Understanding Patients’ Needs and Healthcare Seeking Behavior in Rural Southern India: The Comparison of Providers through Patients’ Perceptions and Cost Issues

This study explores patients’ needs in rural Thanjavur, southern India through understanding how people with diabetes choose providers and perceive care-seeking experience. To measure perception, the study surveyed people regarding six common barriers to care-seeking behavior, selected from both literature and local expert interview. Ninety-one percent of the sampled population goes to public or private allopathic providers out of the six presented providers. The low socioeconomic group and people with more complications or comorbidities are more likely to go to private allopathic providers. What is more, there is no difference between public and private allopathic providers in patients’ perception of care except for perceived cost. Positive perceptions in both providers are very common except for perceptions in blood-sugar management, distance to facilities, and cost of care. Sixty-six percent of patients perceived their blood-sugar control to fluctuate or have no change versus improved control. Twenty-seven percent of patients perceived the distance to facilities as unreasonable, and sixty-two percent of patients perceived the cost as high for them. The results suggest that cost may affect low socioeconomic people’s choice of care significantly. However, for people in middle and higher socioeconomic groups, cost does not appear to be a major factor. For qualitative text analyses, physician’s behavior and reputation emerge as themes, which require further studies.

"On our way": identities and representations of African women seeking asylum in Ireland

This thesis provides the first explicit Postcolonial study of asylum in the Irish context that integrates Black Feminist analyses of intersectional identity with Postcolonial Feminist theories of representation. African women seeking asylum in the Republic of Ireland were key political instruments used by the state to re-draw racial lines. The study examines how, for a group of African women “On their Way” through asylum, identity and representation work hand in hand to force identities, subaltern spaces and bodies to occupy them. Rich biographical data is gathered through mixed art and drama methods over two intensive participatory research projects conducted in a small Irish city. Data analysis critically examines the poetics (practices that signify) and politics (the powers that govern these practices) and affective economies of global and local NGO visual representations, exposing how they consume, fragment, and appropriate African women’s identities and bodies. Though hypervisible, the women themselves “cannot speak”. The women in the study reported feeling “tired” and “used”. Asking “What work are they doing as they do asylum?” the study finds that black female identities and bodies are forced to perform political, cultural, emotional and material labour on their way through this context of Irish asylum. The author argues that Postcolonial Asylum is a performative encounter that re-scripts colonial race/class/gender discourse through a humanitarian alibi to naturalize European/white supremacy, reinscribe patriarchal power and justify racialised incarceration of bodies seeking asylum in the North. This study takes an interdisciplinary approach that centralizes Black and Postcolonial Feminist theory and innovates Participatory Art-Based Action methodology. Black and Postcolonial feminisms can recognize, theorize and replenish black female political and intellectual agency. Participatory Action research, if grounded in Black feminist epistemology and ethics, can allow participants to “speak back” to what is already said about them in spaces of convivial self-representation.

Help-seeking behaviors and mental well-being of first year undergraduate university students

University students demonstrate poor help-seeking behaviors for their mental health, despite often reporting low levels of mental well-being. The aims of this study were to examine the help-seeking intentions and experiences of first year university students in terms of their mental well-being, and to explore these students’ views on formal (e.g. psychiatrists) and informal (e.g. friends) help-seeking. Students from a university in the Republic of Ireland (n=220) completed an online questionnaire which focused on mental well-being and help-seeking behaviors. Almost a third of students had sought help from a mental health professional. Very few students reported availing of university/online supports. Informal sources of help were more popular than formal sources, and those who would avail and had availed of informal sources demonstrated higher well-being scores. Counselors were the source of professional help most widely used. General practitioners, chaplains, social workers, and family therapists were rated the most helpful. Those with low/average well-being scores were less likely to seek help than those with higher scores. Findings indicate the importance of enhancing public knowledge of mental health issues, and for further examination of students’ knowledge of help-seeking resources in order to improve the help-seeking behaviors and mental well-being of this population group.

Distributed Extremum-Seeking Control with Applications to High-Altitude Balloons

The real-time optimization of large-scale systems is a difficult problem due to the need for complex models involving uncertain parameters and the high computational cost of solving such problems by a decentralized approach. Extremum-seeking control (ESC) is a model-free real-time optimization technique which can estimate unknown parameters and can optimize nonlinear time-varying systems using only a measurement of the cost function to be minimized. In this thesis, we develop a distributed version of extremum-seeking control which allows large-scale systems to be optimized without models and with minimal computing power. First, we develop a continuous-time distributed extremum-seeking controller. It has three main components: consensus, parameter estimation, and optimization. The consensus provides each local controller with an estimate of the cost to be minimized, allowing them to coordinate their actions. Using this cost estimate, parameters for a local input-output model are estimated, and the cost is minimized by following a gradient descent based on the estimate of the gradient. Next, a similar distributed extremum-seeking controller is developed in discrete-time. Finally, we consider an interesting application of distributed ESC: formation control of high-altitude balloons for high-speed wireless internet. These balloons must be steered into a favourable formation where they are spread out over the Earth and provide coverage to the entire planet. Distributed ESC is applied to this problem, and is shown to be effective for a system of 1200 ballons subjected to realistic wind currents. The approach does not require a wind model and uses a cost function based on a Voronoi partition of the sphere. Distributed ESC is able to steer balloons from a few initial launch sites into a formation which provides coverage to the entire Earth and can maintain a similar formation as the balloons move with the wind around the Earth.

Renta feudal, ejercicio del poder y diferenciación social campesina en el marco del señorío del cabildo salmantino en la Edad Media

El presente trabajo analiza la evolución del señorío eclesiástico en el largo plazo, para sumar al conocimiento de las formas señoriales de la Extremadura leonesa. Consideramos específicamente el caso del cabildo catedralicio salmantino entre los siglos XII y XV. Buscamos demostrar que no poseyó idéntica estructura durante todo el período y que sus transformaciones se explican por una compleja conjunción de variables. Dichas transformaciones incidieron sobre las estructuras sociales del agro, en especial sobre el desarrollo de procesos de diferenciación social campesina. Demostramos que la forma concreta en que se realizaba la renta podía alterar las estructuras sociales de las comunidades y que el desarrollo de las relaciones sociales asalariadas se encontraba muy vinculado a las coyunturas económicas y a las posibilidades y límites de la gestión señorial. Finalmente, ponemos de relieve que la transformación social no siempre fue irreversible y que su consolidación dependió de la incapacidad de los señores de ejercer sus poderes políticos.

Understanding Suicide and Help-seeking in Urban and Rural Areas in Northern Ireland

Funded by HSC R&D Division, Public Health Agency Why did we start? Most people who complete suicide are in contact with their family doctors or other services in the months prior to death. A better understanding of the nature of these contacts and the various pathways experienced by suicidal people should reveal the gaps and barriers to effective service provision. We also need better information about the difficulties experienced by family carers, both prior to the death and afterwards. Of particular interest to policy makers in Northern Ireland was a concern that people from rural areas may be at increasing risk of suicide. We were commissioned by the Health and Social Care R&D Division of the Northern Ireland Public Health Agency to address the gaps in our understanding of suicide in NI. What did we do? We undertook a mixed methods study in which we examined the records of 403 people who took their own lives over a two-year period between March 2007 and February 2009. We linked these data to GP records and then examined help-seeking pathways of people and their contacts with services. We did in-depth face-to-face interviews with 72 bereaved relatives and friends who discussed their understanding of the events and circumstances surrounding the death, the experience of seeking help for the family member, the personal impact of the suicide, and use of support services. Additionally, we interviewed 19 General Practitioners about their experiences of managing people who died by suicide.            

Abortion in the United States: Occurrence, trends, cross-state care-seeking and unmet need

Thesis (Master's)--University of Washington, 2016-08

Effect of Wealth on Health Care Seeking Behavior And Out of Pocket Health Expenditure in Malawi

Thesis (Master's)--University of Washington, 2016-06

Seeking To Understand, Aspiring to Teach: Exploring How Life Shapes Emotional and Personal Development in Global Health Leaders

Thesis (Master's)--University of Washington, 2016-08

Sense-making in theory and practice: a metatheoretical foundation and application for health information seeking

This thesis attempts to provide deeper historical and theoretical grounding for sense-making, thereby illustrating its applicability to practical information seeking research. In Chapter One I trace the philosophical origins of Brenda Dervin’s theory known as “sense making,” reaching beyond current scholarship that locates the origins of sense-making in twentieth-century Phenomenology and Communication theory and find its rich ontological, epistemological, and etymological heritage that dates back to the Pre-Socratics. After exploring sense-making’s Greek roots, I examine sense-making’s philosophical undercurrents found in Hegel’s Phenomenology of Spirit (1807), where he also returns to the simplicity of the Greeks for his concept of sense. With Chapter Two I explore sense-making methodology and find, in light of the Greek and Hegelian dialectic, a dialogical bridge connecting sense-making’s theory with pragmatic uses. This bridge between Dervin’s situation and use occupies a distinct position in sense-making theory. Moreover, building upon Brenda Dervin’s model of sense-making, I use her metaphors of gap and bridge analogy to discuss the dialectic and dialogic components of sense making. The purpose of Chapter Three is pragmatic – to gain insight into the online information-seeking needs, experiences, and motivation of first-degree relatives (FDRs) of breast cancer survivors through the lens of sense-making. This research analyses four questions: 1) information-seeking behavior among FDRs of cancer survivors compared to survivors and to undiagnosed, non-related online cancer information seekers in the general population, 2) types of and places where information is sought, 3) barriers or gaps and satisfaction rates FDRs face in their cancer information quest, and 4) types and degrees of cancer information and resources FDRs want and use in their information search for themselves and other family members. An online survey instrument designed to investigate these questions was developed and pilot tested. Via an email communication, the Susan Love Breast Cancer Research Foundation distributed 322,000 invitations to its membership to complete the survey, and from March 24th to April 5th 10,692 women agreed to take the survey with 8,804 volunteers actually completing survey responses. Of the 8,804 surveys, 95% of FDRs have searched for cancer information online, and 84% of FDRs use the Internet as a sense-making tool for additional information they have received from doctors or nurses. FDRs report needing much more information than either survivors or family/friends in ten out of fifteen categories related to breast and ovarian cancer. When searching for cancer information online, FDRs also rank highest in several of sense-making’s emotional levels: uncertainty, confusion, frustration, doubt, and disappointment than do either survivors or friends and family. The sense-making process has existed in theory and praxis since the early Greeks. In applying sense–making’s theory to a contemporary problem, the survey reveals unaddressed situations and gaps of FDRs’ information search process. FDRs are a highly motivated group of online information seekers whose needs are largely unaddressed as a result of gaps in available online information targeted to address their specific needs. Since FDRs represent a quarter of the population, further research addressing their specific online information needs and experiences is necessary.

SEEKING CULTURAL FAIRNESS IN A MEASURE OF RELATIONAL REASONING

Relational reasoning, or the ability to identify meaningful patterns within any stream of information, is a fundamental cognitive ability associated with academic success across a variety of domains of learning and levels of schooling. However, the measurement of this construct has been historically problematic. For example, while the construct is typically described as multidimensional—including the identification of multiple types of higher-order patterns—it is most often measured in terms of a single type of pattern: analogy. For that reason, the Test of Relational Reasoning (TORR) was conceived and developed to include three other types of patterns that appear to be meaningful in the educational context: anomaly, antinomy, and antithesis. Moreover, as a way to focus on fluid relational reasoning ability, the TORR was developed to include, except for the directions, entirely visuo-spatial stimuli, which were designed to be as novel as possible for the participant. By focusing on fluid intellectual processing, the TORR was also developed to be fairly administered to undergraduate students—regardless of the particular gender, language, and ethnic groups they belong to. However, although some psychometric investigations of the TORR have been conducted, its actual fairness across those demographic groups has yet to be empirically demonstrated. Therefore, a systematic investigation of differential-item-functioning (DIF) across demographic groups on TORR items was conducted. A large (N = 1,379) sample, representative of the University of Maryland on key demographic variables, was collected, and the resulting data was analyzed using a multi-group, multidimensional item-response theory model comparison procedure. Using this procedure, no significant DIF was found on any of the TORR items across any of the demographic groups of interest. This null finding is interpreted as evidence of the cultural-fairness of the TORR, and potential test-development choices that may have contributed to that cultural-fairness are discussed. For example, the choice to make the TORR an untimed measure, to use novel stimuli, and to avoid stereotype threat in test administration, may have contributed to its cultural-fairness. Future steps for psychometric research on the TORR, and substantive research utilizing the TORR, are also presented and discussed.

Seeking transparency on allocation of kidneys from deceased donors

Kidney transplantation is the preferred treatment for many end stage renal disease patients; however, the small number of organs for transplantation does not allow all patients to have access to this scarce resource. An allocation system for deceased donor kidneys should be anchored to transparent policies and rules. It should take into account the relationship between supply and demand, hence seeking a balance between the higher net benefit of survival that can be provided by a particular organ and the transplant candidates’ waiting time (as well as the probability of being transplanted).

Dual layer solid phase extraction based on molecular imprinting technology: Seeking a route to enhance selectivity for trace analysis of pesticide residues in olive oil.

Aiming to introduce a multiresidue analysis for the trace detection of pesticide residues belonging to organophosphorus and triazine classes from olive oil samples, a new sample preparation methodology comprising the use of a dual layer of “tailor-made” molecularly imprinted polymers (MIPs) SPE for the simultaneous extraction of both pesticides in a single procedure has been attempted. This work has focused on the implementation of a dual MIP-layer SPE procedure (DL-MISPE) encompassing the use of two MIP layers as specific sorbents. In order to achieve higher recovery rates, the amount of MIP layers has been optimized as well as the influence of MIP packaging order. The optimized DL-MISPE approach has been used in the preconcentration of spiked organic olive oil samples with concentrations of dimethoate and terbuthylazine similar to the maximum residue limits and further quantification by HPLC. High recovery rates for dimethoate (95%) and terbuthylazine (94%) have been achieved with good accuracy and precision. Overall, this work constitutes the first attempt on the development of a dual pesticide residue methodology for the trace analysis of pesticide residues based on molecular imprinting technology. Thus, DL-MISPE constitutes a reliable, robust, and sensitive sample preparation methodology that enables preconcentration of the target pesticides in complex olive oil samples, even at levels similar to the maximum residue limits enforced by the legislation.

Ocular injuries and eye care seeking patterns following injuries among cocoa farmers in Ghana.

Background: The work environment of cocoa farmers exposes them to several ocular hazards that predispose them to eye diseases and injuries. However, the extent of ocular injuries and health seeking patterns following these injuries are unknown among cocoa farmers in Ghana. Objectives: To determine the prevalence of ocular injuries and health seeking behaviour following injury among cocoa farmers in Ghana. Methods: Five hundred and fifty six participants were recruited through simple random sampling using a multistage approach from four cocoa growing districts in Ghana. A structured questionnaire was used to collect relevant information such as demography, ocular hazards and injuries experienced. An ocular examination was also conducted to assess the eye health of the participants. Descriptive and regression statistics were used to analyze the data. The rate of ocular injuries was calculated by using the number of injuries reported that resulted in lost work time/days divided by the number of worker years at risk of injury (sum of years worked in cocoa farms for all the participants). Results: The rate of ocular injuries was 11.3/1000 worker years (95% CI: 9.4 - 31) which led to lost work time of 37.3/1000 worker years (95% CI: 34.1 - 40.8). The major causes of ocular injury were plants/branches (n=73, 51.1%), chemicals (n=27, 18.9%), cocoa pod/husk (n=14, 9.8%) and occurred mostly during weeding, harvesting and chemical spraying. Few (n=34, 6.1%) participants reported the use of ocular protection. Fifty-five (38.5%) participants visited the local chemical shops, while 37 (25.9%) visited hospitals/clinics for ocular treatment of their injuries. Conclusion: There is a high rate of ocular injuries among cocoa farmers who make insufficient use of appropriate eye care services. There is the need for eye health education among cocoa farmers in Ghana. Keywords:

INFORMATION PRACTICES DURING LIFE TRANSITION: KOREAN IMMIGRANT WOMEN’S EVERYDAY LIFE INFORMATION SEEKING AND ACCULTURATION

In this dissertation, I explore information practices during life transition in the context of immigration. This study aims to understand how their unique personal, social, and life contexts shape immigration experiences, and how these diverse contexts are related to various information practices that they engage in to resolve daily information needs and achieve immigration goals. In my study I examined daily information needs and acquisition of Korean immigrant women. Data were collected through two interview sessions, diary entries on everyday information seeking up to three weeks, post-diary debriefing interviews to reveal contexts surrounding information practices, and observation sessions. My study shows that one’s accumulated experiences with information-related situations shape the person’s attitudes toward diverse information resources and habitual information practices. Both personal and social contexts surrounding immigrant women change during life transition and shape how they interpret their immigration experiences, what information they need to deal with both daily and long-term goals, and how they modify their information practices to obtain the relevant information in an unfamiliar information environment. Also, life transition of immigration entails changes in immigrant women’s social roles, which engender their daily responsibilities in the new society. These daily responsibilities motivate immigrant women’s everyday interactions with a variety of communities in order to exchange information and conduct their social roles in the new sociocultural environment. While immigrant women had common information needs around culture learning, social roles and associated responsibilities explain differences in their differing information needs and tend to direct daily information practices. The advancement of ICTs allows immigrant women to conduct their social roles in a remote city as well as to maintain multiple connections with both the heritage and host society. Limited cultural knowledge influences immigrant women’s evaluation and use of the obtained information as well as their acquisition of relevant information. This study provides understandings on the role of information during life transition as well as Korean immigrant women’s information practices.