Health Sciences - Theses, Dissertations, and other Required Graduate Degree Essays

Receive updates for this collection

Lost in translation? A critical exploration of Aboriginal mental health reform in the Interior Health

Author: 
Peer reviewed: 
No, item is not peer reviewed.
Date created: 
2009
Abstract: 

Given the history and legacy of colonialism, Aboriginal peoples suffer from disproportionately higher rates of mental health issues than non-Aboriginal Canadians. Mirroring recent political achievements by Aboriginal peoples, British Columbia’s health authorities are committed to closing this gap in health in partnership with Aboriginal peoples. Using institutional ethnography this study examines Aboriginal mental health reform as it is unfolding in Interior Health (IH). The impact on Aboriginal participation and cultural appropriateness of services is explored. Although IH’s reform holds promise in the move to Aboriginal empowerment and healing, this research describes the tensions that arise from the intersection of neoliberal, colonial and bio-medical ideologies embedded within the mental health care system. These tensions have resulted in paradoxical policy outcomes that undermine meaningful Aboriginal participation and culturally appropriate mental health policies and services. The results of this study are relevant generally to policy makers and providers in Aboriginal mental health.

Document type: 
Thesis
File(s): 
Supervisor(s): 
Marina Morrow
Department: 
Faculty of Health Sciences - Simon Fraser University
Thesis type: 
Thesis (M.Sc.)

Advocacy strategies for government sponsored public health agencies: the BCCDC a case study

Peer reviewed: 
No, item is not peer reviewed.
Date created: 
2009
Abstract: 

The Public Health Agency of Canada includes advocacy as a core competency for public health practice in Canada, yet many public health professionals feel that they are unable to fulfil this requirement due to their proximity to the government. While advocacy in public health is a well-researched area, strategies to overcome the differing barriers dependent on an agency’s placement in the public health environment are less well understood. This paper highlights some of the barriers identified by nine (9) program managers, employees, and communication personnel at the British Columbia Centre for Disease Control. Christoffel’s conceptual advocacy framework is used to categorize the advocacy efforts that government-sponsored agencies can engage in. Recommendations to overcome these barriers are proposed based on methods employed by other government-sponsored agencies.

Document type: 
Thesis
File(s): 
Supervisor(s): 
S
Department: 
Faculty of Health Sciences - Simon Fraser University
Thesis type: 
Project (M.P.H.)

Confronting structural violence in sex work: lessons from a community-led HIV prevention project in Mysore, India

Author: 
Peer reviewed: 
No, item is not peer reviewed.
Date created: 
2009
Abstract: 

Evidence from community-led HIV prevention projects suggests that structural interventions may result in reduced rates of HIV and STIs. However, the complex relationship between empowerment and confronting stigma, discrimination and physical abuse necessitates further investigation into the impact that such interventions have on the personal risks for sex workers. This article aims to describe the lived experiences of members from a sex worker’s collective in Mysore, India and the ways in which they have confronted structural violence with various social actors and institutions. The collection of narratives highlights experiences of violence and the development and implementation of strategies that have altered the social, physical, and emotional environment for sex workers. Building an enabling environment has been key to reducing the personal risks inherent to sex work for this community, emphasizing the importance of community-led structural interventions for sex workers in India.

Document type: 
Thesis
File(s): 
Supervisor(s): 
John O'Neil
Department: 
Faculty of Health Sciences - Simon Fraser University
Thesis type: 
Project (M.P.H.)

Political identities, presumed definitions, and protean portrayals: representations of the public-private healthcare debate in Canadian print media

Peer reviewed: 
No, item is not peer reviewed.
Date created: 
2009
Abstract: 

The Canadian debate over public versus private delivery and financing of healthcare has been extensively represented in the news media and is an important issue to the public and policymakers. News media has complex and varied influences on its audiences including informing the public and potentially influencing the policy debate. This study explores the representation of the public-private healthcare debate in three Canadian newspapers over time. Using constructed-week sampling, I selected articles published between September 3, 1985 and February 23, 2009 containing search words related to the debate. I coded articles for content, agenda setting, and framing characteristics. The public-private debate was predominantly represented as a political issue and privatization was framed negatively. The agenda setting potential of the articles suggested a potential duality in the role of news media as potential agenda setters and communication agents for the policy debate.

Document type: 
Thesis
File(s): 
Supervisor(s): 
L
Department: 
Faculty of Health Sciences - Simon Fraser University
Thesis type: 
Project (M.P.H.)

How religion in the media portrays reproductive health in secular states: Roman Catholic agenda-setting in Philippine broadsheets

Peer reviewed: 
No, item is not peer reviewed.
Date created: 
2009
Abstract: 

A media agenda-setting study was conducted to measure the coverage of reproductive health issues in a secular country with a dominant religion, using Roman Catholicism and the Philippines as a case study. A content analysis of eighty-one reproductive health stories from January to June 2008 were analyzed for topic, inclusion of Catholic reference (yes or no), and position (pro-life, prochoice, pro-life and pro-choice, or no position). A purposeful sample of newspapers was chosen according to percent readership in the Philippines. Family planning (32.0%) and HIV/AIDS/STIs (16.0%) were the most frequently covered reproductive health topics. The majority of articles were neutral and held no position. Approximately half (50.6%) of all articles included a Catholic reference to illustrate the topic, and when these articles were analyzed further, a slight majority of these stories were positioned as pro-life. Implications of Roman Catholic agenda-setting in the media on reproductive health are discussed.

Document type: 
Thesis
File(s): 
Supervisor(s): 
Nicole Berry
Department: 
Faculty of Health Sciences - Simon Fraser University
Thesis type: 
Project (M.P.H.)

The Philippine women of Canada’s live-in caregiver program: ethical issues and perspectives

Author: 
Peer reviewed: 
No, item is not peer reviewed.
Date created: 
2009
Abstract: 

The Live-in Caregiver Program (LCP) exists under Canada’s immigration policies. Working as live-in caregivers for two years gives individuals the opportunity to apply for permanent residency. The proportion of LCP workers has been overrepresented by Filipinas. By 2000, Filipinas made up 87 percent of all LCP caregivers. Using an ethics lens, this paper explores issues surrounding Filipina caregivers in the LCP. Joan Tronto’s (1993) work on ‘moral boundaries’ helps examine how existing societal boundaries perpetuate some of the issues negatively affecting Filipina caregivers. Kant’s Categorical Imperative and Michael Burawoy’s (1990) typology of labour lead discussions around the choice and consent of Filipinas in entering and remaining in the LCP. Young’s (2006) ‘structural processes’ was employed to direct attention to socially structured injustices experienced by Filipinas. This paper concludes with the moral duties and obligations of the various actors involved and recommends changes to relevant aspects of the LCP.

Document type: 
Thesis
File(s): 
Supervisor(s): 
Jeremy Snyder
Department: 
Faculty of Health Sciences - Simon Fraser University
Thesis type: 
Project (M.P.H.)

Communities adapting to climate change: emerging public health strategies

Author: 
Peer reviewed: 
No, item is not peer reviewed.
Date created: 
2009
Abstract: 

Local governments throughout North American are mitigating greenhouse gases (GHGs) and adapting to the impacts of climate change. This project utilizes a case-based approach to address the question, “How does health promotion and public health practice influence municipal climate change adaptation?” The project reviewed resource materials and interviewed staff members from ten selected Canadian and American local government ‘leaders’ in adaptation. To provide a public health perspective, staff members from Toronto Public Health and Vancouver Coastal Health were also interviewed. Results demonstrate that there is a disconnect between many local health authorities and their respective municipality. The case studies illustrate the need to employ community-based strategies, recognize leaders in local governments and utilize strategic partnerships while adapting to climate change. Further research is required to understand how local governments can be proactive in preventing and mitigating the negative health and wellbeing consequences of climate change.

Document type: 
Thesis
File(s): 
Supervisor(s): 
T
Department: 
Faculty of Health Sciences - Simon Fraser University
Thesis type: 
Project (M.P.H.)

Incorporating intersectionality and gender-based analysis in the Vancouver Coastal Health Authority: recommendations to improve immigrant health research, policy, and program development

Author: 
Peer reviewed: 
No, item is not peer reviewed.
Date created: 
2009
Abstract: 

This paper examines gender differences in an immigrant health report produced by the Vancouver Coastal Health (VCH) authority in 2008. Gender is a determinant of health particularly relevant to immigrant health. The immigrant health report illustrates multiple gender differences in access to health services, in migration experiences, and in health status among immigrants in the VCH region. The information in the report suggests that the health needs of female immigrants are not being adequately recognized within existing VCH programs and policies. A review of Canadian literature reveals that current health care policies and services across Canada often fail to recognize existing research on gender differences within the health needs of immigrants. This paper recommends the incorporation of gender-based analysis and intersectionality within immigrant health research, policy, and program development in VCH. If incorporated, these frameworks could enhance the ability of VCH to address the diverse health needs of immigrants.

Document type: 
Thesis
File(s): 
Supervisor(s): 
Marina Morrow
Department: 
Faculty of Health Sciences - Simon Fraser University
Thesis type: 
Project (M.P.H.)

Treatment limitations imposed by antiretroviral therapy: a comparison of first line regimens containing boosted-protease inhibitors and non-nucleoside reverse transcriptase inhibitors

Author: 
Peer reviewed: 
No, item is not peer reviewed.
Date created: 
2009
Abstract: 

NNRTI-based ART is mainly used as first-line treatment for HIV in resource-limited settings. Anecdotal evidence suggests a greater chance of resistance from failing NNRTI-based regimens compared to boosted-PI. Development of resistance mutations among individuals who initiated ART with boosted-PIs were compared with those who initiated ART with NNRTIs in a retrospective study of ART-naïve individuals in BC, Canada. A total of 1666 participants initiated ART with 818 (49.1%) on NNRTI-based regimen. Participants who initiated NNRTI-based regimens had more resistance mutation compared to those on boosted-PI (40.3% vs. 27.3%, p <0.001). After switching therapy to second line, the odds of achieving two consecutive pVLs of <50 copies/ml after switching was inversely associated with NNRTI use in the initial ART regimen (OR: 0.32; 95% CI: 0.11 - 0.97). The use of NNRTI-based first-line regimens was associated with more ART drug resistance patterns which limit the number of available second-line drug choices.

Document type: 
Thesis
File(s): 
Supervisor(s): 
Robert Hogg
Department: 
Faculty of Health Sciences - Simon Fraser University
Thesis type: 
Project (M.P.H.)

Determinants of HIV drug resistance testing in British Columbia

Author: 
Peer reviewed: 
No, item is not peer reviewed.
Date created: 
2009
Abstract: 

International therapeutic guidelines recommend HIV drug resistance testing as an important part of routine clinical practice in HIV/AIDS treatment and care. This study aims to examine the factors that determine who gets tested for HIV drug resistance in a setting where access to HIV care is free of charge. Clinical and socio-demographic data from a prospective cohort (LISA) of HIV-positive persons on HAART in British Columbia (BC) was collected at the BC Centre for Excellence in HIV/AIDS. Independent associations between key explanatory variables and the probability of having been tested before or after starting HAART were analyzed via logistic regression. The findings suggest that in BC, a setting with free access to HIV care, resistance testing is not consistently carried out. Furthermore, several explanatory variables were predictive of who is likely to be tested. The clinical community will benefit from a review of the implementation levels of resistance testing practice.

Document type: 
Thesis
File(s): 
Supervisor(s): 
Edward Mills
Department: 
Faculty of Health Sciences - Simon Fraser University
Thesis type: 
Project (M.P.H.)