1,721,033 research outputs found
Collaborative Care Models for Behavioral Healthcare Services Integration
No full textThesis (Ph.D.)--University of Washington, 2023Despite the widespread evidence of the effectiveness of integrated behavioral healthcare interventions at improving health outcomes, particularly among patients with comorbid chronic illnesses, their adoption into primary care delivery settings remains slow. This study evaluates the Collaborative Care Model, an evidence-based integrated behavioral healthcare intervention, in two different implementation contexts: a low-barrier HIV clinic in Seattle, Washington where care for depression and opioid use disorder was integrated into primary care, and four urban diabetes clinics in India where care for depression was integrated into diabetes care. The study had three distinct aims: to elicit the anticipated barriers and facilitators to implementing the Collaborative Care Model in low-barrier HIV care, to evaluate the acceptability and feasibility of the Collaborative Care Model in low-barrier HIV care, and to conduct a mediation analysisevaluating the effect of change in self-stigma on diabetes outcomes as mediated by depression symptom severity in urban diabetes care in India. We found that while the patients and stakeholders at a low-barrier HIV clinic were receptive to implementing the Collaborative Care Model, they identified as barriers the availability of resources in the inner implementation setting; practical concerns about the perceived contextual fit with low-barrier HIV care; and its anticipated suitability due to the burden of other behavioral health comorbidities and complete socio-economic needs. The Collaborative Care Model was acceptable and feasible to implement in a low-barrier HIV clinic but only with key adaptations to core interventions to improve its contextual fit. Of the 175 eligible patients, 36% of were screened, 24% were referred, 15% completed an intake, and 9% progressed to the engaged step of the care cascade. Whereas logistical challenges in the inner implementation setting and staff perceptions of its feasibility hindered patient progression through the care cascade from screening through engagement, the Behavioral Health Care Manager’s ability to exemplify the clinic’s values and culture, qualities underscoring patient satisfaction, facilitated patient progression through the care cascade. Depressive symptoms did not mediate the effect of change in self-stigma on diabetes outcomes and self-stigma scores did not vary longitudinally comparing patients being treated for depression via the Collaborative Care Model to enhanced standard of care in urban diabetes clinics in India
Effects of co-occurring stigmas on PTSD and depression among African American women living with HIV who use substances
No full textThesis (Master's)--University of Washington, 2019Introduction: Intersectional stigma has been shown to have negative impacts on behavior and health outcomes. Few research studies have incorporated both internalized HIV stigma and substance use stigma into a single analysis, and none looking at their relationship to mental health illnesses amongst African American women living with HIV and consume substances. Methods: A cross-sectional analysis of baseline data taken from a HIV stigma reduction randomized control trial was used to examine the relationship between internalized HIV stigma, substance use stigma, and mental health illnesses (PTSD and Depression) amongst African American women living with HIV and who consume substances. We examined PTSD and depression symptoms amongst the population, and used multiple linear regression to analyze the relationship between both stigmas and mental health related illnesses. Results: Fifty-four participants were enrolled in this study, ranging in age from 23 to 61 years. The mean year living with HIV was 14.3 (SD = 7.5). We found that 85.2% reported significant levels of PTSD symptoms, while 44.4% reported moderate depression symptoms. Internalized stigma was associated with moderate depression symptoms (0.38; p < 0.01) and significant PTSD symptoms (0.46; p<0.001). Substance-use stigma showed a trend between moderate depression symptoms (0.23; p=0.07) and significant PTSD symptoms (0.23; p=0.06). Discussion: Our findings demonstrates a relationship between intersectional stigmas and mental health illnesses. Further studies are needed to better understand the complex relationship between intersectional stigmas, HIV status, and mental health outcomes
Cancer Care Providers’ Knowledge and Attitudes Towards Women’s Cancer in Peru
No full textThesis (Master's)--University of Washington, 2018Abstract Cancer Care Providers’ Knowledge and Attitudes Towards Women’s Cancer in Peru Lucia J Rodriguez-Alvizo Chair of the Supervisory Committee: Deepa Rao Department of Global Health In Peru, cancer is the second leading cause of death with an expected increase in new cases. Women comprise 64.4% of new cases with breast and cervical cancer having some of the highest prevalence, mortality, and morbidity. This study utilized mixed-methods to analyze cancer care providers’ knowledge and attitudes during a 2015 Pan American Health Organization’s conference on women’s cancers. Surveys measured knowledge, stigma, and fear as potential barriers to quality of cancer care before and after conference participation. In focus group discussions, providers identified barriers and facilitators to breast and cervical cancer detection and treatment. Paired t test analyses demonstrated an increase in knowledge after conference participation. In addition, providers identified individual (fear, shame, anticipated stigma), interpersonal (gender norms, marital relationships, and lived experience of social network), organizational (structural health system barriers and community based communication), community (stigma), and policy (Plan Esperanza) level barriers and facilitators. Thus, our study showed that educational conferences could be an avenue to increasing provider knowledge. Also, the providers highlighted the importance of social networks, family and social support when strengthening and developing efforts to engage women in care
Going Beyond Counting First Authors in Author Co-citation Analysis
No full textThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
A qualitative analysis of health care provider perceptions of depression and suicidality in Mozambique
No full textThesis (Master's)--University of Washington, 2016-06Aim: The purpose of this study is to identify and describe health care provider explanatory models, beliefs, attitudes, and practices regarding depression and suicidality in Sofala Province, Mozambique. Background: There is currently limited knowledge about the prevalence of mental health conditions in Mozambique, particularly regarding more common mental disorders such as depression. Mozambique was recently listed as having the 7th highest suicide rate in the world. A lack of data and available treatment for common mental disorders contributes to cycles of poor mental health and poor physical health, while impeding efforts to improve access and availability of culturally appropriate mental health care in Mozambique. There is minimal qualitative research regarding stigma related to mental health in Sub-Saharan Africa. Methods: We targeted health care providers to serve as key informants based on their respective mental health care knowledge. An in-depth interview (IDI) guide was used in conducting 25 semi-structured interviews of clinical providers knowledgeable on mental health in the community, and providers working in units with both high patient contact and high potential for depression and/or suicidal ideation. Findings: Analysis revealed that most providers perceive a high prevalence of depression and suicide, with both of these issues cited as a mental health concern that should be treated. Providers indicated that patients had a limited knowledge of mental health services, and expressed a desire for increased training themselves. Isolation, familial and relationship conflict, and HIV diagnosis were common causes for depression and poor mental health, and many providers suggested a need for incorporating community and families in treatment. Conclusion: There is a need to address stigma reduction by means of community education around mental health care, and health care provider knowledge of and comfort addressing depression and suicidality. Linkages should be strengthened between HIV care and mental health care
A Systematic Review: Mental Health Impact of Stigma and Discrimination against South Asian Religious Minorities
No full textThesis (Master's)--University of Washington, 2021We conducted an in-depth, systematic review using content analysis to investigate the mental health impact of religious-based stigma and discrimination among members of South Asian religious minority groups residing in predominantly white, Christian countries: the United States, Canada, member states of the United Kingdom and Australia. We defined South Asians as any member of the diaspora originating from the following countries: Afghanistan, Bangladesh, Bhutan, India, Pakistan, Nepal and Sri Lanka. The aim of this review is to identify and describe the mental health outcomes, including risks for and protective factors against poor mental health outcomes associated with stigma and discrimination faced by South Asian religious minoritie
Risk and Protective Factors of Posttraumatic Stress Disorder (PTSD) Among African American Women Living with HIV
No full textThesis (Master's)--University of Washington, 2017-06African American women comprise an estimated of 64% new infections among women of all races in the US. In this study, we have set out to examine the complex nexus of Posttraumatic Stress Disorder (PTSD) and HIV infection among African American women. Two hundred and thirty-nine African American women living with HIV participated in this cross-sectional study. We examined age, marital status, level of education, stigma and social support as independent variables and PTSD symptoms as the dependent variable using logistic regression. We analyzed the bi-variate associations between each variable and PTSD symptoms, and then constructed a multi-variable model which controlled for all variables simultaneously. Our findings revealed that 67% of the women reported clinically significant PTSD symptoms. Also, age, education, internalized stigma, and social support are associated with PTSD symptoms. Education, older age, and social support were protective factors against PTSD symptoms. Finally, our findings suggest that understanding of PTSD symptoms in this population may be paramount to improving prevention, care, and treatment
A Qualitative Analysis of Early Identification of Pediatric Hearing Loss and Early Intervention Services for Families in Mongolia
No full textThesis (Master's)--University of Washington, 2020There are four equally important elements that must be in place in a continuum of care for successful outcomes in young children with hearing loss learning to listen and speak: a) early identification of hearing loss, b) family engagement, c) hearing technology, and d) access to local professionals with expertise in habilitation services (audiology, early intervention). The aim of this study was to understand the experience in Mongolia for those families who choose the listening and spoken language communication modality after their babies and young children are identified with hearing loss. The study had two objectives: 1) to elicit strengths and weaknesses in the current delivery of pediatric hearing health care services in Mongolia for children with hearing loss learning to listen and speak from newborn hearing screening to habilitation, and 2) to identify cultural, economic, and social enablers and barriers that motivate or demotivate families as they progress along the continuum of care. A qualitative study design was used. Semi-structured in-depth interviews were conducted with 26 individual Mongolian family members of babies and young children with hearing loss who either use hearing aids or cochlear implants or are in the process of obtaining such hearing technology. Focus group discussions and interviews were administered with 41 Mongolian medical professionals and therapists who provide pediatric hearing services to rural and urban populations and with four Mongolian government representatives. Thematic content analysis was applied to the data using inductive coding in the context of a grounded theory approach. Analysis revealed strengths and opportunity areas at each stage of care which contributed to varying family experiences in obtaining pediatric hearing health care services for their children with hearing loss. Results indicated that expanding existing pediatric hearing health care services and professional expertise beyond the capital of Ulaanbaatar, increasing awareness about pediatric hearing loss across Mongolian society, and providing additional financial aid to families would contribute to advancing pediatric hearing health care services in Mongolia. Investment in these areas would enable more of their children with hearing loss to access the essential support they need to learn to listen and speak and reach their potential
An exploratory study of perinatal depressive symptoms and its intersection with intergenerational coresidence among women in Kavrepalanchok, Nepal
No full textThesis (Master's)--University of Washington, 2023This qualitative study delves into the intricate dynamics between perinatal depressive symptoms and intergenerational coresidence, with a specific focus on the relationship between perinatal women (pregnant women and new mothers up to 12 months postpartum) and members of the elder generation (parents and parents-in-law) living in the same household to identify the potential risks and protective factors associated with intergenerational cohabitation that influence perinatal depressive symptoms. Twenty-two in-depth interviews were conducted with perinatal women in Kavrepalanchok district of Nepal using semi-structured interview guide. The participants were identified purposefully through administration of demographic survey and a clinically validated Nepali version of PHQ-9. The interviews were audio-recorded, transcribed, and translated in English for thematic analysis conducted using Dedoose 9.4.20.Eleven major themes were identified that highlighted the challenges faced by perinatal women within the context of intergenerational coresidence and the benefits associated with child rearing. This study shed light on the common sources of stress, such as incompatible value systems, assumed subordination, poor relationships, ineffective communication, and poor coping mechanisms that are potential risk factors influencing presentation of depressive symptoms. Positive interactions and effective communication between the two generations, as well as spousal support, were identified as significant factors that might mitigate risk of perinatal depression. The study highlights the crucial role of family context and support in influencing perinatal depression, and underscores the need for culturally sensitive support systems and family-centered interventions that address the challenges faced by perinatal women in intergenerational households
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