Public health informatics: A consensus on core competencies

Richards, Janise Elaine The University of Texas at Austin 2000 해외박사(DDOD)

This descriptive study identified competencies and the supporting skills and knowledge in public health informatics for public health informaticians and for general public health practitioners. Within the study's integrationist research design, which combines both qualitative and quantitative methods, the methods used were telephone interviews and a web-based Delphi survey. The interviews were substituted for round one of the traditional Delphi method. The interview data were analyzed using a constant comparison method and the final results were used to develop the Delphi survey items. A snowball sampling technique identified the study participants who met the selection criteria of expertise in public health informatics, public health education, public health practice or informatics education. Nine experts participated in the interview process and 23 in the Web-based Delphi. The interview results provided a new definition for public health informatics: Public health informatics is the innovative application of information science, computer science and information technology to improve management of information in public health practice and research, ultimately improving the health of the community. The interview results also indicated that public health informatics had four core domains: organizational and systems management, information systems, information technology, and public health sciences. Within these domains were 12 competencies and 60 supporting skills and knowledge items. After two rounds of the Web-based Delphi survey, the items reached consensus. Nine of the 12 competencies were determined to be critical and three were determined to be important for public health informaticians. For the general public health practitioner, two competencies were determined to be important, eight moderately important, and two insignificant. Of the supporting skills and knowledge, 55% were considered critical, 42% important, and 3% moderately important for public health informaticians. For general public health practitioners 20% were critical, 26% important, 36% moderately important and 18% insignificant or not important. This research can provide a foundation for developing public health informatics curricula in graduate programs and schools of public health and public health workforce training programs.

Health and its contextual determinants of rural adolescents in California

Curtis, Alexa Colgrove University of California, San Francisco 2007 해외박사(DDOD)

Background. Adolescence is a critical developmental period, providing the foundation for both opportunity and risk in adult life. The sociocultural context of the rural community presents unique challenges for rural adolescent health. Patterns of connectedness between the adolescent and the social environment have demonstrated mitigation of risk behaviors in previous studies. Purpose. To describe the health of rural adolescents, 12 to 17 years, in California and to explore the relationship between health behaviors and connectedness to the social context among middle adolescents, ages 14 to 17 years, in the rural community. Method. A secondary data analysis of the 2005 and 2003 Adolescent California Health Interview Survey (CHIS) was conducted in an ethnically and economically diverse sample of 663 and 492, respectively. The 2005 CHIS survey was used to examine the rural adolescent health in California. The 2003 CHIS survey was used to examine the influence of social connectedness on health behaviors. Results. A majority of rural adolescents in California report good to excellent health however significant risk behaviors exist including impaired fitness and nutrition, sexual health risks, substance use, depression, and intra-personal violence. The most influential connectedness factor demonstrating reduced health risk is the home environment, in particular an adult within in the home who "believes the adolescent will be a success". Although the majority of rural adolescents can identify a usual source of care, few are certain they can access confidential services. Many adolescents, particularly minority and low income youth, rely upon community health services. Conclusions. Adolescence is a critical developmental period and adolescents are a potentially vulnerable population. Health risks exist within the rural adolescent population at least equivalent to urban and suburban settings but rural adolescents may be particularly vulnerable related to limited resources to support positive development. Connectedness to social contexts are important for the health of middle adolescents in the rural community. Further research is required examining health and health behaviors, and relationship to social connectedness in rural adolescents. Research that adequately samples high risk rural adolescents is particularly needed.

The impact of gynecological morbidity on women's quality of life in northern Mexico

Garcia-Perez, Maria Hilda University of Michigan 2006 해외박사(DDOD)

This study evaluates the burden of dysmenorrhea, dyspareunia, chronic pelvic pain and urinary incontinence on the quality of life of Mexican women. Recent discussions involving policy-makers and researchers highlight the urgency of developing a broader approach to addressing women's reproductive health needs and their connection with health policy priorities, especially in less developed nations. Despite advances made since the adoption of the concept of reproductive health in the 1990's, the organizing principle of current health policies and most research continues to be the prevalence of illness over health, a fact that reinforces a narrow conceptualization of women's health needs. As a result, the reproductive health agenda has focused on a restricted number of morbidity indicators, particularly those associated with life-threatening diseases. Due in part to this emphasis on life-threatening diseases, gynecological morbidities such as dysmenorrhea, dyspareunia, chronic pelvic pain and urinary incontinence have been neglected in research and service delivery programs targeting women. The burden of these gynecological morbidities on the quality of life of Mexican women was the focus of this cross-sectional population-based survey conducted among 1307 women aged 25-54 in Hermosillo, Mexico. Pelvic pain was a major gynecological complaint among women of reproductive age with 40% reporting dysmenorrhea, 12% dyspareunia and 6% chronic pelvic pain. Younger age increased the odds of these gynecological conditions. This study suggests a substantial overlap between genitourinary tract symptoms, gastrointestinal symptoms and pelvic pain. Urinary incontinence was reported by 18% of the study population. Parity, high body mass index, chronic urinary tract infections and having a history of hysterectomy or uterine leiomyomata were associated with increased odds of reporting incontinence. This research found that gynecological morbidities were associated with women reporting poor health-related quality of life (HRQOL) and having a negative health perception. Approximately 30% of the study population reported a single gynecological morbidity, while 16% reported two or more morbidities. Younger women were at higher risk of having concurrent gynecological morbidities which implied poor-HRQOL associated with depression, anxiety/fear, menstrual disturbance, sleep and sexual problems. Study finding have implications for the public health agenda.

Health, quality of life, and physical activity in youth with cerebral palsy

Bjornson, Kristie F University of Washington 2006 해외박사(DDOD)

Clinical problems for youth with cerebral palsy (CP) include ambulation, mobility, self-care and participation in day-to-day life. Youth with CP are reported to have less than normal general and physical health. Lower quality of life (QOL) has been documented for adolescents with a broad spectrum of disabilities. The purposes of this study were to: (a) describe day-to-day ambulatory activity performance, self-perceived health status, and QOL of youth with CP compared to typically developing youth (TDY); (b) describe the associations between these constructs; (c) explore a model specifying these associations; and (d) address implications for pediatric physical therapy practice and research. A cross-sectional design was used with 81 youth with CP, ages 10-13 years with Gross Motor Function Classification System (GMFCS) Levels I-III and 30 TDY. Participants wore the StepWatch(TM) monitor for 7 days, completed the Activity Scale for Kids (ASKp38) for activity performance with GMFCS defined for activity capacity. The youth completed the Child Health Questionnaire-Child Form (CHQ-CF87) for health status and the Youth Quality of Life (YQOL) for QOL. Current Day Outlook assessed life perception on the day the questionnaires were completed. Youth with CP were found to have significantly lower mean daily walking activity (4,222 steps per day, CI = 3,739-4,749) than TDY (6,739 steps, CI = 6,123-7,355; p = .000). Average daily ambulatory activity decreased as activity capacity decreased (GMFCS). Youth with CP self-report their health status to be significantly lower ( p < .001-.04) than TDY in the areas of role/social behavioral and physical, bodily pain, physical function, and general health. In contrast, youth with CP self-reported their QOL to be similar to TDY. Path models document the positive influence of current day outlook and activity performance (ASKp) on physical, behavioral and emotional health but not general QOL. Ambulatory youth with CP appear to self-report some aspects of health status as lower than TDY but not QOL. Performance based activity outcome measures are indicated to measure the impact of the activity interventions on health status. Future research needs to define optimal levels of activity for general health and prevention of secondary conditions in youth with CP.

Using knowledge discovery to identify potentially useful patterns of health promotion behavior of 10--12 year old Icelandic children

Orlygsdottir, Brynja The University of Iowa 2008 해외박사(DDOD)

Icelandic children can expect to live a long and healthy life and have the right to the highest possible standard of health. Despite this, as in other Western countries, the prevalence of psychosocial complaints and long term conditions in Icelandic children is growing and they are struggling with increased levels of preventable health conditions. The purposes of this cross sectional, secondary analysis were to perform a psychometric evaluation on the instrument School-Children Health Promotion; to describe self-reported health promotion behavior of 10-12 year old Icelandic school children, and to predict novel and potentially useful patterns of health promotion behavior of 10-12 year old Icelandic school children using data mining methods. Existing data from 480 10-12 year old Icelandic school children and 911 parents were analyzed. Analysis of the instrument School-Children Health Promotion indicates that it is, in general, a valid and reliable instrument for measuring health promotion behavior of 10-12 year old Icelandic children. Five factors emerged from the 21 item instrument, which were labeled: "Positive Thinking." "Diet and Sleep Pattern," "Seek Psycho-social Support," "Coping Behavior," and "Health Habits." The results indicated that girls use more positive health promotion behavior than boys; however, differences in health promotion behavior between 5th and 6th grade students were not obvious. The results of data mining analyses, using the classifiers decision tree (J48) and logistic regression (Logistic) to predict health promotion behavior, showed better performance with the subsets of the five factors and the overall instrument than with the full dataset of 199 items. For the subsets, the logistic regression models performed better than the decision trees with AUC ranging from 0.71 to 0.80. The strongest predictors of health promotion behaviors were validation and caring in friendship, intimate disclosure between friends, and quality of life. Results of this secondary analysis indicate that friendship is of vital importance with regards to health promotion behavior. Therefore, further studies on the effect friendship has on health promotion behavior of Icelandic children in the 10-12 year old age group are clearly needed.

Online health information-seeking, health locus of control and health literacy among low-income Internet users in East Baltimore

Laflamme, David Jean The Johns Hopkins University 2003 해외박사(DDOD)

Millions of Americans search for health information online every day. Although the majority of low-income individuals do not have Internet access, this population segment has been making great strides in crossing the Digital Divide in recent years. Little is known about the online health information-seeking (OHIS) behaviors of low-income Internet users. Results from the East Baltimore Internet Health Survey (EBIHS) and comparisons to the Pew Internet and American Life Project's Internet health survey are presented. Ninety-two percent of respondents were African American/Black. The median annual family income was $10,000–$14,999. <italic>Methods</italic>. The EBIHS is a community based participatory research interview study of 520 participants within the East Baltimore Empowerment Zone (EB-EZ), a majority low-income inner-city community. The street-intercept survey method and simple random cluster sampling were used. A survey team of trained community residents conducted the Palm<super>®</super>-based survey. <italic>Results</italic>. One out of four participants reported using the Internet, while 71% of these Internet users reported seeking health information online. Several significant differences in the types of health information sought by low-income Internet users were identified. Discriminant analysis revealed that personal computer (PC) users were more likely to have higher levels of self-efficacy and education, be employed and have visited a doctor in the last 3 months. Internet users were more likely to report a higher level of education and self-efficacy, and lower values of chance health locus of control and perceived health competence. Online health information seekers were more likely to be female and to have greater levels of religiosity and perceived health competence. <italic>Conclusions</italic>. Low-income people who use the Internet in the EB-EZ are not excluded from the large group in the United States who are using online health information to make decisions that influence their health. They often use the Internet in more intensive ways to meet their health needs (more online support groups, more online physician communication, and more follow-up discussion with a doctor or nurse). For the majority of low-income people in the EB-EZ with Internet access and the corresponding skills, the Internet plays a role in serving their healthcare information needs.

Health in Black and White: Debates on Racial and Ethnic Health Disparities in Brazil

Pagano, Anna University of California, San Diego 2011 해외박사(DDOD)

In 2006, the Brazilian Health Council approved a National Health Policy for the Black Population. The Policy is striking because it promotes the image of a biologically and culturally discrete black population in a nation where racial classification has historically been relatively fluid and ambiguous. It transforms established patterns of racialization by collapsing "brown" (pardo) and "black" (preto) Brazilian Census categories into a single "black population" (populacao negra) to be considered a special-needs group by the public health apparatus. This construction resembles the United States' dominant mode of racialization based on hypodescent and represents a significant departure from hegemonic portrayals of Brazil as a racially mixed nation. Furthermore, the Policy challenges national ideologies of racial and cultural unity by affirming the existence of an essential black body with specific health concerns, as well as an essential Afro-Brazilian culture that materializes in recommendations for culturally competent health care. As such, the Policy constitutes an important site for new negotiations of racial and cultural identity in Brazil. In this dissertation, I explore the political and social implications of treating racial and ethnic groups differently within Brazilian health care. I examine how the re-definition and medicalization of racial and cultural identities unfolds in public clinics, temples of Afro-Brazilian religion, and social movements based in Sao Luis and Sao Paulo, Brazil. Through an analysis of ethnographic data that I collected over twenty-four months, I assess the impact of recent developments in race-conscious health policy on Brazilians' lived experiences of race, ethnicity, and health disparities. I argue that the new Policy, and its associated health programs, signals the emergence of a new biopolitical paradigm in which the Brazilian state formalizes citizens' racial and ethnic differences in order to address inequalities among them. I also show that many aspects of these programs, which incorporate global discourses and concepts related to health equity, fail to resonate with Brazilian citizens' notions about race and health. Consequently, patients and healthcare providers often resist the new measures. The result is a disjuncture between policy and practice that ultimately hinders Brazil's efforts to reduce health inequalities among its citizens.

Determinants of safe motherhood and newborn care behaviors in rural India

Sharan, Mona The Johns Hopkins University 2004 해외박사(DDOD)

The study objective was to examine the determinants of safe motherhood and newborn care behaviors that are associated with improved health and survival outcomes among infants. The study objectives were met by an analysis of quantitative and qualitative data from rural India. Study aims. Study aim I utilized quantitative data to examine determinants of domestic safe motherhood and newborn care among women who delivered at home. Study aim II also utilized quantitative data to evaluate the influence of factors associated with women's health seeking behavior. Study aim III utilized qualitative data and focused on understanding health beliefs of mothers and birth attendants that affect domestic care and health seeking behavior for safe motherhood and newborn health. Results. Aim I. Oxytocin, a drug commonly used to induce labor in home deliveries in this setting was associated with higher socioeconomic status, primagravidity and delivery by a traditional birth attendant. Younger maternal age, higher socioeconomic status and antenatal care visits increased the odds of hygienic cord care. Women who had a higher order birth had lower odds of breastfeeding their newborns. Women's knowledge of danger signs elevated the odds of breastfeeding and experience of complications during pregnancy decreased it. Aim II. Higher levels of women's autonomy increased the odds of seeking antenatal care, receiving tetanus immunization, seeking postnatal care, and delivering in a health facility. A higher level of access to health facility also increased the odds of seeking antenatal care, postnatal care and delivering in a health facility. The interaction between access and autonomy was complementary. High access to facilities and high women's autonomy (relative to low access and low autonomy) was associated with an increased odds for three of the four outcomes. Aim III. The qualitative study indicated that some domestic care for safe motherhood and newborn care was dictated by superstitions and traditions, while others were influenced by awareness of disease causation for illnesses such as tetanus. Health seeking behavior was influenced by easy availability of care and women's capacity to afford care, and experience of pregnancy and delivery complications provided the impetus for care seeking. Family members, especially mothers-in-law, had a strong influence on domestic care and health seeking behavior. Discussion. The notion of seeking preventive care for pregnancy, childbirth and newborn health was lacking in the study setting. Women's health beliefs influence their health behaviors but contextual factors such as family and community characteristics have a decisive influence on care decisions. At the family level, the influence of relatives and women's status in the household; and at the community level, characteristics of health systems, including access to facilities, influence safe motherhood and newborn care behaviors.

Family planning experiences and perceptions of access: Latina immigrants in a new settlement state

Alcalde, M. Gabriela The University of North Carolina at Chapel Hill 2012 해외박사(DDOD)

Background. Reproductive health is an integral part of women's self-determination and overall health and wellbeing. Public policies can strengthen or undermine reproductive health. As a health behavior, family planning affects many reproductive health outcomes, and is a key "gateway" health behavior to overall reproductive health and wellbeing. Immigration and welfare policies have significant and often unexplored public health implications. Recent changes in immigration and other public policies affect the health of new Latin American immigrants in myriad ways. In Kentucky, as in other new immigrant settlement states, most adult Latinas are recent immigrants and foreign-born. As such they live in a post-welfare reform environment where immigrants are often barred from accessing public assistance that could mitigate poverty's negative impact on health. Immigrants in these states may also perceive that they are ineligible for services because of the lack of culturally- and linguistically-accessible services and the general attitude towards immigrants. Objective. This study looked at how foreign-born Latina immigrants' perceptions of access to and experiences with family planning in an urban center in Kentucky can inform community-based policy initiatives to improve the reproductive health of Latinas. Methods. Twenty in-depth key informant interviews were conducted from June to August 2011. Nine foreign-born, Latina informal community leaders and 11 social and health service providers, and policy professionals were interviewed in Spanish and English, respectively. Qualitative analysis using an emergent theme approach was conducted using qualitative analysis software. Results. Findings were categorized into 6 areas: social, political, and cultural context of Kentucky; scope and meaning of family planning; instrumental and perceived barriers; instrumental and perceived facilitators; role of policies in access to family planning; and potential impact of the Affordable Care Act on foreign-born Latinas' access to family planning. Both participant populations made the connection between non-health policies (especially immigration, transportation, and language-access) and family planning access. This study's findings suggest that Latina immigrants' perception of access is affected by immigration and transportation policies at the state and federal level, by local attitudes towards immigration, and language access practices at service agencies. Findings also provide insights into culturally- and linguistically-appropriate approaches to increase knowledge and understanding of family planning among foreign-born Latina immigrants. Recommendations. This study indicates the need for changes at the policy, organizational, and programmatic level. Public health leadership is needed to bring about these changes. The need for culturally-and linguistically appropriate community outreach, peer-to-peer education, provider training, strong political messages regarding immigrants, advocacy to reverse policies that damage access to health, and enforcement of existing language access policies are among the recommendations in this study. More research is needed in this area, in particular using participatory methods.

Health and illness beliefs, health behavior and choice of medicine and its use among Asian Indian immigrants

Rao, Deepa Shantharam University of Minnesota 2003 해외박사(DDOD)

The purpose of this study was to familiarize health care practitioners with the health and illness beliefs and health behavior of Asian Indian immigrants so as to enable them to provide culturally appropriate care to this population. The research questions aimed to find the health and illness beliefs, health behavior, choice of medicine and the hierarchy of resort to different medical practices and the expectations of Asian Indian immigrants from their health care providers. The study was an exploratory study employing ethnographic methods to collect data. These included interviews and observations. The study sample included twenty-one immigrants from all walks of life from India. They were recruited using the snowballing technique. <italic>Results</italic>. Asian Indian immigrants consider health to be a very important aspect of life. These health beliefs influence decision making related to preventive health. Depending on the beliefs about the status of their own health, people take measures to either promote their health or to prevent future illness. These practices however differed by age, gender and health status. Asian Indian immigrants also use a variety of treatment options to either prevent future illness or to treat an existing illness. These vary from home made remedies to Indian medical systems such as ayurveda, homeopathy or naturopathy, to western medicine to other alternative practices such as acupressure, acupuncture and chiropractic therapy. The order in which they use these alternatives is not consistent but generally depends on health and illness beliefs, severity of illness, type of illness, prior experience with an illness, cost of medicine and length of stay in the US. Compliance with medications was found to be an issue with this group of immigrants because of the general belief that medications are bad. The Asian Indian immigrants have mixed feelings about their experiences with the health care providers in the US. Many of them like the openness between the practitioners and the patients here but have mixed feelings about the idea of autonomy of patients with the patient having to make decisions about their own health care. Further research is required to fully understand the health behavior of this population.