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LeGrow, Tracy L. "Access to health information and health care decision-making of women in a rural Appalachian community." Huntington, WV : [Marshall University Libraries], 2007. http://www.marshall.edu/etd/descript.asp?ref=746.
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Stilp, Curt Carlton. "Rural Interprofessional Health Care Education: a Study of Student Perspectives." PDXScholar, 2017. https://pdxscholar.library.pdx.edu/open_access_etds/3624.
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As the cost for health care delivery increases, so does the demand for access to care. However, individuals in a rural community often do not have access to the care they need. Shortages of rural health care professionals are an ever-increasing problem. The Affordable Care Act of 2010 sought to increase health care access by focusing on team-based care delivery. Thus, the need to educate health care students in the fundamentals of team-based practice has led to an increased emphasis on Interprofessional Education (IPE). While past research focused on urban IPE, a literature gap exists for the effects of a rural team-based educational experience on practice location decisions. This study examined how rural IPE influenced health profession students' perspectives of what it means to be a member of a rural health care team and explored what factors go into making decisions of where to live and provide care. Motivational Theory provided the framework for a mixed methods approach with data from student reflective journaling and a post-experience Q sort. Analysis yielded important understandings about the impact of rural IPE. Accordingly, having a rural IPE experience provided positive motivation for returning after graduation. Further, the time spent in rural IPE generated understandings of what it means to live and provide care to a rural community. One important new discovery gained is the clinical setting is not where most IPE took place. As a result, social interactions with fellow students and community members achieved the goals of rural IPE. Despite these influential findings, noted barriers to genuine rural IPE persisted. In the end, students, educators, and rural health care professionals need to be aware of the multiple factors that guide decisions of where to live and provide care.
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Rashid, Hussein Mansour Haj. "Provision and use of health and education services in rural Balqa, Jordan." Thesis, University of Southampton, 1989. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.329186.
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Weber, Amy Judith, Olubunmi Kuku, and Edward Leinaar. "Differences in Access to Contraceptive Services Between Rural and Non-Rural Clinics in South Carolina." Digital Commons @ East Tennessee State University, 2018. https://dc.etsu.edu/asrf/2018/schedule/125.
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Unintended pregnancies, defined as either being unwanted or mistimed, represent a major public health challenge. Roughly half of all pregnancies in the United States are unintended, and have been associated with poor health and economic outcomes for infants, children, women, and families. Modern contraceptives have been proven to be both safe and effective in reducing unintended pregnancy. This is particularly true for long-acting reversible contraceptive (LARC) methods, which are associated with both higher user satisfaction and overall efficacy as compared to short-acting methods. We therefore investigated types of contraceptive services offered among rural and non-rural clinics in South Carolina. A survey was developed; all clinics in South Carolina who offer contraceptive services were invited to participate. Completion of the survey was voluntary and an incentive was provided. The survey was multi-faceted, covering several aspects of contraceptive care including scope of services provided, availability of resources, and training received. Of primary interest to this research, is the extent to which highly effective contraception methods, such as LARCs, are available in both urban and rural clinics. Findings suggest that access to highly effective LARCs is not equitable among rural and urban clinics. Approximately 62% of urban clinics offered LARC methods, compared to 36% among rural clinics (p=0.0015). These data indicate that women who reside in a rural locale have significantly lower access to these more effective contraceptive methods. As nearly 25% of women within the United States reside in a rural locale, the need to address barriers to access to contraceptive care is essential. This work will be a useful tool in understanding barriers to contraceptive care utilization and can lead to the development of novel programs to reduce the rate of unintended pregnancy, births and abortions, and corresponding savings in health care costs.
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Carter, Nakia, and Rick Wallace. "Collaborating with Public Libraries, Public Health Departments, and Rural Hospitals to Provide Consumer Health Information Services." Digital Commons @ East Tennessee State University, 2007. https://dc.etsu.edu/etsu-works/8682.
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East Tennessee State University Quillen College of Medicine Library (ETSUQCOML) developed a training program to enable public libraries, public health workers, and rural hospital staff to be consumer health information providers. Four NN/LM-developed classes were taught to public libraries. Regional public library directors were invaluable in obtaining the concurrence of their boards for release time for class attendance. Classes were also developed for the public health workforce and rural hospital staff. Five-hundred thirty-three students attended the classes. Fifty-two public library workers will receive the MLA's Consumer Health Information Specialist certification. Thirty-one public libraries have joined NN/LM. All ordered MedlinePlus marketing materials for their libraries from InformationRx.org.
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Hulst, Samantha. "Diabetes Self-Management Education Service at a Rural Minnesota Health Clinic." Diss., North Dakota State University, 2019. https://hdl.handle.net/10365/29399.
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In 2015, there were an estimated 30.3 million Americans living with diabetes, and 95% of them were diagnosed with type 2 diabetes (T2D) (Centers for Disease Control and Prevention, 2017b). Patients living in rural America have an increased prevalence of diabetes, and their participation rates in preventative care practice are lower (Rutledge, Masalovich, Blacher, & Saunders, 2017). The increased prevalence of the T2D in rural communities does not positively correlate with the number of diabetes self-management education (DSME) services in these areas, which poses a gap in healthcare services (Rutledge et al., 2017). Diabetes self-management education can be defined as ?the process of facilitating the knowledge, skill, and ability necessary for diabetes care? (Powers et al., 2015, p. 71). Diabetes self-management education has shown to decrease participant?s A1c by as much as 0.9%, which has been associated with a 25% reduction in microvascular complications, a 10% decline in diabetes-related mortality, and a reduction in all-cause mortality by 6% (Chrvala, Sherr, & Lipman, 2016). The utilization of DSME services in rural health clinics has the potential to improve health outcomes by decreasing complications directly related to diabetes in those patients participating in the service. The practice improvement project established a pilot DSME group service, which was consistent with the Standards of Medical Care in Diabetes - 2019 (ADA, 2018d). The practice improvement project was structured using the Chronic Care Model and Model for Improvement to help provide a functional and sustainable DSME service. The overall goal of the practice improvement project is to have the organization continue the service after the conclusion of the practice improvement project. The practice improvement project yielded positive results. The organization?s surveys indicated strong support for the service and the ability of the DSME service to fill a gap in their current diabetic education. The DSME participant?s skills and confidence increased through completing the curriculum, positively correlated to improved glycemic control. The organization?s stakeholders also felt that the service would be marketable to the organization?s patient population and profitable by increasing quality numbers and providing the opportunity for reimbursement.
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White, Connie Mae. "Diabetes education guide for primary care providers in Montana." Montana State University, 2005. http://etd.lib.montana.edu/etd/2005/white/WhiteC0505.pdf.
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Getz, William L. "Social Workers' Perceptions of a Rural Emergency Mental Health Trauma Service." ScholarWorks, 2017. https://scholarworks.waldenu.edu/dissertations/3607.
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Studies have shown that emergency mental health trauma (EMHT) services can significantly reduce the long-term effects of trauma after a disaster. However, rural municipalities may find they do not have the capacity to create such a service, or may not realize that their disaster planning includes no provision for emergency mental health care. Such was the case in a rural island community in the state of Washington, where, in 2014, several residents initiated a discussion that helped to identify the community's lack of EMHT services. This project, framed by action research and based on collaboration theory, sought to advance the potential for the community's 21 resident social workers to address this issue collaboratively. Accordingly, the project's research question asked how social workers on south Whidbey Island perceived the issue of a rural EMHT service in their community. Data consisted of responses from 8 participants who completed mailed questionnaires and participated in brief telephone interviews. Descriptive coding analysis of the data confirmed a nearly universal lack of knowledge about an EMHT service, a clear perception of the need for such a service, and a unanimous commitment from the respondents to participate in addressing this problem. Such collaborative activity is expected to have a positive impact on the micro, mezzo, and macro levels of social work practice in south Whidbey, as well as on the community itself, not only in spearheading a dialogue about EMHT but also in activating a group of social workers who had no prior association.
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Ngongo, Ngashi. "Health System Predictors of Antenatal Care Compliance Among Rural Congolese Women." ScholarWorks, 2016. https://scholarworks.waldenu.edu/dissertations/2038.
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Fewer rural Congolese women complete 4 antenatal care (ANC) visits than do urban women, despite high maternal and child mortality rates. This quantitative cross-sectional survey applied Andersen's behavioral model of service utilization to examine whether the ANC facility type, provider type, provider gender, time to ANC facility, cost, and number of services can predict ANC compliance among rural women. The study was a secondary analysis of the 2015 Maternal and Child Health (MCH) survey, which comprised 1,280 eligible women selected through stratified random sampling. The analysis included bivariate and multivariate logistic regressions. The findings showed that women seen in private facilities, AOR = 2.220, 95% CI [1.384, 3.561], p < .01; women seen by female providers, AOR = 1.407, 95% CI [1.055, 1.877], p < .05; and women receiving 7 to 9 ANC services, AOR = 1.680, 95% CI [1.142, 2.472], p < .05, were more likely to complete 4 ANC visits. The cost of services and time to the ANC facility had no association with ANC compliance. Further analysis showed that private facilities provided more services (median of 6 vs. 5, p = .000) and had more women attended to by doctors (11% vs. 2%, p = .000) and female providers (72.9% vs. 58.4%, p < .001). These findings suggest that service quality and provider gender play a role in ANC compliance in rural areas. Therefore, Congolese health authorities should establish quality improvement programs and incentives to attract female providers to rural areas. This study contributes to positive social change by identifying ANC access barriers of rural populations and informing future efforts to close the urban-rural gap in MCH outcomes.
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Belcher, Michael D. "The Impact of a Rural School-Based Health Center on Students and Their Families in Sneedville, Tennessee: A Case Study." [Johnson City, Tenn. : East Tennessee State University], 2004. http://etd-submit.etsu.edu/etd/theses/available/etd-0331104-125143/unrestricted/BelcherM040804f.pdf.
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Thesis (Ed. D.)--East Tennessee State University, 2004.Title from electronic submission form. ETSU ETD database URN: etd-0331104-125143. Includes bibliographical references. Also available via Internet at the UMI web site.
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Olanrewaju, Folawiyo S., Ayotola Falodun, Muhammed Jawla, Patricia Vanhook, and Stacey McKenzie. "Hepatitis C Virus Screening in Federally Qualified Health Centers in Rural Appalachia." Digital Commons @ East Tennessee State University, 2019. https://dc.etsu.edu/asrf/2019/schedule/90.
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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.
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Kersting, Ann L. "Listeria monocytogenes, zoonotic exposure, rural residency, and prevention." Columbus, Ohio : Ohio State University, 2008. http://rave.ohiolink.edu/etdc/view?acc%5Fnum=osu1221751504.
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Musekiwa, Norbert. "State Failure' in provision of education and health services in Zimbabwe: Adjustments, adabtations and evolving coping stratergies of rural communities, 2000-2007." Doctoral thesis, University of Cape Town, 2010. http://hdl.handle.net/11427/3758.
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The study is an analysis of how two rural communities in Zimbabwe adapted and responded to the decline in health and basic education services between 2000 and 2007. From 2000, Zimbabwe faced socioeconomic and political challenges that have been characterised as the "Zimbabwean crisis". The state became unable or unwilling to provide adequate education and health services to the majority of its citizens. The study sought to determine the nature and extent of the emerging coping strategies to a decline in the state service delivery. Hirschman‟s analysis of exit, voice and loyalty influenced the theoretical framework guiding the study. The reformulated framework incorporates three types of exit, three types of voice, three types of direct action, two types of loyalty, and other alternative options such as apathy and spiritualism. The methodological framework entailed a case study approach of two rural communities in Zimbabwe. The study purposely selected Maotsa and Shumba communities because of their individuality and diversity in terms of geography, socioeconomic conditions and the range of health and education services provided. Data gathering involved conducting semi-structured interviews and focus group discussions in the two communities between July 2007 and June 2008. The study employed the membership categorization device to analyse data from the interviews. The responses were also post coded and analysed with Statistical Package for Social Scientists version 16. The statistical analysis complemented the qualitative analysis. The study established that communities and individuals responded to the decline of public services through a multiple of strategies. The prominent responses included exit, voice, direct action and a sense of hopelessness and apathy all occurring in multiple variants. In the face of declining public services, the communities responded by going beyond the exercise of voice in the original Hirschman formation of complaining and protesting to collectively cooperating or individually acting to provide the public goods in place of those previously provided by the state. Unlike traditional voice in which consumers seek corrective action by others, Shumba and Maotsa community restored the public services through voluntary local contributions of labour, money and materials. Arising from previous failures at cooperative effort, the Shumba community was less successful at collective action. Due to increased poverty incidence, the alternative of producing public goods locally was not enduring and the communities invariably sought to leverage external donor support. Shumba community was more successful in attracting external support for community projects.
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Osedeme, Fenose, Sylvester Olubolu Orimaye, Jones Antwan, Timir K. Paul, Jerry G. Dr Blackwell, Matthew J. Budoff, and Hadii M. Mamudu. "Individual and contextual factors associated with subclinical atherosclerosis in diabetes patients in rural Central Appalachia." Digital Commons @ East Tennessee State University, 2018. https://dc.etsu.edu/asrf/2018/schedule/55.
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Background: The prevalence of diabetes is disproportionately distributed in Central Appalachia compared with other regions in the U.S. Previous research reveals that nearly 65% and 17% of patients with diabetes reported having history of cardiovascular heart disease (CHD) and coronary artery disease (CAD) respectively. This study examined the prevalence of factors associated with subclinical atherosclerosis (measured as coronary artery calcium) in patients with diabetes in geographic locations of rural Central Appalachia.
Methods: The study population consisted of 2479 asymptomatic individuals from the rural Central Appalachian region of Kentucky, North Carolina, Tennessee, and Virginia between August 2012 and November 2016. Descriptive analysis was completed for the total sample size with sub analysis of individuals with diabetes. T-test was used for comparison of categorical (example: hypertension and physical inactivity) and continuous variables (example: age and BMI), respectively. In addition, multinomial logistic regression was conducted to assess the association between multiple risk factors including CAC scores, and geographic locations of patients with diabetes in rural Central Appalachia.
Results: There was no significant difference between ages for diabetic and non-diabetic patients. Individual factors which are associated with diabetes include current CAC score (p<0.001, CI: 45.90 – 189.98), BMI (p<0.001, CI: 3.01 – 5.64), sedentary lifestyle (p<0.005, CI: 0.039 – 0.215), history of CAD (p<0.001, CI: 0.08 - 0.19), hypercholesterolemia (p<0.001, CI: 0.64 – 0.23), and hypertension (p<0.001, CI: 0.18 – 0.34). There was no significant correlation between geographic locations and diabetes. Among male and female genders, hypertension, hypercholesterolemia, history of CAD, sedentary lifestyle, current CAC score, and BMI have a significant positive correlation with diabetes except for self-reported obesity which only has a significant positive correlation with the female gender.
Conclusion: Individual factors remain associated with diabetes across the male and female genders regardless of the geographic locations of the diabetic patients in rural Appalachia. There is strong evidence that cardiovascular related factors could be associated with diabetes across both genders in rural Central Appalachia. We suggest the implementation of evidence-based public health strategies to address the modifiable behaviors that can improve the health of people in rural Central Appalachia.
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Palmer, Ryan Tyler. "Exploring Online Community Among Rural Medical Education Students: A Case Study." PDXScholar, 2013. https://pdxscholar.library.pdx.edu/open_access_etds/990.
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There is a severe shortage of rural physicians in America. One reason physicians choose not to practice, or persist in practice, in rural areas is due to a lack of professional community, i.e., community of practice (CoP). Online, "virtual" CoPs, enabled by now common Internet communication technology can help give rural physicians the CoP experience they traditionally have lacked, despite their remote practice locations. Therefore, it is important for rural medical education programs to provide technological experiences that give students the skills needed to create virtual CoPs in future rural practice contexts.
The Oregon Rural Scholars Program (ORSP) provides such a technological experience in the form of the Student Clinical Round (SCR) activity. ORSP students located in remote, rural parts of Oregon "meet" in a synchronous online space (i.e., a virtual meeting room) with a faculty member, where they participate in the SCR activity via video chat, screen and document sharing, real-time collaborative note taking, and text chatting. The literature indicates that activities like the SCR may be precursors to virtual CoPs, and therefore it is important to better understand the ORSP SCR as it could be a strategy for creating virtual CoPs among rural practitioners.
As the ORSP SCR is a novel educational approach among U.S. rural medical education programs, an intrinsic case study design was used to explore the impact of the SCR activity on one cohort of ORSP third-year medical students. Additionally, the study sought to better understand the nature of the ORSP students' experiences of having participated in the SCR. Recorded SCR sessions were coded using the Community of Inquiry (CoI) framework, a well validated methodology for analyzing higher education online learning. The CoI analysis revealed a movement of the group away from an individual, task focus towards a community, collaborative focus as the SCR sessions progressed. Additionally, student interview and field notes analyses revealed that the SCR experience reduced isolation, increased sense of community and positively influenced rural practice choice among the study participants.
Conclusions drawn from this study are that the online ORSP SCR experience provides a strong social constructivist learning environment, thus creating the context for virtual CoP emergence. Additionally, the SCR activity is capable of generating an actual virtual CoP, an event directly observed during the study.
Recommendations call for rural medical education programs as well as current rural practitioners to adopt similar online approaches to group learning, as such approaches may provide contexts for virtual CoP formation, thus contributing to the likelihood future physicians may become and current physicians may persist as rural practitioners.
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Whitfield, Benjamin, Leigh D. M. D. Johnson, and Jodi Ph D. Polaha. "Costs and Benefits of Patient Home Visits in a Family Medicine Residency Program." Digital Commons @ East Tennessee State University, 2019. https://dc.etsu.edu/asrf/2019/schedule/136.
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Home visits are a required training component of many Family Medicine residency programs in the United States. However, they are becoming less popular due to such factors as increasing resident responsibilities, decreasing reimbursement, and a decline in resident intention to incorporate home visits into future practice. This study’s aims are: (1) to evaluate the current practices of one Family Medicine residency training program’s time and resource expenditure to conduct home visits, and (2) to evaluate resident and faculty experiences of home visits. Residents and faculty in a Family Medicine training program were provided with a 12- question survey immediately after completing a home visit. A total of 19 surveys from residents and faculty were collected and analyzed. Average reported time spent per home visit was 90 minutes (range = 50-180 minutes), and the home visit teams included an average of 4 members (range = 2-6 members). The providers felt that they knew their patients and the patients’ circumstances better after the home visit with a score of 4.1 (on a 1-5 scale with 5 being a positively framed statement). Resident opinions were neutral (average score 3.1 on a 1-5 scale) regarding whether they found home visits to be educational to their residency training in Family Medicine. Residents also had mixed feelings (average score 2.9) regarding whether they would perform more home visits during their residency training if given the opportunity. Most faculty members (5/7) indicated they had done home visits during their residency training and all faculty (7/7) felt that home visits added value to their training in Family Medicine. Finally, qualitative recommendations were collected from respondents which may allow this training program to improve home visits in the future. Overall, significant time is currently being spent conducting home visits, with a difference in perceived efficacy between residents and faculty. Future research may include a cost analysis to quantify financial value, as well as expanding data collection to other Family Medicine residency training programs to improve generalizability.
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Cardoso, José Leandro Rocha. "Educando os educadores: ciências sociais e educação sanitária na experiência do SESP (1950-1960)." reponame:Repositório Institucional da FIOCRUZ, 2009. https://www.arca.fiocruz.br/handle/icict/6138.
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Previous issue date: 2009O presente trabalho aborda a utilização dos estudos em ciências sociais no direcionamento das atividades de educação sanitária no Serviço Especial de Saúde Pública, durante a década de 1950. Na Seção de Pesquisas Sociais, os cientistas, influenciados pelos estudos de comunidade, se dedicaram à tarefa de interpretar o modo de vida do sertanejo, promovendo estudos sobre seus hábitos, sua cultura e seus referenciais de cura, a fim de dar suporte teórico e metodológico às atividades de educação sanitária e promover a elaboração de estudos socio-econômicos, visando a organização comunitária das populações rurais. As diretrizes sociais para a atuação do SESP, definidas como marco inicial para a construção de uma dita moderna saúde pública, foram transmitidas aos demais profissionais do SESP por meio de cursos de formação, folhetos, revistas, boletins e livros publicados, como o livro A Educação dos Grupos, que constituíram o suporte teórico por meio do qual seriam formados os educadores de saúde pública do SESP, que, a rigor, deveriam ser todos os seus funcionários, ligados direta ou indiretamente à função de educar, para fins de saneamento, a população rural.
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Girio, Erin L. "Kindergarten Screening and Parent Engagement to Enhance Mental Health Service Utilization." Ohio University / OhioLINK, 2010. http://rave.ohiolink.edu/etdc/view?acc_num=ohiou1283178607.
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McLernon, Michelle Yvonne. "Risk Propensity, Self-Efficacy and Driving Behaviors Among Rural, Off-Duty Emergency Services Personnel." OpenSIUC, 2014. https://opensiuc.lib.siu.edu/dissertations/837.
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Emergency medical services personnel work in a fast-paced, stressful environment requiring rapid, efficient response to critical situations, creating unique safety considerations within the workforce. With an occupational fatality rate notably higher than average, most of which are attributed to vehicular crashes, compounded by risks faced on rural roadways, rural EMS personnel face unique driving challenges that may be exacerbated by the very traits, self-efficacy and risk propensity, that may have initially drawn them to the profession. The purpose of this study was to identify the extent to which rural EMS personnel engage in off-duty, risky driving behaviors and to examine the relationship between these behaviors and their levels of risk propensity as well as their self-efficacy relative to driving. A cross-sectional, quantitative study was conducted to explore the relationship between the variables. A 63-item survey was completed by 227 rural EMS personnel. The statistical model resulting from this study identifies risky-driving self-efficacy and risk propensity as significant predictors of engaging in risky driving behaviors, with self-efficacy emerging as the strongest predictor. The predictive model fit well within the Social Cognitive Theory construct of triadic reciprocity, providing a platform from which to develop mitigating strategies to foster systemic as well as behavioral changes, while tailoring interventions to highly self-efficacious, risk-taking individuals who gravitate toward risky professions, including rural EMS personnel.
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Bills, George F. "Untangling Neoliberalism’s Gordian Knot: Cancer Prevention and Control Services for Rural Appalachian Populations." UKnowledge, 2013. http://uknowledge.uky.edu/sociology_etds/12.
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In eastern Kentucky, as in much of central Appalachia, current local storylines narrate the frictions and contradictions involved in the structural transition from a post-WWII Fordist industrial economy and a Keynesian welfare state to a Post-Fordist service economy and Neoliberal hollow state, starving for energy to sustain consumer indulgence (Jessop, 1993; Harvey, 2003; 2005). Neoliberalism is the ideological force redefining the “societal infrastructure of language” that legitimates this transition, in part by redefining the key terms of democracy and citizenship, as well as valorizing the market, the individual, and technocratic innovation (Chouliaraki & Fairclough, 1999; Harvey, 2005). This project develops a perspective that understands cancer prevention and control in Appalachiaas part of the structural transition that is realigning community social ties in relation to ideological forces deployed as “commonsense” storylines that “lubricate” frictions that complicates the transition.
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Hepburn, Mary Patricia. "An exploration of environmental understanding among primary health care providers in an Eastern Cape community." Thesis, Rhodes University, 1999. http://hdl.handle.net/10962/d1003415.
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This study explores environmental understanding among the health care practitioners serving a rural community in the Eastern Cape Province in South Africa. During the preliminary phases of the research, the decision was made to adopt a participatory approach to the inquiry as far as was possible. Semi-structured interviews, participant observation and focus group discussions were the techniques chosen to focus the participants' thinking about: the meaning of environment, environmental issues and problems which impact on health, and, environmental education in practice. Comparisons between the recently transformed health education idea proposed by the World Health Organization (WHO), known as "health promotion", and a popular environmental education model are made. It is argued that many of the obstacles to effective health education described by the participants in the study can be overcome by using environmental educationlhealth promotion approaches. The findings show that the health practitioners studied relate to a wide range of environmental issues with varying levels of engagement. They are influenced by changing values, their feelings about indigenous knowledge, and their notions about how people should respond to the environment. An urgent need for more and better communication among the different levels of health practitioners is identified. Finally, it is recommended that health care practitioners be supported with opportunities for professional development which can lead to a confident, seIfreflective approach to health education.
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Briggs-Bolling, Izetta Mounice. "Non Medical Prescription Drug use in Rural Communities and Social Work." ScholarWorks, 2017. https://scholarworks.waldenu.edu/dissertations/4424.
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This study explored the roles and responsibilities of social workers providing services to nonmedical prescription drug users (NMPDU). Researchers have indicated NMPDU disproportionately affects people living in rural communities. The overarching research question sought to explore the concerns of social workers when providing services to patients coping with NMPDU in the rural community of Ulster County, New York. The intention was to examine systemic challenges facing rural social workers when attempting to decrease morbidity risks and increase the health of Ulster County residents. A total of 7 social workers participated in 3 focus groups to explore their ideas for defining, clarifying, and identifying solutions to the problem. The social exchange theory was used to frame the roles and responsibilities of social workers within rural communities at the macro, mezzo, and micro levels. Qualitative content analysis identified 5 themes: roles and responsibilities, barriers, education, treatment interventions, NMPDU and illicit substances of use. The results of the study included advocating for the fair and equitable distribution of resources for all residents coping with NMPDU in Ulster County, their responsibility to collaborate on pressing matters and educate physicians, community service providers, local legislators, individuals, and families of the warning signs and harmful effects of NMPDU. Findings may effect social change by enhancing the role of social workers by reducing overdose and death rates of NMPDUs.
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Van, Hoi Le. "Health for community dwelling older people : trends, inequalities, needs and care in rural Vietnam." Doctoral thesis, Umeå universitet, Epidemiologi och global hälsa, 2011. http://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-47467.
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Background InVietnam, the proportion of people aged 60 and above has increased rapidly in recent decades. The majority live in rural areas where socioeconomic status is more disadvantaged than in urban areas.Vietnam’s economic status is improving but disparities in income and living conditions are widening between groups and regions. A consistent and emerging danger of communicable diseases and an increase of non-communicable diseases exist concurrently. The emigration of young people and the impact of other socioeconomic changes leave more elderly on their own and with less family support. Introduction of user fees and development of a private sector improve the coverage and quality of health care but increase household health expenditures and inequalities in health care. Life expectancy at birth has increased, but not much is known about changes during old age. There is a lack of evidence, particularly in rural settings, about health-related quality of life (HRQoL) among older people within the context of socioeconomic changes and health-sector reform. Knowledge of long-term elderly care needs in the community and the relevant models are still limited. To provide evidence for developing new policies and models of care, this thesis aimed to assess general health status, health care needs, and perspectives on future health care options for community-dwelling older people. Methods An abridged life table was used to estimate cohort life expectancies at old age from longitudinal data collected by FilaBavi DSS during 1999-2006. This covered 7,668 people aged 60 and above with 43,272 person-years. A 2007 cross-sectional survey was conducted among people aged 60 and over living in 2,240 households that were randomly selected from the FilaBavi DSS. Interviews used a structured questionnaire to assess HRQoL, daily care needs, and willingness to use and to pay for models of care. Participant and household socioeconomic characteristics were extracted from the 2007 DSS re-census. Differences in life expectancy are examined by socioeconomic factors. The EQ-5D index is calculated based on the time trade-off tariff. Distributions of study subjects by study variables are described with 95% confidence intervals. Multivariate analyses are performed to identify socioeconomic determinants of HRQoL, need of support, ADL index, and willingness to use and pay for models of care. In addition, four focus group discussions with the elderly, their household members, and community association representatives were conducted to explore perspectives on the use of services by applying content analysis. Results Life expectancy at age 60 increased by approximately one year from 1999-2002 to 2003-2006, but tended to decrease in the most vulnerable groups. There is a wide gap in life expectancy by poverty status and living arrangement. The sex gap in life expectancy is consistent across all socioeconomic groups and is wider among the more disadvantaged populations. The EQ-5D index at old age is 0.876. Younger age groups, position as household head, working, literacy, and belonging to better wealth quintiles are determinants of higher HRQoL. Ageing has a primary influence on HRQoL that is mainly due to reduction in physical (rather than mental) functions. Being a household head and working at old age are advantageous for attaining better HRQoL in physical rather than psychological terms. Economic conditions affect HRQoL through sensory rather than physical functions. Long-term living conditions are more likely to affect HRQoL than short-term economic conditions. Dependence in instrumental or intellectual activities of daily living (ADLs) is more common than in basic ADLs. People who need complete help are fewer than those who need some help in almost all ADLs. Over two-fifths of people who needed help received enough support in all ADL dimensions. Children and grand-children are confirmed to be the main caregivers. Presence of chronic illness, age groups, sex, educational level, marital status, household membership, working status, household size, living arrangement, residential area, household wealth, and poverty status are determinants of the need for care. Use of mobile teams is the most requested service; the fewest respondents intend to use a nursing centre. Households expect to use services for their elderly to a greater extent than did the elderly themselves. Willingness to use services decreases when potential fees increase. The proportion of respondents who require free services is 2 to 3 times higher than those willing to pay full cost. Households are willing to pay more for day care and nursing centres than are the elderly. The elderly are more willing to pay for mobile teams than are their households. ADL index, age group, sex, literacy, marital status, living arrangement, head of household status, living area, working status, poverty and household wealth are factors related to willingness to use services. Conclusions There is a trend of increasing life expectancy at older ages in ruralVietnam. Inequalities in life expectancy exist between socioeconomic groups. HRQoL at old age is at a high level, but varies substantially according to socioeconomic factors. An unmet need of daily care for older people remains. Family is the main source of support for care. Need for care is in more demand among disadvantaged groups. Development of a social network for community-based long-term elderly care is needed. The network should focus on instrumental and intellectual ADLs rather than basic ADLs. Home-based care is more essential than institutionalized care. Community-based elderly care will be used and partly paid for if it is provided by the government or associations. The determinants of elderly health and care needs should be addressed by appropriate social and health policies with greater targeting of the poorest and most disadvantaged groups. Building capacity for health professionals and informal caregivers, as well as support for the most vulnerable elderly groups, is essential for providing and assessing the services.Aging and Living Conditions Program
Vietnam-Sweden Collaborative Program in Health, SIDA/Sarec
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Oldham, Jean Allen. "Dating Violence on Small Rural College Campuses: Are Administrator and Student Perceptions Similar?" UKnowledge, 2014. http://uknowledge.uky.edu/khp_etds/16.
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In recent years dating violence has become more and more prevalent on college campuses. Reports of the range of dating violence vary widely, with studies reporting from 20% to 85% of college women experiencing dating violence. However, almost all research has been conducted among urban and/or large colleges and universities, with virtually no attention to what is happening on small and/or rural college and university campuses.
When a possible 20% of college women have experienced dating violence on college campuses, there becomes a crucial need for administration at a college to have an accurate assessment of the college’s liability, and of the adequacy of the college’s programs and policies relative to dating violence. This study sought to determine whether administrators and female students on small rural college campuses have the same perceptions of the type and incidence of dating violence on their campus, and of the programs and policies the college has put into place to prevent and respond to dating violence. Two domains of perceptions were addressed, dating violence beliefs and experience, and dating violence policy knowledge. The same question was examined to determine if perceptions of resident and commuter students were the same, and if perceptions of under and upper class students were the same. The investigator surveyed 52 college administrators and 306 female students at a total of four small rural college campuses to determine whether administrator and female student perceptions of dating violence incidence/type and dating violence program/policy knowledge at the college were similar.
Results were that administrators tended to have similar perceptions to students as regards dating violence beliefs and experience, although not specific types of dating violence. Students did not exhibit a strong knowledge of dating violence policy. Resident and commuter students displayed similar perceptions to each other, as did under class and upper class students.
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Alves, Hayda Josiane. "Praticas e representações sobre alimentação e saude entre fruticultores da zona rural de Valinhos-SP." [s.n.], 2007. http://repositorio.unicamp.br/jspui/handle/REPOSIP/310853.
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Orientador: Maria Cristina Faber BoogDissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciencias Medicas
Made available in DSpace on 2018-08-09T02:01:18Z (GMT). No. of bitstreams: 1 Alves_HaydaJosiane_M.pdf: 2355220 bytes, checksum: 7eba3c83b150bee451d80785b0d3e041 (MD5) Previous issue date: 2007
Resumo: O estudo foi desenvolvido na linha de pesquisa ¿Trabalho-Saúde-Educação¿, como parte de um projeto do Grupo A3EN ¿ Grupo de Apoio, Aprimoramento e Atualização em Educação Nutricional, tendo como objetivo estudar as práticas e representações sobre alimentação entre fruticultores meeiros, entendendo-as como um processo social, importante na determinação das condições de saúde de uma população. Foi empregada a abordagem qualitativa, por meio de entrevistas não estruturadas, focalizadas. Para análise do conteúdo simbólico utilizou-se a teoria das representações sociais de Moscovici. Os saberes objetivos e subjetivos vinculados ao contexto rural constroem o comportamento alimentar das famílias, dando origem a práticas e representações que influenciam o consumo de alimentos, especialmente de frutas, o cotidiano alimentar na esfera doméstica, o conceito de alimentação saudável, a forma de apropriação da alimentação escolar e as relações do grupo com o setor saúde e com as redes de apoio social. Os homens gerenciam a renda doméstica e realizam a compra de alimentos. O cotidiano alimentar das famílias é condicionado à monotonia alimentar. As verduras e legumes são classificados como alimentos não essenciais. A realização de hortas e a partilha desses alimentos está relacionada a determinadas normas de convivência do campo. As frutas estão mais ligadas à esfera do trabalho na lavoura do que a elementos que as aproximem ao conceito de comida, expresso nas representações: não alimenta; garante a sobrevivência do trabalho familiar no campo representando o sustento familiar. Apesar das frutas cultivadas serem consumidas rotineiramente, frutas são consideradas ¿comida¿ apenas quando compradas. As famílias se percebem como ¿remediadas¿ em relação à condição social, tendo em vista o amparo das redes de apoio social, esta situação as exclui da categoria ¿pobre de verdade¿. O conceito de pobreza está relacionado à garantia de alimentação. Entre os conceitos de alimentação saudável estão: não é algo ligado à rotina; não é essencial; é um objeto de diferenciação social, pois é composta por alimentos especiais, não consumidos diariamente; é uma comida de que se gosta; é uma comida que não faz mal à saúde. O Bolsa Família foi o programa social mais freqüentemente citado, porém, a sua oferta está relacionada ao caráter de sujeição ao programa. As preparações salgadas são mais valorizadas na alimentação escolar por reproduzirem o universo simbólico dos valores vinculados aos alimentos na esfera doméstica. As políticas públicas de saúde e estratégias de intervenção em alimentação em zona rural devem considerar tanto as práticas cotidianas desenvolvidas pela comunidade quanto a subjetividade a elas vinculada
Abstract: This study was developed in the "Work-Health-Education" line of research, as part of a project of the A3EN Group - Group of Support, Improvement and Updates in Nutrition Education, having as its objective the study of the practices and representations related to food among sharecropper fruit producers, understanding them as a social process, important in determining the health conditions of a population. The qualitative approach was used, through non-structured but focused interviews. For the analysis of the symbolic content, Moscovici's theory of social representations was used. The objective and subjective knowledge linked to the rural context constructs the food habits of the families, giving rise to practices and representations that influence the consumption of foods, especially fruit, the everyday domestic eating habits, the concept of healthy eating, the attitude to school meals and the relationship of the group with the health sector and social support networks. The men manage domestic income and the purchase of foodstuffs. The everyday eating habits of the families is conditioned to monotony. Vegetables and legumes are classified as non-essential foods. The keeping of vegetable gardens and the sharing of these foods is related to certain norms of communal living in the country. Fruits are more associated with the world of work in the fields than with elements that approach the concept of food, a process linked with their representations: they are not feeding; they guarantee the survival of family work in the fields representing the upkeep of the family. Even though the fruit grown is consumed regularly, fruit is considered "food" only when bought. The families see themselves as "remedied" in relation to social condition, considering the work of the social support networks, this situation excludes them from the category of "really poor". The concept of poverty is related to the guarantee of food. Among the concepts of healthy food are: it is not something linked to their routine; it is not essential; it is an object of social differentiation, as it is composed of special foods, not consumed daily; it is a food that you like; it is a food that is not bad for one's health. The "Bolsa Família" (Family Benefit) was the most frequently mentioned social programme, however, its availability is related to the form of being subjected to the programme. Salty foods are most valued in school meals as they reproduce the universe symbolizing the values linked to the foods in the domestic sphere. Public health policies and strategies of food intervention in the rural area should consider not only the daily practices developed by the community but also the subjectivity they are linked with
Mestrado
Enfermagem e Trabalho
Mestre em Enfermagem
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Flowers, Lena Butler. "Health education in the Black Rural Church." DigitalCommons@Robert W. Woodruff Library, Atlanta University Center, 2005. http://digitalcommons.auctr.edu/dissertations/3277.
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The purpose of this project was to develop a Health Education program for the Black rural church that would serve to educate and inform the Black church on the health disparities facing a community and to provide programs that lead to healthier lifestyles. The project for this dissertation has three components:
1. Health Fair 2. Health Education Bible Study 3. Enrichment Challenge ( Personal Development of Holistic Healing)
Bellview African Methodist Episcopal Church (AME), located in Aragon, Georgia, was the site of the project. The participants were composed of members of varying denominations in Aragon and Rockmart, Georgia, These communities are know for having "good" church and for their ethnic fellowship meals consisting of fried chicken, seasoned collard greens with "fat back," macaroni and cheese, candied yams, potato salad, hot-buttered cornbread, chocolate and caramel cake, and sweet tea. These meals, typically served during the church fellowship, are high in fat, cholesterol, sugar, and salt. A steady diet like this can lead to hypertension and heart disease further resulting in strokes, heart attacks, and eventual death. It was the purpose of this project to provide meaningful health-related educational intervention that would result in healthier lifestyles. The program presented embraces the concept of holistic health. It provided six elements of health intervention: spiritual, intellectual, emotional, social environmental, and physical intervention strategies.
The Health Fair model gave the participants the opportunity to check for high blood pressure, diabetes, body fat, and disorders of the feet. This provided the individuals with and awareness of various ailments. Small and large group discussions were held throughout the day. The health fair was a first step focused on eliminating the racial disparities in health in the Black rural church.
Te Bible Study model gave the participants an opportunity to study health education with and emphasis on good nutrition. It was a blend of faith and health. Personal development is important to individual growth, therefore, a program of personal development with emphasis on holistic healing was used as a reinforcement activity to strengthen the participant in the area of social, environmental, physical, spiritual and intellectual health. This model of holistic healing with a biblical foundation helped the participant to understand that all six methods of intervention are essential for total healthy growth.
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Myers, Sandra Campbell. "Comprehensive Sex Education in a Rural School District." Youngstown State University / OhioLINK, 2013. http://rave.ohiolink.edu/etdc/view?acc_num=ysu1391689957.
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Ganley, Caitlan. "Knowledge, Attitudes and Beliefs Towards Contraception Among Rural Mozambican Women." Thesis, Icahn School of Medicine at Mount Sinai, 2013. http://pqdtopen.proquest.com/#viewpdf?dispub=1537301.
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Much of Sub-Saharan Africa lags behind the world in reproductive health. The nine villages surrounding Gorongosa are remote rural villages with very limited access to health care, and contraceptive options. A survey regarding the health of women and children in the community was created and every woman between the ages of 15, and 59 was surveyed, a total of 2438 in all. There were many sections but this thesis focuses on the results of the contraception and family planning segment. In this population only 4% of women are using any form of family planning, 8.2% state they would like to, but only 3% state a desire to become pregnant at the point of the survey. Only 17.2% can name a method of contraception, and 27% believe that temporary contraception can lead to permanent infertility. Significant associations were found between knowledge and positive beliefs about contraception and use, or a desire to use contraception, indicating there is a role for educational programs to help inform women of their options and give them the opportunity for reproductive self-determination.
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Galper, Carol Quillman. "Evidence of professional values in a rural medical education program: Implications for medical education leaders." Diss., The University of Arizona, 2002. http://hdl.handle.net/10150/279943.
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Medical education leaders have been concerned about the decline in professionalism among medical students. While many studies have documented the professional socialization of medical students most have simply noted the process or examined the adaptation on the part of the students to the environment of the academic health center. Few have examined the socialization of professionalism, although many articles in the literature have discussed the lack of professionalism seen among medical students and they progress through their medical education. This is seen in students' distancing from patients, adopting the use of dehumanizing terminology when referring to patients and their families, and the decline in psycho-social functioning. There appear to be many factors that have facilitated this decline in professional values. Some include the increasing involvement of managed care in the teaching hospital, requirements for faculty to increase their clinical revenue thus reducing their time spent with students, and relegation of the teaching of medical students to residents. This study examines an alternate environment, the rural site, as one that may favor the adoption of the traditional or core professional values of physicians. This research qualitatively examines student's comments related to their involvement in a rural medical education program. This program, which selects 15 students each year from the entering class of medical students, seeks to nurture interest in rural practice. These medical students appear to have increased exposure to professional values due to their increased time spent in the rural environment. These teaching sites provide an alternative with which to compare the values held and reinforced in the academic health center. The values in the rural environments appear to be different than those in the academic health center, and seem to reflect professionalism in ways that are more consistent with the traditional values of physicians. These values include ones such as service to the community, altruism, honesty, respect and collegiality. The professional socialization of medical students requires the socialization of professional values. The rural medical education sites examined here through the students' comments reflect a different type of experience, one in which professional values are modeled, expected and upheld.
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Lamb, Maxwell, Sean Vinh, Chandler Parris, Emily K. Flores, and KariLynn Dowling-McClay. "Impact on Student Attitudes through Participation in Interprofessional Student Teams at a Remote Area Medical Event in Rural Appalachia." Digital Commons @ East Tennessee State University, 2020. https://dc.etsu.edu/asrf/2020/presentations/18.
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Interprofessional teamwork is being adopted as the best way to care for patients, but it is also important to determine how future healthcare providers view this model of patient care. What are their attitudes and beliefs after having the opportunity to work in an interprofessional team? The primary objective of this study was to determine changes in health profession students’ attitudes toward interprofessional collaboration through participation in a Remote Area Medical (RAM) event in rural Appalachia. Researchers hypothesized that working in interprofessional teams positively impacts students’ attitudes toward interprofessional practice. To explore these variables, RedCap was utilized to collect demographic information, generate a pre/post survey matching code, and administer previously validated interprofessional education (IPE) questionnaires to RAM clinic student volunteers (representing five ETSU health sciences colleges and various undergraduate programs) before and after the event. Students were allowed to voluntarily complete the pre-survey online prior to participating in the event or at sign-in and the post-survey at sign-out or online after the event. The Student Perceptions of Interprofessional Clinical Education-Revised Instrument, Version 2 (SPICE-R2), which is validated for use in pre- and post-surveys, utilized 5-point Likert-type questions (strongly disagree to strongly agree) to evaluate students’ perceptions of their role on the team and the team’s impact on healthcare and patient outcomes. The Interprofessional Collaborative Competency Attainment Scale-Revised (ICCAS-R), which is only validated for use in post-surveys, required students to simultaneously evaluate their ability to perform tangible interprofessional team skills before and after the event using 5-point Likert-type questions (poor to excellent). At the event, students were placed into interprofessional teams to provide care to patients. Faculty members from a variety of professions provided leadership to the teams and guidance as needed. The pre-survey had 107 responses and the post-survey had 108 responses. However, after matching the pre- and post-surveys with student-generated codes, there were 70 valid matched responses. Data analysis was conducted using SPSS version 25. There were no statistically significant changes in SPICE-R2 IPE constructs from the pre-survey to post-survey. However, high pre-survey scores indicated that this student cohort already had a high level of appreciation for interprofessional teams, with mean scores of 4.5 out of 5 for teamwork, 4 out of 5 for roles and responsibilities, and 4.36 out of 5 for healthcare outcomes. The mean overall composite score on the ICCAS-R increased from 3.65 out of 5 on the pre-event portion to 4.03 out of 5 on the post-event portion (p < 0.001) , indicating that students increased their self-evaluated ability to perform tangible skills used in the interprofessional team through participation in the RAM clinic. Findings of this research may allow educators in both classroom and healthcare settings to better understand how hands-on IPE experiences influence students’ interprofessional attitudes and beliefs.
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Owens, Susan J. "Understanding RN workforce education in the rural north-central region of Michigan." Thesis, Indiana University, 2014. http://pqdtopen.proquest.com/#viewpdf?dispub=3609666.
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National calls for a better-educated nursing workforce are proliferating. The Institute of Medicine (IOM) challenged the nursing profession by setting the goal of having 80% of the nation's nurses prepared at the baccalaureate level (BSN) or higher by 2020. This is an ambitious goal given that, nationally, only 50% of nurses have a BSN. In fact, only 40% of nurses in Michigan have a BSN, and in the rural North-Central Region of this state, only 29% (the lowest in the state) of the nurses have a BSN. The purpose of this hermeneutic phenomenological study was to understand and interpret the meaning of being an associate degree (AD) nurse, the meaning attaining a BSN has for rural registered nurses who currently have an AD, and the barriers they experience that inform their decisions to return to school (or not). The investigator interviewed 11 AD nurses from rural North-Central Michigan and analyzed interview transcripts to identify common experiences and shared meanings using methods identified by Diekelmann, Allen, and Tanner (1989). Two themes were explicated in this study: "Getting in and Getting out" and "What Difference Does it Make?" The findings in this study challenge many of the common assumptions about academic progression in nursing and provide educators, administrators, and legislators with insight about the strategies that may be most helpful for achieving the IOM goal in rural Michigan.
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Stidworthy, Jennifer Jane. "The implementation of a portfolio assessment system for a rural clinical school in South Africa : what can be learned from the implementation of portfolios as an assessment system in a rural clinical school." Thesis, Stellenbosch : Stellenbosch University, 2013. http://hdl.handle.net/10019.1/80389.
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Thesis (MPhil)--Stellenbosch University, 2013.ENGLISH ABSTRACT: A portfolio assessment system was designed to meet the needs of a Rural Clinical School education platform, hosting final year MB ChB students for the duration of their final year. A study entitled “What can be learned from the implementation of a portfolio assessment system, to be used in the assessment of clinical reasoning of final MB ChB students placed in a Rural Clinical School in South Africa? “ was conducted. The experience of educators and students during this process was explored. The findings are in keeping with the literature. Van Tartwijk & Driessen 2009, Eley et Al 2002, Lake & Ryan 2004, Burch & Seggie 2008 claim that portfolios drive deep student learning and develop clinical reasoning. Burch & Seggie (2008) offer an assessment tool which has proved feasible within the South African setting on which this portfolio assessment system was modelled. The assessment tool design faced a number of challenges within the RCS setting which were addressed during a review process. The portfolio assessment system is viewed as a work in progress requiring further development. Despite the constraints and challenges, both staff and students unanimously supported the development of patient case studies within the design as a valuable learning tool.
AFRIKAANSE OPSOMMING: ‘n Portefeulje assesserings sisteem is ontwerp om die behoeftes van ‘n UKWANDA Landelike Kliniese Skool opvoedings program wat die gasheer van die MB ChB student tydens hul finale jaar is, na te kom. ‘n Studie genaamd “ Wat kan geleer word uit die implementering van ‘n portefeulje assesserings sisteem, wat gebruik gaan word om die kliniese redenering te bepaal van finale jaar MB ChB student wat geplaas is in ‘n Landelike Klinieke Skool in Suid Afrika? ” is uitgeoefen. Die ervaring van die dosent, so wel as die studente, is ondersoek. Die bevinding is in lyn met die literatuur. Van Tartwijk & Driessen 2009, Eley et Al 2002, Lake & Ryan 2004, Burch & Seggie 2008 beweer dat portfeuljes dryf student tot diep studie en ontwikkel kliniese redenasie. Burch & Seggie (2008) bied ‘n assesserings (hulp)middel aan wat toepaslik en uitvoerbaar is in die SA konteks , waarop die portfeulje assessering sisteem gebaseer is. Die ontwerp van die assesserings (hulp)middel het vele uitdagings binne die RCS opset in die oog gestaar. Dit is aangespreek tydens ‘n proses van hersiening. (Lather, 2006).Die portefeulje assesserings sisteem word gesien as ‘n werk onder hande en vereis verdere ontwikkeling. Ten spyte van die beperkinge en uitdagings het beide die staf en die student onomwonde die ontwikkeling van pasiente gevalle studies, binne die ontwerp, as ‘n waardevolle leermiddel gesien.
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Harris, Lauren. "Migration, Education, and Health Policy: A Closer Look into the Reasons Behind Poor Health Outcomes in Rural Ecuador." Scholar Commons, 2010. http://scholarcommons.usf.edu/etd/3666.
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Despite an increase in the number of Ecuadorian medical professionals, health
outcomes in rural areas of the country have steadily declined over the
past decade. Using a political economic framework and data collected
from interviews with Ecuadorian doctors, government officials, policy makers, and
local rural populations, this thesis investigates how the interplay
among medical migration, educational structures, and public health
policy contributes to growing health disparities between urban and rural dwellers.
Addressing each of these factors both individually and collectively, this thesis also
outlines a series of policy recommendations that will allow the Ecuadorian
healthcare system to better meet the needs of its rural population.
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Cox, Taylor, Claire Gleadhill, William Seagrave, Coty Cooper, Alantis Hunt, Kelly Mitchell, Anthony DeLucia, and Randy Byington. "Promoting Health Education and Literacy in Rural Tennessee: The Go-Packs Pilot Project." Digital Commons @ East Tennessee State University, 2018. https://dc.etsu.edu/asrf/2018/schedule/86.
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Little Milligan Elementary School in rural Carter County, Tennessee was provided with health literacy resources in the form of health education Go-Packs––easily implementable lessons contained in a small storage tote––as part of the community project requirement of the James H. Quillen College of Medicine Rural Primary Care Track Curriculum. These Go-Packs included detailed lesson plans and accompanying materials that were designed to facilitate health education in the classrooms by providing easily deployable lessons for the teachers to utilize. Four Go-Packs were provided for hygiene, oral health, tobacco use, and nutrition that teachers used to augment instruction during teachable moments that arose in their classrooms. Our objective was to determine whether the development and implementation of these Go-Packs increased the amount of health education delivered to the students and determine what barriers persist to provide health education in the classroom. Participants were randomly assigned a number which they placed on their pre and post surveys. A focus group was also conducted to better understand the faculty’s experience utilizing the Go-Packs and where improvements could be made. A paired sample t-test showed no significant differences in pre and post attitudes of teachers at the school. The focus group and survey questions identified the need to improve the usability of specific Go-Packs, map the Go-Packs to state mandated curriculums and target Go-Pack usage towards non-core instructors.
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O'Neill, Jennifer Lynn. "An assessment of health literacy about complementary and alternative medicine in adult residents of Flathead County, Montana." Thesis, Montana State University, 2007. http://etd.lib.montana.edu/etd/2007/oneill/O'NeillJ0507.pdf.
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Brodie, Kimberly Becknel. "Intrapersonal and community-related influences of rural adolescent pregnancy: A mixed-method approach." ScholarWorks, 2009. https://scholarworks.waldenu.edu/dissertations/674.
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The majority of data on adolescent pregnancy pertains to urban communities, therefore, the individual and social influences associated with adolescent pregnancy in rural communities have not been extensively explored. The pregnancy rate among adolescent women aged 15 to 19 in rural Vance County, North Carolina, is 113.7 per 1,000, nearly twice the state average. This sequential mixed-method study used the social ecological model to evaluate the intrapersonal and community-related factors associated with adolescent pregnancy in this rural area. A quantitative survey assessed intrapersonal factors, namely sexual health knowledge, sex-related attitudes, and self-esteem in pregnant or parenting and nonpregnant or nonparenting groups. Two sample t tests revealed significant differences between groups relative to personal sexual values and attitudes toward premarital sex. There were no significant differences between groups for sexual health knowledge scores or self-esteem scores. Qualitative focus group discussions with one group, consisting of pregnant, parenting, nonpregnant, and nonparenting participants, assessed community opportunity structure as a behavior-influencing dynamic. Open-coding analysis revealed perceptions of strained employment and education-related structures, low community expectations of pregnant adolescents, and the influence of peer-related normative beliefs in early sexual intercourse. To bring about social change, community organizations should collaborate to engage participant-driven research while prioritizing the implementation of county-wide, comprehensive sex education programs. Improved programming could repair social norms, increase sexual health knowledge, and encourage personal responsibility over sexual health decisions.
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Ahmed, Shameem. "Breast feeding, weaning and infant growth in rural Chandpur, Bangladesh." Thesis, University College London (University of London), 1988. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.339360.
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Vinh, Sean, Rebecca Maloney, Addison Lawson, and Emily K. Flores. "Impact of Interprofessional Healthcare Student Teams at a Remote Area Medical Event in Rural Appalachia." Digital Commons @ East Tennessee State University, 2019. https://dc.etsu.edu/asrf/2019/schedule/79.
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Interprofessional collaboration in healthcare is vital to the nation’s health and interprofessional education is of significant interest in the current academic climate and practice environment. Remote Area Medical is a non-profit healthcare organization that partners with community hosts to provide dental, vision, and medical services to medically underserved patients in remote areas of the United States and abroad. RAM mobile clinics have served over 785,000 people since their founding in 1985, providing vital healthcare services free of charge through the volunteer services of healthcare professionals. RAM mobile clinics provide an excellent opportunity for interprofessional collaboration and interprofessional education as learners partner with volunteer professionals to serve the community. The RAM mobile clinic in Gray, Tennessee was first established in 2017 and implemented the innovate utilization of undergraduate and graduate health professional students from the East Tennessee State University Academic Health Sciences Center in student teams. Interprofessional student teams along with precepting faculty are flexible in location and services offered to best serve the needs of the mobile clinic at any given time. Interprofessional student teams work to improve patient utilization of services offered at the event and assist with medication histories and health screens while growing student interprofessional patient care skills in the process. The objective of this research is to describe the impact of interprofessional student teams on patient care at the Gray, Tennessee RAM mobile clinic during the first two years. Data was collected from the years 2017 and 2018 by the student volunteer coordinator then analyzed by student researchers. The interprofessional student teams consisted of 87 student volunteers that were training in Clinical and Rehabilitative Sciences, Medicine, Nursing, Public Health, or Pharmacy over the course of the three-day mobile clinic in 2017 and 109 different student volunteers in 2018. Student teams were precepted by interprofessional faculty and logged 2,332 interventions in 2017 and 1,130 interventions in 2018. The top two interventions in 2017 were Medication Histories and Blood Glucose Screens while the top two interventions in 2018 were Medication Histories and Health Screens. Variation in number of interventions logged and type of interventions logged can be explained by event characteristics that differed between the two years. Student participants commented positively on their engagement with one another and discussions they had to better understand each other’s professions between patient encounters. This research attempts to demonstrate that the impact of interprofessional student teams at a RAM mobile clinic is worth the investment of faculty resources in planning and execution to engage student learning while benefitting the patient population being served. This research also provided a hypothesis for additional research to be conducted around the 2019 Gray, Tennessee RAM mobile clinic.
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Samples, Donald A. "A Study on Attitudes of Rural and Urban Respiratory Care Practitioners Toward the Impact of Continuing Education." Digital Commons @ East Tennessee State University, 1998. https://dc.etsu.edu/etd/2972.
Full textAbstract:
The purpose of this study was to examine the preferences, impact, and attitude of respiratory care practitioners toward continuing education. A review of demographic characteristics was conducted to develop a professional profile of practitioners in Tennessee. An assessment of continuing education practices provided information concerning types of courses, preferences, and methods used to meet continuing education requirements. Data collection was made possible through the use of a questionnaire. A stratified random sample was drawn from the 1,966 respiratory care practitioners in Tennessee. Based on the practitioner's residence, 150 practitioners were selected from rural and urban communities. A total of 300 self-administered questionnaires were mailed to practitioners to comprise the sample. Data collection was conducted over a 4 week period with a second mailing occurring after the first 2 weeks. A total of 120 surveys were returned for a response rate of 40%. The findings in this study demonstrated that rural and urban respiratory care practitioners in Tennessee have similar preferences toward continuing education. Respiratory care practitioners felt mandatory continuing education was beneficial and should be retained in Tennessee. This study indicated no differences in the impact of mandatory continuing education on the attitude of rural and urban practitioners. Both groups reported that mandatory continuing education had impacted the attitude of respiratory care practitioners in a positive manner. The study produced findings that revealed differences between rural and urban practitioners most preferred and used methods of continuing education. Urban practitioners indicated an increase involvement of physicians as a method most preferred and used for continuing education when compared to rural respondents. Comparison of rural and urban respondents found both groups preferences for course content were the same. The need for continuing education in various content areas transcends geographical boundaries. The typical respiratory care practitioner tended to be a female between the ages of 26-45, while working as a full-time practitioner in an acute care hospital. However, differences were identified between the two populations when comparing professional characteristics. Most rural practitioners were credentialed as certified respiratory care technicians with urban practitioners identified themselves as registered respiratory therapist.
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Mugo, Ann. "Obesity Among Women in Rural Kenya: Knowledge, Beliefs, and Perceptions." ScholarWorks, 2016. https://scholarworks.waldenu.edu/dissertations/1977.
Full textAbstract:
Obesity or being overweight is a prevalent health concern around the world. Despite the growing problem in developing countries such as Kenya, there is scant literature available on obesity or being overweight among women in rural Kenya. This research study provides information necessary for bridging the gap in understanding the perceptions, beliefs, and knowledge of obesity among women in rural Kenya. This study used the social cognitive theory (SCT) framework to assist in understanding the impact of obesity or being overweight among women living in rural Kenya. Participants were women aged 20 to 45 recruited from a local church in rural Subukia. Using a phenomenological inquiry, in-depth interviews were conducted. Data obtained were analyzed by open coding. Themes that emerged from data analysis showed that less than half of the study participants had an appropriate knowledge of obesity. Participants desired to have big round bodies, as it was perceived as desirable and as being healthy. However, this perception put these women at increased risk of obesity and associated health risks. Implications for positive social change include the use of study findings by policy makers to develop obesity prevention programs. Such programs may promote obesity awareness and obesity prevention strategies. This promotion may include providing education on topics such as healthy nutrition and the importance of physical activity. Policy makers may develop obesity prevention programs aimed at not only educating, but also empowering rural communities to practice healthy lifestyles based on their cultural and social norms. Such empowerment may encourage the adoption of obesity reducing lifestyles and positive behavior change.
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Felix, Geralda. "Rural Haitian Women's Experiences With Poor Health Through Poverty." ScholarWorks, 2017. https://scholarworks.waldenu.edu/dissertations/3987.
Full textAbstract:
People living in rural Haiti lack access to basic health care services due to poverty. Rural poverty in Haiti particularly affects women's health because Haiti has had the highest maternal mortality and infant mortality rates in the Americas, in addition to some of the worst health statistics in the Western Hemisphere. The purpose of this phenomenological study was to cultivate a greater understanding of the poverty factors that affect access to health care services specifically among poor women living in rural Haiti. This study was based on the social ecological model for population health development, theorizing that a person's health is influenced by factors at multiple levels including intrapersonal, interpersonal, organizational, and public policy and community roles. The main research question in this study explored potential relationships between poverty and poor health among women in rural Haiti as it relates to health status and access to health care services. Using semi structured interviews and Moustakas's modified van Kaam 7 steps method for phenomenological analysis, I explored the poverty phenomenon and various aspects of the lived experiences of 12 poor women in rural Haiti. The research findings indicated that factors such as barriers to health care, alternative health care, and poor living conditions contributed to the way that the poverty phenomenon affects the health and lives of poor rural Haitian women. The social change implication for this study includes development of new programs in rural Haiti that improve access to basic health care services together with more accessible clinics and staff on call 24 hours a day, 7 days a week that will positively influence women's health outcomes and health status.
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Falkenburry, Kerry Lee. "A CONTENT ANALYSIS OF THE HEALTH EDUCATION CURRICULUM AT A RURAL SOUTHERN ILLINOIS HIGH SCHOOL USING THE HEALTH EDUCATION CURRICULUM ANALYSIS TOOL (HECAT)." OpenSIUC, 2011. https://opensiuc.lib.siu.edu/theses/654.
Full textAbstract:
The primary purpose of this study was to evaluate an existing high school health education curriculum to determine if it met the Health Education Curriculum Analysis Tool (HECAT) criteria. The secondary purpose was to make recommendations for an 80-session high school health education curriculum to meet most of the criteria of the HECAT. Using the HECAT, the current curriculum at a rural southern Illinois high school was reviewed. A sample 80-session curriculum was developed that addressed many essential health education topics. In the current curriculum, a determination of percentages of functional health concepts met was made. In addition, student skill learning/application and teacher instruction and skill assessment were addressed and ranked.
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Messmer, Sarah Elizabeth. "A Pilot Study on Women's Health Education in Rural Guatemala: Impact on Beliefs and Behaviors." Thesis, Harvard University, 2014. http://etds.lib.harvard.edu/hms/admin/view/60.
Full textAbstract:
Great disparities exist in women’s health outcomes in rural indigenous communities in Guatemala; indigenous women are less likely to utilize family planning and cervical cancer screening services. This pilot study assessed baseline women’s health knowledge and the effects of a comprehensive women’s health course on women’s health knowledge and behaviors. From February to November 2013, 61 participants in a seven-week language-appropriate women’s health curriculum were evaluated before and after the course using a 10-item knowledge assessment. Cervical cancer screening and contraceptive utilization rates were assessed by self-report before and after the course. Several women’s health knowledge deficits were noted: belief that contraception causes cancer, inability to name symptoms of STIs, lack of understanding of pap smears, and lack of familiarity with condoms. The average pre-test score was 54.6%; increasing to 83.7% on the post-test (p<0.0001). 79% had received a pap smear prior to the course; this increased to 92% at the post-test (p=0.013). 53% had utilized contraception prior to the course; at the time of the post-test the percentage was 54% (p=1). This study reveals important patterns in women’s health beliefs in rural Guatemala, and shows that a seven-week curriculum was effective in improving scores on a knowledge assessment.
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Neighbor, Rebecca, Claire Gleadhill, and Kacie Denton. "Viral Hemorrhagic Conjunctivitis Outbreak in Rural Belize." Digital Commons @ East Tennessee State University, 2019. https://dc.etsu.edu/asrf/2019/schedule/196.
Full textAbstract:
ABSTRACT OBJECTIVES:
The objectives of this project are to review current literature regarding conjunctivitis including the pathogens that cause conjunctivitis, how to diagnose and differentiate between viral and bacterial conjunctivitis, and the different modalities to treating the disease with limited resources in rural communities. Then examine an outbreak of viral hemorrhagic conjunctivitis in rural Belize in October of 2017. This includes examining data collected by ETSU Family Medicine Department during health outreach clinics regarding diagnosis made, treatment provided, and comparing this information to a survey collected about social determinants of health. Finally, discuss the importance of disseminating public health education regarding how to limit the spread of contagious infections to a rural population with limited health literacy and access to resources.
METHODS:
In October of 2017 East Tennessee State University (ETSU) Quillen College of Medicine medical students, primary care physicians, and residents traveled to rural Belize to provide free primary care. The clinics consisted of seeing patients at both an established clinic in Roaring Creek, Belize and at remote health clinics in even more rural locations. Many of the patients who presented to the clinics had similar complaints of itchy, red, and productive eyes. Quantitative data was recorded from patient charts regarding their presenting symptoms, diagnosis, and the treatment. The data was organized utilizing microsoft excel and evaluated using SPSS and measures of central tendency. Qualitative data was also collected from interactions with patients and newspaper articles published in Belize about the conjunctivitis outbreak.
RESULTS:
The results showed that a total of 431 patients received care and 52% of them were diagnosed with conjunctivitis. 46.9% of the patients were determined to have viral conjunctivitis, while 2.8% of them had bacterial conjunctivitis. It was discovered that many patients utilized one reusable cloth to wipe their children's eyes repeatedly thus spreading the disease across and throughout the rural communities. It was found through careful conversations with patients that they were putting urine and breast milk into their eyes in hopes that it would help their pink eye. The Belize Ministry of Health Reported that there were 5,343 cases of pink eye countrywide, with a viral strain being more predominant than bacterial.
CONCLUSION:
In conclusion, extremely contagious diseases like conjunctivitis are dangerous in rural developing countries because of lack of education about hygiene and limited resources necessary to contain such diseases. While medication is not effective for viral conjunctivitis, it can have devastating consequences (e.g blindness) if a superinfection is not caught early in the course. Education can be the best medicine especially in cases of viral diseases. Patients were also provided with resources to wash their hands often, sterilized water to flush their eyes, and single use towels. A lesson on conjunctivitis, its complications, and how to prevent the spread of the disease was aired on public television. This reports provides examples of both practice creative ways to spread health literacy in rural populations with limited access to resources.
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Abou-Rizk, Zeina W. "The body image and eating habits of young girls in a rural Ontarian elementary school using the Comprehensive School Health program." Thesis, University of Ottawa (Canada), 2007. http://hdl.handle.net/10393/27567.
Full textAbstract:
The purpose of this study was to develop a better understanding of the body image, eating habits, and health perceptions of girls in a rural Ontarian elementary school using the Comprehensive School Health program. A case-study design was used for this project. Two interviews were conducted with the principal and with the 6th grade teacher. In addition, two focus groups were held with the girls of the 6th grade. The focus groups consisted of group discussions with the girls, the administration of the Collins Body Figures Scale (Collins, 1991), as well as a shortened version of the Children's Eating Attitude Test-26 questionnaire (ChEAT-26) (Maloney, McGuire, & Daniels, 1988). The results showed that there were very few health education initiatives related to body image and nutrition for the grade 6 class of the school, and suggested that the girls had healthy eating habits and low levels of body dissatisfaction.
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Azunie, Naomi Chuiwo. "An Integrated Approach to Malaria Prevention and Control in Rural Cameroon." ScholarWorks, 2017. https://scholarworks.waldenu.edu/dissertations/3971.
Full textAbstract:
Malaria is a life-threatening parasitic disease spread to humans through bites of an infected mosquito. In rural Cameroon, malaria is one of the major causes of morbidity and mortality. Several studies have examined the use of various malaria preventive tools; however, there is insufficient literature available on use of an integrated approach to prevent and control malaria in rural Cameroon. The aim of this study was to provide information necessary for bridging the gap in understanding the proper use of insecticide treated nets (ITNs) and antimalarial drugs and the roles of education and socioeconomic status in malaria prevention and control efforts in rural Cameroon. This quantitative cross-sectional study was guided by the socioecological framework. Secondary data from the 2011 Cameroon Demographic and Health Survey (sample size of 216) was used in this study. The Chi-Square, binary logistic, and multinomial logistic regressions were used to analyze the data. The result revealed that there was a significant association (p < 0.05) between proper use of ITNs and malaria prevalence among children under 5 years old, education and proper use of antimalarial drugs, and socioeconomic status and health seeking behavior. There was also a significant association between healthcare preference and malaria treatment outcomes among children under 5 and pregnant women. These findings may contribute to social change by helping public health officials in Cameron to continue to prioritize local needs and enforce the proper use of available malaria tools in rural communities through an integrated approach to prevent and control malaria in rural Cameroon, especially for children under 5 years old and pregnant women, which would lead to improved quality of life.
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Masters, Paula. "Evaluating Socially Determined Health in Rural Appalachia: Use of the Social Quality Theory." Digital Commons @ East Tennessee State University, 2018. https://dc.etsu.edu/etd/3414.
Full textAbstract:
People living in rural America face unique social circumstances that can prevent them from reaching optimal health status. This fact holds especially true in the rural Appalachian region of the United States where income, education, living circumstances, and lack of resources create an environment that has some of the highest rates of morbidity and mortality in the country. While the rest of the country has seen improvement in many health behaviors and health outcomes, rural Appalachian communities remain unchanged and further behind other regions. In many cases, programming and policy have failed to create a culture of health in Appalachia. Social determinants of the area should be included in interventions and this practice is imperative to achieve effectiveness.
This study examined the social context and definitions of health in a rural, Appalachian community using the Social Quality Theory as a guiding framework. A community-based participatory research approach was adopted and implemented through the use of focus groups. The study generated many meaningful findings. It not only provided a new framework, but also provides an examination of how a rural, impoverished community lacks the social infrastructure to improve health. Current perceptions of health are limited to thoughts of disease or illness and overshadowed by negative social norms. There are few social resources currently available to improve health and a large presence of cultural impediments. Yet this “culture” also provides some advantages and assets that the community may leverage for change.
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Lormis, Jeremy. "Effects of Ethical and Environmental Factors on Rural Counselors." Thesis, Regent University, 2016. http://pqdtopen.proquest.com/#viewpdf?dispub=10107451.
Full textAbstract:
The unique nature, challenges, and demands of rural counseling has been linked to higher rates of burnout and turnover among rural counselors in comparison to their urban and suburban counterparts. The current study examined the relationship between burnout and selected variables among professional counselors working in rural settings. A review of the literature indicated that multiple relationships, confidentiality, competence and training, lower compensation, lack of privacy, and personal and professional isolation were the variables most frequently identified as problematic for rural counselors. Data from 127 respondents were analyzed using multiple regression models. Individually, the independent variables were significant predictors of burnout, however, only confidentiality, lower compensation, lack of privacy, and personal and professional isolation were significant predictors in the multiple regression models.
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Curran, Jeffrey. "BUILDING RESILIENCE AND COMMUNITY CAPACITY: THE SACHIGO LAKE WILDERNESS EMERGENCY RESPONSE EDUCATION INITIATIVE." Thesis, Laurentian University of Sudbury, 2014. https://zone.biblio.laurentian.ca/dspace/handle/10219/2210.
Full textAbstract:
The Sachigo Lake Wilderness Emergency Response Education Initiative represented a
partnership between Sachigo Lake First Nation in northern Ontario Canada, and medical
professionals and university researchers from outside the community. This study was one
component of a larger community-based participatory research program to develop locally
relevant first response training to address the isolation from emergency healthcare in Sachigo
Lake. The aim of this qualitative study was to complete a formative evaluation to understand
how a five-day comprehensive training course implemented in May 2012: (a) met the local needs
of Sachigo Lake; and (b) fostered resilience and community capacity. The results of this study
describe the unique features of delivering first aid training in a remote context and illustrate the
intrapersonal and interpersonal impacts of the program. Health promotion through community based
first aid education is a model with potential to improve emergency care in the absence of
formal emergency medical services.
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Perkins, Renee. "The Influence of Marketing Strategies on Employee Perception of a Small Rural Kentucky Hospital." TopSCHOLAR®, 1992. https://digitalcommons.wku.edu/theses/2716.
Full textAbstract:
A well-known fact relating to health care in the 1990s is the delimma being faced by small rural hospitals across the United States. They are now at a crossroads between survival and closure. This thesis addresses the influence that effective marketing strategies can have on the outcome of rural hospitals if such strategies are targeted to the right populations Although the patients, the community, and the physicians are important target groups, this thesis addresses the impact marketing can have on the employee population and how that population can, in turn, affect community perception.
This is the first study to be done at Caverna Memorial Hospital to indicate employee perception as a result of marketing, and careful research of available literature shows that it may well be one of the first done in a rural hospital in Kentucky on this particular relationship An important premise to this study is the fact that employees need to know that their success as an employee is dependent upon the hospital and, just as important, the hospitals survival can be dependent upon the employees' influence on potential customers.
The study concentrated on outpatient services and took place in a 30-bed hospital located in south central Kentucky. This hospital has economic problems and conditions that make it typical of small rural hospitals across the country.
The instrument utilized for this study is a pretest and posttest questionnaire presented to the entire employee population before and after a period of time when marketing endeavors were undertaken by the hospital. To test the difference of scores between the pretest and posttest, repeated measures Analysis of Variance was used to compare means of both groups. The principle finding was that employees viewed the hospital and its' outpatient services in a more positive light after marketing endeavors had been undertaken.
Since effective marketing endeavors do have the potential of positively influencing employees in a small rural hospital setting, and since hospital employees have the potential of influencing potential customers, hospital administrators may do well to consider budgeting for marketing and directing such marketing tactics to the often forgotten employee population.