There is a dearth of validated self-efficacy (SE) measures in the field of preventive oncology. The objective of this study is to describe the development and validation of a measure to assess patients' perceived ability to obtain the recommended care following an abnormality suspicious for breast cancer. Guided by a social cognitive theory framework, a 51-item measure was developed to explore perceived capability to obtain follow up care under a number of barriers. A multi-step process was utilized to assess the instrument's psychometric properties. First, cognitive validity assessments with experts were conducted, and these aided in the wording refinement of several items. An exploratory factor analysis was performed, and a 4-factor solution emerged containing factors related to barriers to care such as costs, transportation, structural and communication barriers. Reliability analyses were conducted for the total scale and subscales. Then, relationships between theoretically-related constructs were explored to assess convergent validity (self-efficacy and outcome expectations, perceived control), and divergent validity (self-efficacy and depression). Findings provide evidence of both convergent and discriminant validity. This multi-step process aided in the reduction of the scale to 12 validated and reliable items.

Ghana, a low-income developing country in sub-Saharan Africa is experiencing low maternal health service utilization and high rates of maternal mortality, especially in the rural areas. The Talensi-Nabdam District is one of the poorest and most remote districts in Ghana. The reproductive health status of women in the most remote communities in this District is poor. Dialogue about women’s reproductive health care needs in Ghana have been influenced by health care authorities, professionals, researchers and experts’ perceptions. The purpose of this ethnographic research was to explore rural Ghanaian women’s experiences of seeking reproductive health care from their own perspectives. The study was based on data collected from participant observations, unstructured face-to-face interviews and focus group discussions. A total of 27 women of varying socio-demographic backgrounds participated in the study. Interviews were conducted at locations of the women’s choice and in women’s local dialect. Data were translated and transcribed verbatim, and analyzed thematically. Four major themes emerged from the findings: submitting to the voices of family, women’s experiences of receiving nursing care, the community of gossip, and gaining voice. The findings of this study have implications for nursing practice, education and nursing inquiry. Awareness of barriers that rural women encounter in meeting their reproductive health care needs among health care providers is important in facilitating positive health care seeking behaviours. Nurse educators should orient themselves to the challenges to meeting women’s health care needs, and include in culturally sensitive approaches in nursing education programs. Further research is needed to investigate strategies that will enhance women’s reproductive health care seeking behaviours in rural settings and to focus on women’s perspectives in particular. In addition, research is needed to examine nurses’ perspectives on factors that influence quality care delivery to address women’s reproductive health issues.

Ghana, a low-income developing country in sub-Saharan Africa is experiencing low maternal health service utilization and high rates of maternal mortality, especially in the rural areas. The Talensi-Nabdam District is one of the poorest and most remote districts in Ghana. The reproductive health status of women in the most remote communities in this District is poor. Dialogue about women’s reproductive health care needs in Ghana have been influenced by health care authorities, professionals, researchers and experts’ perceptions. The purpose of this ethnographic research was to explore rural Ghanaian women’s experiences of seeking reproductive health care from their own perspectives. The study was based on data collected from participant observations, unstructured face-to-face interviews and focus group discussions. A total of 27 women of varying socio-demographic backgrounds participated in the study. Interviews were conducted at locations of the women’s choice and in women’s local dialect. Data were translated and transcribed verbatim, and analyzed thematically. Four major themes emerged from the findings: submitting to the voices of family, women’s experiences of receiving nursing care, the community of gossip, and gaining voice. The findings of this study have implications for nursing practice, education and nursing inquiry. Awareness of barriers that rural women encounter in meeting their reproductive health care needs among health care providers is important in facilitating positive health care seeking behaviours. Nurse educators should orient themselves to the challenges to meeting women’s health care needs, and include in culturally sensitive approaches in nursing education programs. Further research is needed to investigate strategies that will enhance women’s reproductive health care seeking behaviours in rural settings and to focus on women’s perspectives in particular. In addition, research is needed to examine nurses’ perspectives on factors that influence quality care delivery to address women’s reproductive health issues. / Health and Social Development, Faculty of (Okanagan) / Nursing, School of (Okanagan) / Graduate

Les traitements antirétroviraux (TARV) sont proposés à large échelle en Afrique sub-Sahariennedepuis plus de dix ans, au départ destinés à contrôler la morbidité sévère des personnes à un stade avancé del’infection à VIH. Les recommandations pour initier les TARV ont ensuite évolué à mesure que les étudescliniques et épidémiologiques mettaient en évidence les bénéfices thérapeutiques et préventifs d’une initiationprécoce des TARV. Des essais randomisés sont actuellement en cours en Afrique australe pour vérifier lesbénéfices d’une approche universelle de dépistage et de traitement à des stades précoces de l’infection à VIH(approche « Test and Treat ») sur l’incidence du VIH en communauté. Cependant, la couverture antirétroviraleest encore loin d’être optimale au sud du Sahara, notamment en Afrique du Sud où 6,3 millions de personnesvivent avec le VIH. L’objectif de cette thèse est de comprendre quelles sont les barrières à l’initiation des TARVen nous intéressant à une zone rurale fortement touchée par le VIH au sein de la province sud-africaine duKwaZulu-Natal. Après avoir brièvement décrit le suivi des patients de l’entrée dans un large programme desoins VIH jusqu’à l’initiation des TARV, nous avons mesuré l’évolution des taux d’initiation des TARV suite àl’expansion des critères d’éligibilité dans ce programme. Nous avons ensuite identifié certaines barrières àl’initiation des TARV en croisant les données du programme de soins VIH à celles recueillies au sein d’unesurveillance démographique. Les résultats de cette thèse permettent de mieux appréhender les questionsrelatives à l’accès aux TARV qui pourraient se poser avec une approche « Test and Treat ». / Antiretroviral treatments (ART) have been available in sub-Saharan Africa for more than ten years.Their use was initially targeted with the strict aim to control severe morbidity in individuals with an advancedHIV disease. International guidelines for initiating ART have subsequently evolved as clinical andepidemiological studies highlighted the therapeutic and preventive benefits of early ART initiation. Randomizedtrials are currently underway in several southern African countries to measure the benefits of the universal“Test and Treat” approach on HIV incidence in a community. However, ART coverage is still far from optimal insub-Saharan Africa, especially in South Africa where 6.3 millions of individuals are living with HIV. We thusaimed to better understand what are the barriers to ART initiation by focusing on a rural area heavily affectedby HIV in the province of KwaZulu-Natal, South Africa. We first briefly described the journey HIV-infectedindividuals embark on, from entry into a large HIV treatment and care programme to ART initiation. Then wemeasured the temporal evolutions of ART initiation rates according to the changes of clinical guidelines. Wefinally identified some barriers to ART initiation linking data from the HIV care programme with those from ademographic surveillance system. The results of this thesis will help to better understand the issues relative toaccess to ART that might arise with the universal “Test and Treat” approach, especially in South Africa.

Background: Viral hepatitis C (HCV) represents a major public health problem worldwide and also in the Czech Republic. There are as many as 80,000 people have been living with chronic HCV in Czechia since 2015, most of them are/were drug addicts who have been infected by contaminated syringes. Global and national efforts to eliminate HCV are currently underway, focusing primarily on improving the quality of treatment continuity (sustainability, uninterrupted treatment) which involves ensuring the availability of testing for all patients, patients' involvement in their own treatment, sustaining treatment, achieving a response rate and the necessary follow-up care. Objective: To describe the HCV continuum of care in people who inject drugs (mapping testing rate, treatment uptake and treatment completion), and to describe the factors that affect this process. Based on the collected data, to formulate recommendations for addiction care professionals in order to improve HCV continuum of care. Methodology: A questionnaire survey among clients of low-threshold centres in Prague was carried out. The convenient sample consisted of a total of 60 respondents, 20 from each of the three centres. Data were analyzed using descriptive statistics. Data collection was realised in August 2019. Results: Out of the 60...

Purpose: The Veteran's Health Administration (VHA) has created a training program for interdisciplinary teams of providers on the unique treatment needs of transgender veterans. An overview of this program's structure and content is described along with an evaluation of each session and the program overall. Methods: A specialty care team delivered 14 didactic courses supplemented with case consultation twice per month over the course of 7 months through video teleconferencing to 16 teams of learners. Each team, consisting of at least one mental health provider (e.g., social worker, psychologist, or psychiatrist) and one medical provider (e.g., physician, nurse, physician assistant, advanced practice nurse, or pharmacist), received training and consultation on transgender veteran care. Results: In the first three waves of learners, 111 providers across a variety of disciplines attended the sessions and received training. Didactic topics included hormone therapy initiation and adjustments, primary care issues, advocacy within the system, and psychotherapy issues. Responses were provided to 39 veteran-specific consult questions to augment learning. Learners reported an increase in knowledge plus an increase in team cohesion and functioning. As a result, learners anticipated treating more transgender veterans in the future. Conclusion: VHA providers are learning about the unique healthcare needs of transgender veterans and benefitting from the training opportunity offered through the Transgender Specialty Care Access Network-Extension of Community Healthcare Outcomes program. The success of this program in training interdisciplinary teams of providers suggests that it might serve as a model for other large healthcare systems. In addition, it provides a path forward for individual learners (both within VHA and in the community) who wish to increase their knowledge.

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Background: Patient experience is a crucial measure of patient-centeredness and quality care delivery. Digital health may contribute to patient experience by offering tailored and accessible avenues of care. Purpose: I explored how access to digital health, including telehealth, electronic health records, and online booking, may be associated with improved primary care experience for Ontario adults. Methods: This cross-sectional study included Ontario adults (16 years or older) who responded to waves 27 to 29 of the Health Care Experience Survey (HCES) between May 2019 and February 2020. Adults who did not see their primary care provider within the past 12 months or did not have a primary care provider were excluded. Outcomes included a summed patient experience score derived from five HCES experience-related questions and time to appointment for a health concern. Associations between outcomes and digital health interventions were tested through chi-square tests and logistic regression while adjusting for confounders and stratifying by health care utilization. Results: 3,700 participants met the inclusion criteria, where 2204 remotely communicated with their primary care provider (59.6%), 98 digitally accessed health records (2.6%), and 120 booked an appointment online (3.2%). We observed no significant associations between digital health tools and patient experience or time to appointments through chi-square tests. Participants with over three primary care visits in the past year who accessed online booking were 84% less likely to report poorer experience scores than participants without online booking access [Adjusted OR 0.16, 95% CI 0.02 – 0.56, p < 0.05]. Participants with three or fewer primary care encounters who accessed online booking, compared to the same reference group, were 72% less likely to report having a same or next day appointment with their primary care provider [Adjusted OR 0.25, 95% CI 0.08 – 0.64, p < 0.01]. Significant associations were observed between other sociodemographic factors and patient experience and access to care outcomes. Interpretation: The associations between digital health access and patient experience and access to care were inconsistent across different analyses. Despite experimental studies observing the benefits of digital health adoption in primary care, the effect is unclear in the real-world context. Furthermore, drawing conclusions on the relationship between digital health and quality care outcomes was limited due to the lack of adoption of digital health before the COVID-19 pandemic. As digital health adoption grows, future research should utilize the availability of further data to evaluate the effectiveness of digital health in Ontario primary care. / Thesis / Master of Science (MSc) / Patient outcomes such as experience and timeliness of care are frequently viewed as aims of quality health care. Although past studies indicate digital health supports quality care, the real-world effectiveness of digital health is underexplored in Ontario. This thesis aimed to explore relationships between real-world use of digital health in Ontario and primary care experience and access using survey data. This study found very few survey respondents used digital health before the COVID-19 pandemic. The primary care experience and access to care of adults who did use digital health did not differ very much from adults who did not use the technology. Some outcomes differed in adults who booked their primary care appointment online compared to those who did not; however, the study could not conclude on the relationship. Other personal factors such as age and residence area impacted the quality of primary care. This study was limited due to the lack of digital health users. Future studies should explore digital health's impact on patient outcomes beyond the pandemic.

No description available.