories to better understand and improve PDA communication behaviors of both prescribers and pharmacists, and thereby improve engagement in PDA prevention and treatment.

Malaria is a major public health problem in under developed countries especially countries undergoing war or conflict due to breakdown of health system and exposure of the vulnerable population through displacement. The knowledge, practice and attitude (KAP) of community members have direct influences on malaria preventive measures. A quantitative, explorative and descriptive study was conducted among rural communities of Mundri East County using interview schedules to ascertain malaria related knowledge, practices and attitude and the common factors hindering the malaria control measures at house hold level. Data were collected from 68 respondents from the randomly selected household through personal interviews using a pre-tested interview schedule which was analysed using the SPSS version 15 computer soft ware program. Most of the respondents demonstrated some understanding of malaria as a disease, its transmission, prevention and treatment, although there is a need to improve this through the preferable and acceptable community channels as well as the methods of accessing the modern and scientifically proved and acceptable methods. Given the relatively moderate acceptability of malaria control measures used by the participants in Mundri East County, there is need to conduct further research on the practical implemented measure including the local herbs used for preventive and treatment of malaria Understanding the factors that inhibits or promotes the malaria control measures at community level is necessary for better planning and implementation of malaria intervention programme, which keeps complex and sensitive matters such as educational background, religious and cultural beliefs, and political affiliations in mind. / Health Studies / M.A. (Public Health)

Background: Rates of accidental overdose mortality from substance use disorder (SUD) have risen dramatically in the United States since 1990. Between 1999 and 2004 alone rates increased 62% nationwide, with rural overdose mortality increasing at a rate 3 times that seen in urban populations. Cultural differences between rural and urban populations (e.g., educational attainment, unemployment rates, social characteristics, etc.) affect the nature of SUD, leading to disparate risk of overdose across these communities. Methods: Multiple-groups latent class analysis with covariates was applied to data from the 2011 and 2012 National Survey on Drug Use and Health (n=12.140) to examine potential differences in latent classifications of SUD between rural and urban adult (aged 18 years and older) populations. Nine drug categories were used to identify latent classes of SUD defined by probability of diagnosis within these categories. Once the class structures were established for rural and urban samples, posterior membership probabilities were entered into a multinomial regression analysis of socio-demographic predictors' association with the likelihood of SUD latent class membership. Results: Latent class structures differed across the sub-groups, with the rural sample fitting a 3-class structure (Bootstrap Likelihood Ratio Test P value=0.03) and the urban fitting a 6-class model (Bootstrap Likelihood Ratio Test P valueThis result supports the hypothesis that different underlying elements exist in the two populations that affect SUD patterns, and thus can inform the development of surveillance instruments, clinical services, and prevention programming tailored to specific communities.

This study compared perceptions of prescribers and pharmacists (N = 89) regarding multiple aspects of prescription drug abuse. Questionnaires were developed to assess perceptions regarding the prevalence of prescription drug abuse, self-perceived communication competence, and additional communication and prescription drug abuse domains. Pharmacists perceived a larger percentage of patients (41%) to be abusing opioid pain relievers as compared with their prescriber colleagues (17%). Both prescribers and pharmacists indicated improvements in prescriber–pharmacist communication would serve to deter prescription drug abuse. Self-efficacy beliefs for detecting and discussing prescription drug abuse with patients were low for both cohorts. Implications and limitations are noted.

Malaria is a major public health problem in under developed countries especially countries undergoing war or conflict due to breakdown of health system and exposure of the vulnerable population through displacement. The knowledge, practice and attitude (KAP) of community members have direct influences on malaria preventive measures. A quantitative, explorative and descriptive study was conducted among rural communities of Mundri East County using interview schedules to ascertain malaria related knowledge, practices and attitude and the common factors hindering the malaria control measures at house hold level. Data were collected from 68 respondents from the randomly selected household through personal interviews using a pre-tested interview schedule which was analysed using the SPSS version 15 computer soft ware program. Most of the respondents demonstrated some understanding of malaria as a disease, its transmission, prevention and treatment, although there is a need to improve this through the preferable and acceptable community channels as well as the methods of accessing the modern and scientifically proved and acceptable methods. Given the relatively moderate acceptability of malaria control measures used by the participants in Mundri East County, there is need to conduct further research on the practical implemented measure including the local herbs used for preventive and treatment of malaria Understanding the factors that inhibits or promotes the malaria control measures at community level is necessary for better planning and implementation of malaria intervention programme, which keeps complex and sensitive matters such as educational background, religious and cultural beliefs, and political affiliations in mind. / Health Studies / M.A. (Public Health)

Background: Community pharmacists are legally required to evaluate and confirm the legitimacy of prescription opioids (POs) prior to dispensing. Yet, previous research has indicated community pharmacists perceive nearly 50% of dispensed POs to be issued lacking a legitimate medical purpose. Objective: To analyze correlates of PO legitimacy judgments across pharmacist and pharmacy setting characteristics. Methods: A cross-sectional study of 2000 Tennessee pharmacists was conducted during October and November of 2012. Community pharmacists' self-reported attitudes, beliefs, and behaviors specific to PO legitimacy were elicited. Step-wise multinomial logistic regression techniques were used to model correlates of PO legitimacy across low, moderate and high PO legitimacy estimations. Results: Being female, practicing in a chain or independent practice setting, fear of employer disciplinary action if PO legitimacy is questioned, and self-confidence in one's ability to detect PO abuse increased the odds of low (vs. high) PO legitimacy estimation (p < 0.05). Employment in chain and independent pharmacies, having POs as a greater percent of total prescriptions filled, and having the perception of PO abuse as a problem in the practice setting were significant positive correlates of moderate (vs high) PO legitimacy estimation (p < 0.05). Conclusions: Both modifiable and non-modifiable correlates were statistically significantly associated with PO legitimacy judgments. Distinct correlates were noted across low and moderate as compared to high estimations of PO legitimacy. Legitimacy judgments can inform theoretical exploration of PO dispensing behaviors and inform intervention development targeted at reducing and preventing prescription drug abuse.

Background: Community pharmacists are a key intervention point in efforts to prevent and mitigate the impact of prescription drug abuse and misuse (PDA/M); yet pharmacists' perceptions regarding PDA/M have been explored only briefly in the literature. Objectives: 1) To explore Tennessee community pharmacists' perceptions regarding opioid pain reliever (OPR) prescribing, dispensing and abuse; 2) to explore community pharmacists' self-efficacy beliefs regarding PDA/M-specific communication; and 3) to evaluate perceived barriers to engaging patients in PDA/M-specific communication. Methods: A 55-item survey instrument was developed using the Theory of Planned Behavior (TpB) as a theoretical framework. Questionnaires were mailed to a stratified sample of 2000 licensed Tennessee pharmacists using the Tailored Design Method of survey administration during October and November, 2012. Results: A response rate of 40% was obtained. A majority of pharmacists (87.5%) perceived OPR abuse to be a problem in their practice settings. On average, a little more than half (53%) of prescriptions issued for OPRs were estimated to be for patients with one or more legitimate medical reasons justifying the medication(s). A small fraction of pharmacists (13%) reported having addiction treatment facility information in their practice settings, and only a small percent reported strong self-efficacy beliefs regarding PDA/M patient communication. Job-related time constraints were perceived as the primary barrier to engaging in PDA/M communication. Conclusions: Community pharmacists in Tennessee are aware of PDA/M by patients receiving opioid prescriptions and value their role in communicating with these patients but indicate their ability to do so effectively is hindered by a lack of confidence, training, and time. Further research to identify and test methods for facilitating PDA/M communication by pharmacists is indicated.

The phenomenon of social isolation among school children in most instances goes unnoticed by both teachers and parents and this oversight could have serious negative restraints on the socially isolated child's cognitive, affective, moral, personality and social development. Social isolation can be caused either through being rejected or neglected by the peer group. This study was carried out among primary and secondary school learners to detei:,mine the extent to which these children are socially isolated; and to identify factors contributing to learners' social isolation. The aim of the study is to provide teachers and parents with a foundation and rationale for effective intervention. A literature study was done to identify the factors influencing social isolation. Some of the factors identified were: social competence, self-esteem, psychological well-being, intelligence, academic achievement, moral values, physical disability, sports participation, self-perceived physical attractiveness, self-perceived physical disability, marital status of parents, parental supervision, parental acceptance, parental autonomy granting and parental conflict. All aspects of development (namely, physical, cognitive, affective, personality, moral and social) were studied in relation to the phenomenon of social isolation. By means of an empirical investigation, it was found after a regression analysis that self-esteem, obedience and social competence accounted for most of the variance in social isolation for primary school learners and in the case of secondary school learners, social competence, family supervision and self-esteem. The two most common factors were social competence and selfesteem. From the empirical findings it was also noted that learners' home language and grade were also associated with social isolation. The educational implications of the findings of the literature and the empirical study are discussed and guidelines given to assist teachers and parents to identify and eliminate the factors contributing to the development of isolation among school learners. If both parents and teachers take cognisance of these recommendations and try to implement them, it should help children in their self-actualisation and facilitate their attainment of adulthood with the least developmental restraints. / Psychology of Education / D. Ed. (Psychology of Education)

Thesis (MBA (Business Management))--Stellenbosch University, 2008. / The government has identified the need to transform the South African economy from one that is primarily resource based to one that is knowledge-based and has formulated a 10 year plan in order to accomplish this objective. The plan involves the creation and funding of five theme-specific consortium-based centres of competence that focus on the five top national health priorities, linked to the growth of the local pharmaceutical industry. This research study proposed that if collaboration and communication between academic researchers and the biotechnology industry in South Africa was improved it would lead to an increase in the development of innovative products for HIV/AIDS prevention and treatment. The objective of the study was the development of a strategy for a centre of competence for HIV research and development that brings together academic researchers and industry in a public private partnership and that will enable the proposal to be tested. Centre of competence programmes in both developed and developing countries, including Sweden, Austria and Estonia, were reviewed. The success factors for the various programmes were discussed. The strategic planning analysis began by considering the mandate of the CoC for HIV R&D. The requirements and expectations of the DST in establishment of the centres of competence were examined. An analysis of the external environment relevant to the South African biotechnology industry was then performed. This involved a detailed macro-environmental analysis in which political, economic, social, technological and environmental factors were considered. It was followed by an analysis of the current biotechnology industry in South Africa. The industry’s dominant economic features were identified as were its future driving forces. In a competitive environment analysis the South African biotechnology industry was found to be extremely competitive. Two industry issues, price controls and access to capital, were identified and discussed. The industry key success factors identified included access to large and sustained capital, attracting and retaining talented employees, an efficient and high quality regulatory authority, continued government support, productive and appropriate partnerships and skilled intellectual property management. An internal environment analysis was performed which identified competencies and resource strengths of the CoC for HIV R&D, including the high level of academic research in the HIV/AIDS field and expertise in clinical trials of HIV/AIDS products. Competitive deficiencies and resource weaknesses identified included shortages of skills and talent and the lack of co-ordination for funding of HIV/AIDS research. The analysis of the internal environment continued with the examination of the internal value chain of the CoC for HIV R&D. This consisted of discovery, pre-clinical development and clinical development stages. Gaps in the value chain were identified, including the lack of facilities for high-throughput screening of compounds for anti-HIV activity, lack of pre-clinical testing facilities and lack of manufacturing plants capable of producing products for use in clinical trials. The results of the external and internal environment analysis were used in a SWOC analysis and a number of strategies were identified to capitalise on opportunities and to address challenges. A subsequent competitive strength assessment identified a competitive advantage in the formation of the CoC for HIV R&D. In addition a number of strategic issues facing the centre were identified and ways to address or manage the issues were proposed. The strategic planning process was completed by the selection of a strategic approach for the CoC for HIV R&D. The study concluded that a PPP of public and private organisations operating under a corporate strategy of related diversification developed and implemented by the CoC for HIV R&D, would be suitable for testing the Proposal. The study’s conclusion also highlighted the need to ensure that the CoC for HIV R&D receives a long term commitment of funding from public sources, and that is managed by an experienced team with strong leadership skills. Important strategies emerging from the study and specifically from the SWOC analysis were development of a national HIV research plan and funding of the highest priority projects; focusing research funding on research with greatest potential for generation of HIV/AIDS products; and establishment of new technology platforms to fill gaps in the value chain. Finally, a number of recommendations were made for implementation of the results of this study or as the basis for further study.

The phenomenon of social isolation among school children in most instances goes unnoticed by both teachers and parents and this oversight could have serious negative restraints on the socially isolated child's cognitive, affective, moral, personality and social development. Social isolation can be caused either through being rejected or neglected by the peer group. This study was carried out among primary and secondary school learners to detei:,mine the extent to which these children are socially isolated; and to identify factors contributing to learners' social isolation. The aim of the study is to provide teachers and parents with a foundation and rationale for effective intervention. A literature study was done to identify the factors influencing social isolation. Some of the factors identified were: social competence, self-esteem, psychological well-being, intelligence, academic achievement, moral values, physical disability, sports participation, self-perceived physical attractiveness, self-perceived physical disability, marital status of parents, parental supervision, parental acceptance, parental autonomy granting and parental conflict. All aspects of development (namely, physical, cognitive, affective, personality, moral and social) were studied in relation to the phenomenon of social isolation. By means of an empirical investigation, it was found after a regression analysis that self-esteem, obedience and social competence accounted for most of the variance in social isolation for primary school learners and in the case of secondary school learners, social competence, family supervision and self-esteem. The two most common factors were social competence and selfesteem. From the empirical findings it was also noted that learners' home language and grade were also associated with social isolation. The educational implications of the findings of the literature and the empirical study are discussed and guidelines given to assist teachers and parents to identify and eliminate the factors contributing to the development of isolation among school learners. If both parents and teachers take cognisance of these recommendations and try to implement them, it should help children in their self-actualisation and facilitate their attainment of adulthood with the least developmental restraints. / Psychology of Education / D. Ed. (Psychology of Education)