Purpose: Most individuals do not perceive a need for substance use treatment despite meeting diagnostic criteria for substance use disorders and they are least likely to pursue treatment voluntarily. There are also those who perceive a need for treatment and yet do not pursue it. This study aimed to understand which factors increase the likelihood of perceiving a need for treatment for individuals who meet diagnostic criteria for substance use disorders in the hopes to better assist with more targeted efforts for gender-specific treatment recruitment and retention. Using Andersen and Newman’s (1973/2005) model of individual determinants of healthcare utilization, the central hypothesis of the study was that gender moderates the relationship between substance use problem severity and perceived treatment need, so that women with increasing problems due to their use of substances are more likely than men to perceive a need for treatment. Additional predisposing and enabling factors from Andersen and Newman’s (1973/2005) model were included in the study to understand their impact on perceived need. Method: The study was a secondary data analysis of the 2010 National Survey on Drug Use and Health (NSDUH) using logistic regression. The weighted sample consisted of a total 20,077,235 American household residents (The unweighted sample was 5,484 participants). Results of the logistic regression were verified using Relogit software for rare events logistic regression due to the rare event of perceived treatment need (King & Zeng, 2001a; 2001b). Results: The moderating effect of female gender was not found. Conversely, men were significantly more likely than women to perceive a need for treatment as substance use problem severity increased. The study also found that a number of factors such as race, ethnicity, socioeconomic status, age, marital status, education, co-occurring mental health disorders, and prior treatment history differently impacted the likelihood of perceiving a need for treatment among men and women. Conclusion: Perceived treatment need among individuals who meet criteria for substance use disorders is rare, but identifying factors associated with an increased likelihood of perceiving need for treatment can help the development of gender-appropriate outreach and recruitment for social work treatment, and public health messages.

Mental illness is far higher among prisoners than in general populations, especially for female prisoners. Previous research has discovered that traumatic experience plays a crucial role in the development of psychiatric disorder and other mental health issues in female prisoners. The present paper reviews eight articles, investigating into the negative outcomes associated with trauma-related mental health issues for female prisoners, and how their trauma-related mental health needs are addressed in prison. Systematic text condensation was used to discover similar themes and meanings throughout the articles. The results found a high prevalence of unrecognized and misdiagnosed trauma-related mental health issues across the articles, in particular post-traumatic stress disorder, with treatment having too much focus on substance abuse rather than addressing trauma directly. The review concludes that current prison screening measures and interventions do not identify trauma-related mental health issues adequately or address trauma directly. As a result, prison services do not meet the complex trauma needs of women. Further research needs to be conducted in this area for this population, as trauma-specific treatment is in its infancy.

Health care professionals have begun to view family members as an integral part of the healing process and the well-being of patients in the intensive care unit. The needs of family members may be varied, and nurses must become attuned to the family members' needs and acquire skills to direct interventions toward identifying and meeting those needs. The aim of the research study was to explore and identify the perceptions of family members' needs and to ascertain if those needs were perceived as met or unmet by the family members of patients housed in the intensive care units. The hypothesis proposed that a gap exists between identified needs of family members visiting intensive care patients and their perceptions of needs as being met or unmet. Data analysis included quantitative and qualitative methods.

No description available.

This dissertation focuses on the health, health care utilization rates, and unmet health care needs of individuals aging with work-related impairments. A life course perspective is used to understand the health experiences of these individuals, and a mixed method approach was used to study their health and health care use. Three components make up the dissertation, two quantitative projects and one qualitative project. The first article provides a broad overview of chronic health conditions reported by respondents from the Research Action Alliance on the Consequences of Work Injury (RAACWI) Health and Health Care Utilization Survey who experienced a work-related impairment. Health outcomes and access to health care for this group is compared to a similar aged sample of Ontarian respondents from the Canadian Community Health Survey. The second article uses the National Population Health Survey to examine whether rates of unmet health care needs over eight cycles varied based on disability status. Respondents are categorized as either without disability, having a work-related disability, having a disability as a result of a disease or illness, or having disability for other reasons. The reasons for unmet health care needs is examined for seven cycles to determine whether unmet health care need could be characterized as personal or structural. The third article provides a deeper understanding of how 11 individuals age with a work injury. A convenience sample of 11 participants from the RAACWI Health Survey participated in semi-structured, in-depth interviews where they discussed their work injury and how they are coping with its ongoing consequences, including subsequent health problems as they age. This article provides a richer understanding of health changes and unmet health care needs that could not be examined in the other projects due to the nature of quantitative analysis. Together these three articles enable me to showcase the lived experiences of individuals with work-related impairments and how they age with the work injury and subsequent, additional chronic health conditions. / Dissertation / Candidate in Philosophy

Background: The COVID-19 pandemic disrupted access to healthcare services in Canada, but little is known about the magnitude of unmet healthcare needs and characteristics associated with increased risk of unmet needs in the adult population. Objectives: First, to describe unmet healthcare needs, including COVID-19 testing access, and to evaluate the association of the social determinants of health (SDOH) and chronic conditions with unmet healthcare needs. Secondly, to evaluate the association between symptoms of depression and anxiety with unmet healthcare needs, and test if the interaction was modified by sex. Methods: The data of 23,972 adults who completed the Canadian Longitudinal Study on Aging COVID-19 Questionnaire Study exit survey (Sept.–Dec. 2020) was analyzed. Three outcomes were evaluated: 1) challenges accessing healthcare, 2) not going to a hospital or seeing a doctor when needed, 3) experiencing barriers to COVID-19 testing. For objective 1, a prospective cohort study was conducted. For objective 2, a cross-sectional study was conducted. RESULTS: Overall, 25% of adults in Canada reported challenges accessing healthcare, 8% did not go to a hospital or see a doctor when needed, and 4% experienced barriers to COVID-19 testing. Several SDOH, including sex, immigrant status, racial background, education and income, were associated with unmet needs. The odds of reporting all three outcomes declined with age. Pre-pandemic unmet needs were strongly associated with higher odds of all three outcomes, while the presence of chronic conditions was associated with higher odds of the first two outcomes. Symptoms of depression and anxiety were strongly associated with all three outcomes. Interaction with sex was found for the first outcome, with stronger associations in females. Conclusions: This thesis identified groups that experienced difficulties accessing healthcare services during the pandemic. Future research may assess consequences of unmet needs, evaluate mechanisms that cause unmet needs and determine ideal interventions. / Thesis / Master of Public Health (MPH) / The COVID-19 pandemic in Canada affected how individuals were able to access healthcare services. To understand which groups experienced a greater level of difficulties, we examined the experience of unmet healthcare needs during the first year of the pandemic using a sample of 23,972 adults that had completed the Canadian Longitudinal Study on Aging (CLSA) COVID-19 Questionnaire Study (Sept. – Dec. 2020). We found evidence that the experience of unmet healthcare needs varied by several sociodemographic characteristics, such as sex, immigrant status, racial background, education and income. Younger adults were more likely to report unmet needs. Individuals with chronic conditions and those had reported unmet healthcare needs prior to the pandemic were also more likely to report unmet needs during the pandemic. Individuals with symptoms of depression and anxiety were also more likely to report unmet healthcare needs. These results can be used to inform interventions that improve access to healthcare services for vulnerable groups.

No description available.

The goal of this investigation was to assess service use, self-management strategies, and health status of older adults (60+ years) with perceived need who sought assistance from the Virginia Medicaid Elderly and Disabled Consumer-Direction (EDCD) waiver services. A sequential explanatory mixed method design was used to address the overall research question: How do older adults manage unmet needs? Using health services data from two independent State agencies, regression techniques were used to examine predictors of service use, hospitalization, and mortality among 1,008 individuals. A purposive subsample of eight rural-dwelling waiver-ineligible individuals was identified for follow-up semi-structured telephone interviews to explore self-management strategies for confronting functional care needs. Waiver-ineligible individuals were at risk for hospitalization and mortality; rural-dwelling individuals were more likely to be waiver-ineligible and had increased risk of mortality. Analysis of interviews revealed individuals had ongoing unmet needs and relied on family and community services and used internal and external strategies to manage them; plans were not in place should their health continued to decline. For this group of near-risk older adults who are waiver-ineligible and do not have financial means to pay for more help, accessible preventive services are necessary to reduce risk of adverse health outcomes. Policymakers are encouraged to advocate for preventive services that assist individuals before care needs become unmanageable. Agencies responsible for service delivery need to target efforts toward this group, particularly those residing in rural areas. Researchers must continue forging partnerships that permit use of health services data to identify when and how older adults use services, and explore how self-management strategies influence health and functioning over time. / Ph. D.

Résumé: Introduction: Cette étude s’intéresse à l’expérience de soins de patients aînés de 70 ans et plus atteints de cancer entourant une visite à l’urgence. Elle repose sur plusieurs résultats d’études démontrant que ces personnes présentent des besoins spécifiques non comblés, les amenant à utiliser les services d’urgence pour y répondre. Peu d’études se sont intéressées à leur expérience de soins et encore plus rarement dans le contexte d’une visite à l’urgence. But : Mieux comprendre l’expérience de soins des patients aînés atteints de cancer entourant une visite à l’urgence. Cette étude comprend quatre objectifs soit : 1) établir le profil des patients de 70 ans et plus ayant consulté l’urgence pour un problème lié à leur cancer dans les 12 mois précédant l’étude; 2) identifier les raisons et les facteurs amenant ces patients à consulter les services d’urgence; 3) identifier les stratégies de coping utilisées avant d’aller à l’urgence et 4) décrire l’expérience de soins de ces patients à l’urgence. Méthode: Une étude à devis mixte simultané a été entreprise. Une analyse descriptive des bases de données administratives a été réalisée pour documenter le profil sociodémographique, clinique et l'utilisation des services des patients aînés atteints de cancer de 70 ans et plus qui ont visité l'urgence d'un centre hospitalier au Québec, le Canada (n = 792, Objectifs 1-2). Ensuite, des entrevues semi-structurées ont suivi (n = 11) et ont été analysées par une analyse de contenu en profondeur (Objectifs 2, 3, & 4). Résultats: Un total de 792 patients aînés atteints de cancer ont visité l'urgence pour un total de 1572 visites. Les raisons de consultation les plus fréquentes étaient de nature respiratoire (15,8%), digestive (13,4%) et les troubles cardiovasculaires (8,2%). Plus de la moitié des visites était réalisée de jour. L’anxiété, les problèmes d’accessibilité et la détérioration importante de la santé étaient des facteurs qui influençaient le recours aux services d’urgence. Les patients ont été en mesure de déployer une multitude de stratégies de coping pour faire face à leurs problèmes de santé. Par ailleurs, l’expérience de soins est un processus unique, vécu de manière très individuelle. Conclusion: Cette étude décrit l’expérience de soins de patients aînés atteints de cancer à l’urgence et souligne plusieurs domaines d’amélioration des services en périphérie de l’urgence, mais aussi au sein même du service d’urgence. / Abstract: Introduction: Older cancer patients are known to have specific unmet needs due to the complexity of their health care, leading them to use emergency services. However, it is known that emergency rooms are not well-suited to the needs of the elderly. Few studies have focused on the health care experience of older cancer patients and even less so in the context of emergency room (ER) visits. Purpose: This study aims to better understand the experience of older cancer patients in the context of ER visits for unexpected health deterioration related to cancer. We sought to: 1) establish the profile of patients aged 70 years and older who made ER visits for problems related to their cancer in the 12 months preceding the study; 2) identify the reasons and factors that motivate older patients with cancer to make ER visits; 3) identify coping strategies used by older cancer patients prior to ER visits; and 4) describe the health care experience of older cancer patients in the context of ER visits. Methods: A concurrent mixed-method design was used. Descriptive analysis of administrative databases was first conducted to document the socio-demographic, clinical, and service utilization profile of elderly cancer patients aged 70 years and older who visited the ER of a hospital in Québec, Canada (n = 792, Objectives 1-2). Semi-structured interviews were subsequently conducted (n = 11) and then analysed using in-depth content analysis (Objectives 2, 3, & 4). Results: The sample of 792 older cancer patients made a total of 1,572 ER visits. The most frequent medical reasons for ER visits were respiratory (15.8%) and digestive (13.4%) concerns, and cardiovascular conditions (8.2%). Content analysis of the qualitative data suggested that older cancer patients made most of the ER visits when experiencing high levels of anxiety, when other cancer care services were unavailable, or because of a serious life-threatening health condition. Patients were able to use a variety of coping strategies to deal with health issues. Furthermore, the care process is experienced uniquely for each individual. Conclusion: This study describes the health care experience of older cancer patients in the context of ER visits and suggests areas of improvement both outside of and within emergency services.

<p>Bakgrund: Idag finns det cirka 40 000 individer som har diagnosen schizofreni i Sverige. Schizofreni innebär psykisk ohälsa i form av bland annat hallucinationer, vanföreställningar samt apati och passivitet, vilket leder till en försämrad livskvalitet. Syfte: Syftet med litteraturstudien var att belysa upplevelsen av livskvalitet hos patienter med diagnosen schizofreni. Metod: Studien utfördes som en allmän litteraturstudie där sju vetenskapliga artiklar, som var relevanta till syftet, valdes ut, kvalitetsgranskades och analyserades. Resultat: Resultatet delades in i fem olika rubriker. Det visade sig att svåra symtom, civilstatus, socialt nätverk, otillfredsställda behov och ekonomi alla vara direkt relaterade till livskvaliteten hos patienter med schizofreni. Slutsats: Förbättrade levnadsförhållanden betyder inte nödvändigtvis förbättrad livskvalitet. Många faktorer bland annat trygg och lugn omgivning, bra ekonomi och ett bra socialt nätverk påverkar livskvaliteten. Därför bör sjukvårdspersonal tillgodose patienternas behov på ett adekvat sätt och därmed bidra till en förbättrad livskvalitet.</p> / <p>Background: About 40 000 individuals in Sweden lives with the diagnose schizophrenia. Schizophrenia involves psychiatric disease with symptoms such as hallucinations, delusions, apathy and passivity, which lead to a decline in quality of life. Purpose: The purpose of the study was to elucidate the experience of quality of life in patients with schizophrenia. Method: The study was conducted as a literature review where seven scientific articles were chosen, critically reviewed and analysed. Result: The result was divided in to five different categories. Severe symptoms, marital status, social network, unmet needs and economy appeared to be all directly related to quality of life in patients with schizophrenia. Conclusion: Improved living conditions do not necessarily improve quality of life. Many factors including security, quiet environment, good economy and a good social network affects the quality of life. Therefore, health care professionals should meet patient needs in an adequate manner and thus contribute to an improved quality of life.</p>