Les médecins généralistes libéraux sont inégalement répartis en France depuis longtemps. Ces inégalités se renforcent au détriment d’espaces moins attractifs. Des zones avec des difficultés d’accès aux soins, urbaines et rurales, apparaissent ou s’étendent. Depuis 2008, les pouvoirs publics accompagnent financièrement les maisons de santé pluriprofessionnelles en espérant qu’elles attirent et maintiennent des médecins dans ces espaces.Cette recherche étudie dans quelle mesure l’espace et le territoire participent à l’implantation de MSP, et en retour quels sont les effets de ces structures sur les espaces et territoires concernés. L’implantation des MSP et leurs effets seront étudiées à différentes échelles géographiques à partir d’approches quantitative et qualitative. Au plan quantitatif, l’analyse spatiale des MSP utilise plusieurs outils (typologies et SIG). Ceci est complété par plusieurs terrains dans lesquels il s’agit d’étudier la place des MSP dans des régions et territoires donnés, en recueillant les témoignages des principaux acteurs concernés. Les effets des MSP sur l’offre de soins sont étudiés sur le territoire métropolitain selon une approche nationale comparant l’évolution de la densité de généralistes libéraux dans des espaces avec MSP comparativement à des espaces « similaires » sans MSP. La conduite de terrains dans deux régions vient compléter et discuter les résultats.Mots clés : espace défavorisé, espace fragile, espace rural, évaluation de politiques publiques, géographie de la santé, maisons de santé pluriprofessionnelles (MSP), soins de premiers recours, médecins généralistes libéraux. / France faces an old and persistent problem, which is geographical imbalance of general practitioners. This uneven distribution grows at a steady pace due to less attractive areas. New urban and rural areas are emerging with limited access to primary health care, while existing ones grow even bigger. Since 2008, the liberal primary care team (PCT) are financially supported by the public authorities. They hope this structure will attract and retain general practitioner in the aforementioned areas.This study aims to explore how the space and the territory contribute to the localisation of PCT and how these structures affect spaces and territories. Localisation and impact of PCT are studied at different level, using quantitative and qualitative approaches. Spatial analysis of PCT is based on several tools such as SIG and typology in synergy with field investigation in two French regions. Effects of PCT on general practitioner density are studied on a national scale comparing the evolution of this density in space with PCT and similar space without PCT. The results are completed with field investigation.

This project was an assessment of elderly health care needs and access. Three urban San Bernardino communities in zip codes 92405, 92410, and 92411 were targeted. The assessment was structured according to King's theoretical construction of community as a multilevel interaction between personal, interpersonal and social systems. The components of the assessment included digital photographs, web-based internet assessments, key informant interviews, and community business visits.

No description available.

Underserved youth (e.g., from families facing inadequate housing, food insecurity, financial instability) are disproportionately exposed to traumatic experiences (e.g., family discord or violence, neglect, poverty, racism), which can lead to several negative life-long consequences (e.g., affective and somatic disturbances, anxiety, depression, suicidal ideation). Community organizations that target underserved youth may be ideally situated to offset the negative consequences of trauma through leveraging a trauma-sensitive sport model for youth programming. A trauma-sensitive sport model involves a blend of positive youth development approaches (i.e., creating safe environments for youth to experience positive relationships, autonomy, and opportunities to build skills), trauma-sensitive approaches (e.g., considering the potential effects of trauma on youth’s participation and development, and prioritising their needs for safety, voice, empowerment, choice, and collaboration), and program designs that leverage and re-design sporting activities to help youth navigate trauma symptoms, build a social support system, and develop various resilience-related skills (e.g., emotional regulation, decision-making). Little research has examined the implementation and effectiveness of a trauma-sensitive sport model for youth programming in a community setting. Use of this model can contribute to greater capacities of youth sport leaders to promote underserved youth’s healthy participation and development. This dissertation was conducted in partnership with BGC Canada, a national non-profit community organization that serves disadvantaged communities. From 2016-2021, a trauma-sensitive sport model for youth programming was implemented in this organization through the Bounce Back League (BBL) initiative. The purpose of this dissertation was to explore the knowledge-to-action processes involved in translating this model in a community program setting. The knowledge-to-action cycle (KTAC; Graham et al., 2006) was used to conceptually guide the studies carried out in this dissertation, in outlining key phases for consideration in translating a trauma-sensitive sport model. While most of these phases are described in this dissertation, the empirical articles focused on assessing four phases of this cycle, which included: (a) assess barriers and facilitators to knowledge use, (b) select, tailor, and implement interventions, (c) monitor knowledge use, and (d) evaluate outcomes. Intrinsic case study methodologies were used to understand community-based knowledge translation processes and outcomes within the case of the BBL initiative. A community-based participatory research approach was used to engage in equitable collaboration between researchers and community members for the development of this initiative. Utilisation-focused evaluation principles were used to work with community members to determine what to evaluate, how to evaluate, and how results would be used. Grounded in a pragmatic paradigm, a mixed methods research design was used to collect data through the initiative, which included individual and group interviews with leaders, leader-reported logbooks, leaders self-reported questionnaires, leaders' assessments of youth's participation, communications on an online messaging platform (Slack), and researchers' observations of training opportunities and leaders' practices. The purpose of Article 1 was to outline the overarching process of integrating a trauma-sensitive sport model within the BBL program, from 2016-2021. Several stages of program development were described, including: (a) collaboratively planning the program; (b) piloting the program to three clubs; (c) adapting the program using pilot insights; (d) expanding the adapted program to ten clubs; and (e) creating opportunities to maintain, sustain, and scale-out practices throughout grant duration and beyond. Lessons learned regarding the leadership team’s experiences in terms of developing, adapting, and integrating a trauma-sensitive sport model for youth programming in this community context were shared. The purpose of Article 2 was to explore factors involved in the implementation of a trauma-sensitive sport model for youth programming in BBL. This article paralleled the KTAC phase of assess barriers and facilitators to knowledge use. A mixed-methods evaluation of the pilot phase of BBL was conducted. Three clubs participated in training, implementation, and evaluation of BBL. The data were collected through interviews, logbooks, and assessments. The quantitative data were interpreted using descriptive statistics and comparative t-tests; the qualitative data were interpreted using thematic and content analyses. The RE-AIM framework was used to categorise the various processes and outcomes involved in program implementation. The results showed that programs reached a large number of youth but struggled to retain youth from season to season. The leaders perceived that the intentional structure of the program, opportunities to practice self-regulation, relationship focus, and life skill focus, were all linked to positive participation in youth members. Components of leaders' training and program delivery were noted as successful, but the sustained benefits of these successes were challenged by leader turnover and funding limitations. In line with the KTAC phases, insights were generated on what works and what does not in facilitating this type of programming in a community setting for underserved youth and helped inform future adaptations to the program as it was rolled out (discussed in Article 1). The purpose of Article 3 was to explore leaders' learning experiences from participating in an initial training workshop and prior to their implementation of programming. This article paralleled the select, tailor, and implement interventions phase and the evaluate outcomes phase of the KTAC model. The value-creation framework was used to explore learning experiences based on the interactions and values that leaders discussed. Participants were leaders who attended initial training workshops. A mixed-methods approach was used to collect data through observations, interviews, and self-reported questionnaires. The quantitative data were interpreted using descriptive statistics and Wilcoxon Signed-Ranks Tests; the qualitative data were interpreted using thematic analysis. The results showed that the leaders: (a) valued having a variety of learning opportunities that were relevant to their roles and contexts, (b) appreciated the diverse focus on foundational and practical content, and (c) shared an interest to learn how to support trauma-exposed youth and facilitate better programming. Implications were discussed for the improvement of training opportunities to better meet leaders' needs within a community organization and support leaders' intentions to apply knowledge into action. Article 4 builds on the previous study, where the purpose was to explore leaders' learning experiences as they implemented programming and while they participated in continuing training and development activities. This article also paralleled the select, tailor, and implement interventions phase and the evaluate outcomes phase of the KTAC model. The participants were leaders who were involved in implementing BBL at their clubs. A mixed-methods approach was used to collect data through interviews, observations, surveys, and communications on an online messaging platform (Slack). The quantitative data were analysed using descriptive statistics, data charting, and non-parametric analyses; the qualitative data were interpreted using thematic analysis. The results indicated that the leaders learned through various interactions throughout their practice (e.g., implementing programs at their homes sites, receiving mentoring, conversations with peers), and discussed gains in applied value (e.g., program facilitation strategies, youth-support skills), realised value (e.g., youth's receptivity and behaviour change), and transformative value (e.g., transfer of leaders' skills, influence on club culture). Implications were discussed for the improvement of training opportunities to promote ongoing social learning and maintenance of program practices. The purpose of Article 5 was to explore the fidelity and quality of leaders' application of a trauma-sensitive sport model to programming. This article paralleled the monitor knowledge use phase of the KTAC model. The promising practices criteria were used as an evaluation framework to categorise dimensions of quality relevant to program effectiveness. Leaders from 11 BBL programs participated. A mixed-methods approach was used to collect data through observations, interviews, and logbooks. The quantitative data were interpreted using descriptive statistics; the qualitative data were interpreted using thematic analysis. The results showed that: (a) all programs showed evidence of supportive adult and youth relationships, (b) programs led by trained leaders maintained program fidelity and implemented more features to a stronger extent than untrained leaders, (c) trained leaders may have compromised mastery orientation opportunities in favour of other program components. Implications were discussed related to what may facilitate or constrain program fidelity and quality in this setting, and how training and development opportunities can mitigate challenges in leaders' capacities. This dissertation offered an evaluation of the knowledge-to-action processes involved in integrating a trauma-sensitive sport model into BGC Canada. The results of this dissertation provided insights of how BGC Canada leaders learned and facilitated a trauma-sensitive sport model for youth programming, the differences training and development may contribute to the quality of their program practices, and how involvement in this initiative resulted in changes in leaders' behaviours, skills, and identities, as well as positive youth developmental outcomes. Practical implications were shared on how BGC Canada and similar community organizations can enhance their partnership and facilitate these interventions. As well, the value of taking a systems-based approach to planning future interventions with a trauma-sensitive sport model was also discussed to maximise multi-level impacts. Academic implications were shared on how future research can also take a systems-based approach to evaluating knowledge translation processes in youth sport interventions.

No description available.

The prevalence of Hepatitis C Virus (HCV) in the US is estimated at 3.5 million with 18,153 deaths in 2016. It is the most common bloodborne infection, with a higher age-adjusted mortality rate than Hepatitis B Virus or Human Immunodeficiency Virus. Without treatment, nearly 1.1 million people will die from HCV by 2060. About 41,200 new cases of HCV were reported in 41 states in the US in 2016. The reported cases of acute HCV in 2016 is 2.3 per 100,000 in Tennessee, which is more than twice the national goal set by Healthy People 2020. This is a descriptive study to ascertain the HCV prevalence and usefulness of screening in medical outreach settings (MO) compared to indigent healthcare clinics (IHC) in northeast Tennessee. This study period was from April 2017 – February 2019. Participants (n=250), were adults, who engaged in routine, opt-out HCV testing at 4 IHC and 3 MO sites in the Tri-Cities, TN region. During the screening, demographic information- age, gender, race- were collected and the de-identified data were analyzed using Statistical Analysis System (SAS 9.3) to perform a descriptive analysis. Also, several discrete Chi-Square tests of independence between the demographic variables, screening locations, and HCV antibody prevalence was conducted. A total of 250 clients were screened for HCV. The majority of clients screened were non-Hispanic whites 228 (91.20%); females 136 (54.40%); young adults 131 (52.40%) and at IHC clinics 187 (74.80%). Screening showed HCV antibody prevalence of 14.8%. The majority of positive cases were non-Hispanic whites 36 (97.30%; P=0.1561); females 19 (51.35%; P=0.6867) and young adults 23 (62.16%; P=0.286). The prevalence at the IHC clinics and MO settings were 36 (97.30%; P=0.0006) and 1(2.70%) respectively. This analysis shows the higher yield of targeted HCV screening at IHC clinics. Focused HCV screening is critical in the era of opioid epidemic, particularly when direct-acting antiviral agents (DAAs) which offer a Sustained Virologic Response (SVR) rate of more than 90% are available. The use of case control or cohort study designs to establish causality is recommended for improving focused HCV screening.

Adverse Childhood Experiences (ACEs) include childhood exposure to abuse or violence, a parents' divorce, mental illness, substance use disorder, and are identified as risk factors for negative life outcomes. While ACEs screenings are commonly used in mental health and pediatric settings, screening for ACEs in primary care settings is less prevalent. The purpose of this project is to integrate screening for ACEs into a primary care setting and make appropriate referrals for follow-up, thus reducing potential negative life outcomes. The process was designed for a primary care practice located in Winston-Salem, North Carolina. Part one assessed level of awareness and screening history which determined training focus. Each provider and staff member received 30-45 minutes of training on ACEs screening algorithm, a detailed approach to guide treatment. The training was followed by question-and-answer sessions to address concerns. Part two, involved screening using the Center for Youth Wellness, Adverse Childhood Experiences Questionnaire for Children (CYW ACE-Q Child) which was initiated by the front office employee. Front office employee identified patients present for an annual well visit, briefly explained the screening tool, and handed it to the patient on a clipboard. The patient returned the completed form to the Certified Medical Assistant (CMA) when called in from the waiting room. The provider reviewed the ACEs screening and made referrals as appropriate. Part three involved data collection and analysis. Responses were collected weekly for nine weeks. The responses collected will be analyzed using quantitative statistics. The expected outcome is to note progressive increase in screening activities and when appropriate, followed by referrals to community agencies and organizations. The project educated clinicians about ACEs and created awareness among clinicians in a primary care setting to mitigate potential negative life outcomes. Barriers to integrating ACEs screening included employees' absence of training, lack of confidence in the subject matter, limited time frame to complete the screening, and fear of damaging patient-provider relationships. Barriers were mitigated through employee training, repetitive implementation of ACEs screening, and therapeutic communication with patients. The CYW ACE-Q was reserved for those arriving early or on time for their annual wellness visit to allow adequate time for completion. Recommendations include incorporating the CYW ACE-Q into all primary care visits to further intervene with referrals thereby enhancing patients' overall quality of life.

No description available.

This dissertation focuses on amplifying the voices of marginalized students in alternative education, with an emphasis on the positive impact of resilience on their outcomes. The study addresses the challenges these students face, particularly those from BIPOC communities, in navigating educational systems that have historically marginalized them. The purpose of this qualitative research was to explore the experiences of BIPOC students in a Central Valley alternative education program, highlighting how nurturing relationships, resilience, and the fulfillment of basic needs contribute to their academic success and personal growth. Utilizing a framework that incorporates theories of resilience, educational equity, and transformative leadership, the study situates the students' experiences within a broader context of systemic challenges and potential reform. Through in-depth interviews with five graduates from marginalized backgrounds, the research identified several key themes: (a) the power of resilience in overcoming adversity; (b) the significance of positive relationships with educators and peers; (c) the importance of addressing mental and emotional well-being; (d) the transformative potential of inclusive educational environments; and (e) the role of supportive communities in fostering success. The findings underscore the importance of resilience and relational strategies in helping marginalized students thrive in alternative educational settings. This study contributes to the ongoing conversation on educational equity by advocating for approaches that empower students to achieve their full potential, ensuring that their voices are heard, and their successes are celebrated.

Indiana University-Purdue University Indianapolis (IUPUI) / Oral health is crucial to overall health and a focus of the U.S. Health Center program, which provides preventive dental services in medically underserved communities. Dental hygiene is an oral health profession whose practice is focused on dental disease prevention and oral health promotion. Variations in the practice and regulation of dental hygiene has been demonstrated to influence access to dental care at a state level; restrictive policies are associated lower rates of access to care. Understanding whether and to what extent policy variations affect availability and access to dental care and the oral health of medically underserved communities served by grantees of the U.S. Health Center program is the focus of this study. This longitudinal study examines dental service utilization at 1,135 health center grantees that received community health center funding from 2004 to 2011. The Dental Hygiene Professional Practice Index (DHPPI) was used as an indicator of the state policy environment. The influence of grantee and state level characteristics are also considered. Mixed effects models were used to account for correlations introduced by the multiple hierarchical structure of the data. Key findings of this study demonstrate that state policy environment is a predictor of the availability and access to dental care and the oral health status of medically underserved communities that received care at a grantee of the U.S. Health Center program. Grantees located in states with highly restrictive policy environments were 73% less likely to deliver dental services and, those that do, provided care to 7% fewer patients than those grantees located in states with the most supportive policy environments. Population’s served by grantees from the most restrictive states received less preventive care and had greater restorative and emergency dental care needs. State policy environment is a predictor of availability and access to dental care and the oral health status of medically underserved communities. This study has important implications for policy at the federal, state, and local levels. Findings demonstrate the need for policy and advocacy efforts at all levels, especially within states with restrictive policy environments.