D.P.H. - Public Health
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ItemExamining Eye Care in the South Pacific through a Health Systems Strengthening Lens([Honolulu] : [University of Hawaii at Manoa], [August 2016], 2016-08)There is great potential to reduce the incidence and prevalence of visual impairment if concentrated effort is made through interventions that follow the health systems-strengthening framework. This dissertation uses three studies to examine eye care in Pacific Islands Countries and Territories (PICTs) through a health systems-strengthening lens. The first study used qualitative methods to analyze key informant interviews. The key informants represented six nongovernmental organizations (NGOs) active in eye and vision care in PICTs. A grounded-theory approach was used to create a theoretical frame work which was compared to the health systems-strengthening framework. NGOs are active in five of the six health system building blocks, but function in a limited area of those building blocks. The second study used qualitative methods to analyze PICT community expectations of the non-health enhancing aspects of the health system. Eight focus groups were held in two countries: Fiji, and Western Samoa. The focus groups were generally satisfied with the eye care component of the health system. The seven elements of responsiveness were important and applicable in PICT settings although some elements (prompt attention, dignity) were more important than others. The third study used quantitative methods to investigate the level of professional motivation PICT eye care providers have, as well as to determine what, if any, aspects of the health system can predict motivation level, and lastly to determine how NGOs influence professional motivation. PICT eye care providers were highly motivated, but that motivation seems to be intrinsic. PICTs have a highly motivated eye care workforce, despite a perception of a lack of support from Ministries of Health. Communities appreciate having eye care services available, but have concerns with wait times and not always being treated with dignity. Half of respondent NGOs primarily provide clinical services, which is what is least desired by eye care providers. Efforts to strengthen the health system will require, in part, the identification, and support of leaders and a shift of vision NGOs from concentrating on eye care to concentrating on the broader health system. The involvement of community in the planning and decision making process is encouraged.
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ItemUnderstanding Multilevel Factors in Prevention of Cavities among Japanese Children([Honolulu] : [University of Hawaii at Manoa], [May 2016], 2016-05)The objective of this dissertation is to understand multilevel factors in prevention of cavities among Japanese children. Oral health is important to general health and quality of life, and cavities cause irreversible negative damage over the life course. This dissertation consists of three studies. The first study is a systematic review to examine school-based interventions to prevent cavities for elementary school age children in Japan. Of the 13 included studies, 12 tested fluoride mouth-rinsing (FMR) programs. FMR programs appear to be very effective in preventing childhood cavities in Japan, which does not have systemic water fluoridation. The second study was used quantitative methods to examine factors to explain disparities in cavities among 12-year-old children across Japan’s 47 prefectures. Data by prefecture were culled from public databases and analyzed using SPSS. Three factors--average income per person in the prefecture, percentage of schools in the prefecture with school-based FMR interventions, and average numbers of convenience stores per 100,000 persons—explained almost 50% of national variance in cavities of 12-year-old children in Japan. The third study was used qualitative methods to examine barriers and facilitating factors for Japanese parents living in Hawai‘i to prevent cavities for their children. Uninsured status, slow adaptation to the U.S. oral health system by Japanese mothers, and Japanese hesitancy to ask questions were found to be the main barriers. Insured status, high cost for insurance and treatment, and the U.S. check-up appointment system were found to be the main facilitating factors. In conclusion, this dissertation found strong evidence that FMR should be introduced at all schools in Japan as a culturally competent approach to reducing cavities in children. Findings also suggest that municipalities in Hawai‘i need to be aware that short-term residents from Japan have limited knowledge of the U.S. oral health care system. They also have passive attitudes about prevention of cavities in their children due to Japanese policies that provide free annual check-up at schools and low or free treatment. Therefore, policy makers in Japan also need to support programs that teach parents to take more responsibility for preventing cavities in their children.