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Co-Opting Alliance With Efficient Grease Theory: An Observational Descriptive Study Of Corruption And Trust Nexus In Political Institutions In West Africa, Yarh Komolo

Dissertations and Theses

This dissertation presents an analysis of the impact of corruption as related to trust in political institutions in select West African nations. Corruption and some of its implicative hues are highlighted, considering such practice is generally an entrenched part of Africa in its economic, political, social, and cultural fabric and lifeline. In respect to the specific region of interest, robust Afrobarometer observational surveys convey data covering 14 of the 16 countries that comprise West Africa, with the exclusion of Guinea-Bissau and Mauritania which lack survey data. The study covers a seven-year period that runs from 2014 to 2021, excluding 2016 …

Developing Public Service Leadership: Understanding The Field Immersion/Comparative Cases Model For Mid-Career Professional Education In Environment And Natural Resources Leadership, Erin M. Steinkruger

Dissertations and Theses

Public administrators in the United States face increasingly complex challenges and are called to leadership by position and in practice. In a hyper-pluralistic society, individuals must lead from where they sit, arbitrating value differences in day-to-day functions and taking on adversity and uncertainty in pursuit of the public good. These individuals are served by a variety of leadership training programs both internal and external to their organizations. This study characterizes the field immersion/comparative cases (FICC) model for public service leadership development and uses a grounded theory approach to build understanding about how individuals learn about leadership; what learning outcomes emerge …

The Factors Contributing To The Resilience Of Thailand's Social Welfare Nonprofit Organizations Since The Onset Of The Country's Prolonged Political Crisis In 2005, Narttana Sakolvittayanon

Dissertations and Theses

Since 2005, nonprofit organizations in Thailand, a transitive country, have experienced survival challenges due to social, economic, and political changes. This study aims to explore the organizational attributes of nonprofit organizations in Thailand that contribute to resilient capacity, which is an ability to survive and continue providing goods and services to fulfill missions when facing challenges. The research questions of this study are what factors have affected the resilience of social welfare nonprofit organizations in Thailand since the onset of the country’s prolonged political crisis in 2005? And to what extent do theories of nonprofit resilience in advanced liberal democracies …

"I Stayed There The Whole Night": Exploring Caregivers' Experiences With The Healthcare System When Caring For A Parent At The End Of Life, Lillian Mehran

Dissertations and Theses

Background: In the United States, there are nearly 53 million individuals serving as caregivers to a loved one. Half of all caregivers are caring for a parent or parent-in-law, and 79% of caregivers are caring for a person aged 50 or older. In New York State, there are an estimated 4.1 million caregivers who collectively provide over 2.6 billion hours of unpaid care, with those caring for a person at the end of life providing twice as many hours of caregiving per week compared to other caregivers. The number of individuals requiring caregiving is expected to increase as a significant …

Increasing Access To Doulas In Oregon: A Delphi Study, Courtney Elizabeth Crane

Dissertations and Theses

Doulas are trained, nonmedical support professionals that provide continuous emotional, informational, physical, and practical support before, during, and after childbirth. Doula care has been shown to reduce the cost of birth-related healthcare, reduce adverse birth outcomes, and increase patient satisfaction and positive birth experience. In 2011 Oregon became the first state to authorize payment expenditures of doula care through Medicaid as a strategy to reduce birth-related health disparities and increase culturally and linguistically appropriate healthcare delivery. The intention of the set of policies and administrative rules was to mandate access to doulas and other types of Traditional Health Workers (THWs) …

Episode Based Payment Models And The Hospital Safety-Net: An Evaluation Of The Center For Medicare And Medicaid Services’ Comprehensive Joint Replacement Bundled Payment Program, John A. Gravina

Dissertations and Theses

Episode Based Payment Models and the Hospital Safety-net: An Evaluation of the Center for Medicare and Medicaid Services’ Comprehensive Joint Replacement Bundled Payment Program

By John Anthony Gravina

Advisor: Alexis Pozen, Ph.D.

Introduction: Payments for Healthcare services are increasingly being tied to clinical quality, patient experience, health outcomes, and efficiency through value-based payment arrangements (VBP). VBP presents a potential opportunity to reduce healthcare expenditures by requiring providers to take on financial risk associated with the cost and quality of care, therefore aligning payment incentives with the goals of providing higher quality and efficient care. As of 2020, 80 percent of …

'There Are No Bathrooms Available!': How Older Adults Experiencing Houselessness Manage Their Daily Activities, Ellis Jourdan Hews

Dissertations and Theses

Older adults living unhoused encounter limitations and challenges that drastically decrease their wellbeing and quality of life. The purpose of my study was to understand how experiencing houselessness impacted older adults' ability to conduct their activities of daily living (ADLs) and instrumental activities of daily living (IADLs) within their communities. I conducted phone interviews with older adults aged 50 and older who experienced houselessness in the Portland metro area. The participants described the persons and places that shaped their community life when they were living unhoused, and they described how those entities intervened to alleviate barriers to daily activities. The …

Gender Role As A Mediating Factor In Gender Pay Equity Analysis, Jillian Ann Girard

Dissertations and Theses

The gender wage gap has been persistent despite the introduction of new laws designed to address the disparity. One of the challenges in addressing this inequity is the lack of complete understanding of the driving factors of the pay gap. One yet unexplored factor is the impact of the gender role, which is a social role based on sex/gender which provides a structure and expectations for social relationships. The purpose of this research was to explore the relationship between gender role, biological sex, and base pay. A matched, cross-sectional sample drawn from large U.S. cities was utilized to test the …

Outsiders Within Inequality Regimes: A Sociological Framework To Advance The Lives Of Women Veterans, Sarah Louise Aktepy

Dissertations and Theses

This three-paper dissertation examines pervasive gender inequalities across two institutions: the US military and Department of Veterans Affairs (VA). The first paper, "'Don't Rock the Boat:' Experiences and Perceptions of Gender-Based Violence in the U.S. Military" uses qualitative interviews to better understand the experiences of gendered harassment and violence of women veterans in the US military. The second paper, "First Do No Harm: Assessing Veterans Affairs Screening for Military Sexual Abuse among our Nations Veterans" uses survey data and qualitative interviews to identify factors that contribute to inaccurate results of clinical screening for veterans with military sexual violence histories within …

The Role Of Strategic Governance In Reducing Infant Mortality Under Crisis Conditions, Lynn Christine Finley

Dissertations and Theses

The infant mortality rate (IMR) in some developing countries has decreased faster than the global average even though these countries lack strong economic growth, good governance, and democracy (often acknowledged precursors to improved health outcomes). What accounts for the improvement of the IMR in the absence of these traditional pathways to health gains? Some scholars suggest that the concept of "strategic governance" might help direct attention to intermediary factors that reduce neonatal deaths in countries that experience crisis conditions. The main objective of this dissertation is to investigate the set of governance practices that have reduced IMR in two such …

The Reproductive Health And Academic Impact Of The New York City School-Based Health Center Reproductive Health Project For Adolescents, Michelle Silverio

Dissertations and Theses

Background: Gaining an understanding of how school reproductive health policies impact adolescent sexual health and academic outcomes is a public health priority in the United States (U.S.) since it has the highest rates of adolescent pregnancy and sexually transmitted infections among developed nations. Adolescence is a critical developmental period and influences in this period affect reproductive health and social well-being over a person’s entire lifespan. Almost all adolescents spend the majority of their time in school settings; therefore local school reproductive health policies may have substantial lifetime impacts. Policies such as providing comprehensive sexual health education and contraceptive access in …

The Role Of The Academic Analyst In Shared Governance, Rebecca Ann Mathern

Dissertations and Theses

This research explores the roles of academic professionals in higher education, specific to how they engage in decision-making processes. Academic professionals provide important functions in higher education work but there is little in the literature about these actors and their contributions to leadership and governance. A literature review triangulated role theory, organization theory, and the shared-governance field of study to bring together actors within higher education and compare their involvement based on the shared-governance model in operation at different institutions. The researcher introduced the hypothesis that when registrars are not involved in curriculum management, there may be negative effects on …

Rates Of Developmental And Behavioral Screening Of Young Children: Implications For Health Care Policy And Practice, Shirley Berger

Dissertations and Theses

Background: The skills and capacities developed during early childhood are the foundation for a child’s future academic functioning, economic productivity, and lifelong health and mental health. When young children have developmental delays or disabilities, early identification and intervention lead to better outcomes; however, only a minority are identified before school entry. Primary care is an important setting for identification of developmental and behavioral conditions as most young children attend well-child visits regularly and parents expect developmental guidance from pediatricians. Two key pediatric preventive services are recommended: developmental monitoring/surveillance at every well-child visit and developmental screening at 9 months, 18 months, …

Nonprofit Hospital Community Benefit Requirements: An Exploration Of National Health Policy Models, Justin P. Swearingen

Dissertations and Theses

Introduction: Nonprofit hospital organizations are public charities with complete tax immunity. Such exemptions are worth $24.6 billion and impact the health of hundreds of millions of people, yet what these charities must do to meet the current “community benefit standard” to maintain their tax-exempt status remains a policy debate. To help inform policymaking, an evaluation of four national requirement models was performed: Tax Value Requirement (at least the value of the tax exemptions must be spent on community benefit), Grassley Requirement (at least 5% of revenue must be spent on community benefit), Expense Requirement (at least 3% of expenses must …

The New York City Childcare Influenza Vaccine Mandate: A Case Study, Amy E. Metroka

Dissertations and Theses

Background. In 2014, New York City (NYC) became the third jurisdiction in the United States (US) to enact a childcare influenza vaccine mandate, after the states of New Jersey and Connecticut. The mandate was enacted by the NYC Board of Health by amending the NYC Health Code. The mandate’s goal was to increase vaccination rates among 6-59-month-olds attending city-regulated public and private childcare programs, including prekindergarten, to protect children, families, and the community against influenza. Children younger than 5 years are at high risk for severe illness and complications from influenza. Children are also known to be a major source …

Challenges, Experiences, And Future Directions Of Senior Centers Serving The Portland Metropolitan Area, Melissa Lynn Cannon

Dissertations and Theses

A growing body of research emphasizes the development of an understanding of the relationship between older adults and their physical and social environments (Wahl & Weisman, 2003). Researchers, planners, policymakers, and community residents have been increasingly interested in shaping urban environments as places that foster active aging and independence among older adults. Senior centers have served a critical role in their communities as focal points for older adults, as individuals or in groups, to participate in services and activities that support their independence and encourage their involvement in and with the community (NCOA, 1979). The aging of the population and …

The Consolidation Of The Consociational Democracy In Lebanon: The Challenges To Democracy In Lebanon, Micheline Germanos Ghattas

Dissertations and Theses

This dissertation looks at democracy in Lebanon, a country that has a pluralistic society with many societal cleavages. The subject of this study is the consolidation of democracy in Lebanon, described by Arend Lijphart as a "consociational democracy". The research question and sub-question posed are:

1- How consolidated is democracy in Lebanon?

2- What are the challenges facing the consolidation of democracy in Lebanon?

The preamble of the 1926 Lebanese Constitution declares the country to be a parliamentary democratic republic. The political regime is a democracy, but one that is not built on the rule of the majority in numbers, …

Women's Actions And Reactions To Male Migration: A Case Study Of Women In San Juan Guelavía, Oaxaca, Mexico, Julie Boyles

Dissertations and Theses

Using a mixed methods, interdisciplinary case study approach, this research project explores the benefits, risks, and challenges of male migration for women who reside in San Juan Guelavía, Oaxaca, Mexico. In a unique approach in the field of migration studies, this project considers not only women whose husbands have migrated--absent husbands--but also the impact of male migration on women whose husbands have returned as well as women whose husbands have never left--anchored husbands. Women with returned husbands and even women with anchored husbands feel the threat, worry, and fear that male migration could, at an unknown point in the future, …

Euthanasia, The Ethics Of Patient Care And The Language Of Propaganda, Elizabeth Maria Krapf

Dissertations and Theses

This thesis is an examination of euthanasia, eugenics, the ethic of patient care, and linguistic propaganda in the Second World War. The examination of euthanasia discusses not only the history and involvement of the facility at Hadamar in Germany, but also discuss the current euthanasia debate. Euthanasia in World War II arose out of the Nazi desire to cleanse the Reich and was greatly influenced by the American eugenics movement of the early 20th century. Eugenics was built up to include anyone considered undesirable and unworthy of life and killed many thousands of people before the invasion of allied troops …

Lost In Translation : Ideas Of Population Health Determinants In The American Policy Arena, Maria Gilson Sistrom

Dissertations and Theses

A growing body of research reveals the determinants of population health to be social, political and economic, yet health policy in the United States remains largely individualistic (Evans, Barer, & Marmor, 1994). At the same time research is revealing these structural determinants of health, measures of population health in the United States are worsening in comparison to other developed countries (Bezruchka, 2001). Explanations for this include the influence of culture, medical, public health and governmental institutions and historic development and processes on health policy. Researchers hold to a view of the policy process that is informed by science, yet policy …

Measuring Community-Engaged Departments: A Study To Develop An Effective Self-Assessment Rubric For The Institutionalization Of Community Engagement In Academic Departments, Kevin Kecskes

Dissertations and Theses

Change in American higher education is occurring at a rapid pace. The increasing reemergence of civic or community engagement as a key component in the overall landscape of American higher is emblematic of that change. Academic departments play a critical role in higher education change, including institutionalizing community engagement on campuses. Yet, designing a way of measuring community engagement specifically at the level of the academic department has not been undertaken.

Based on advice from national expert/key informant interviews and the recognition of the importance of the role of academic departments in the overall institutionalization of community engagement in higher …

The Effects Of Parent Care And Child Care Role Quality On Work Outcomes Among Dual-Earner Couples In The Sandwiched Generation, Angela Rickard

Dissertations and Theses

Research has shown that more men and women are occupying multiple roles as employees and caregivers to a child or an elder. The proliferation of women in the U.S. workforce since the 1960's has resulted in a “typical” American family that no longer consists of an employed father and stay-at-home mother, but rather one in which the father and mother both work outside the home. Indeed, the “dual-earner” family is the dominant family form in the U.S. today and into the foreseeable future. The aging and increased longevity of the American population, coupled with changes in the level and timing …

American Indian Elderly And Long-Term Care : Interorganizational Barriers To The Use Of Oregon's Home And Community-Based Medicaid Waiver, Jo Lynn Isgrigg

Dissertations and Theses

Developing culturally supportive long-term care services for Native American elderly has gained increasing attention on the federal level. On the state level, Oregon's Senior and Disabled Services Division (SDSD) possesses a federal Medicaid waiver that allows for the development of home and community-based long-term care services. While this waiver is culturally neutral, its value is that it would allow tribal governments within Oregon to develop their own culturally supportive home- and community-based services, yet none have done so.

The purpose of this study was to determine why senior service agencies of tribal governments within Oregon have not participated in the …

The Value Of Independence In Old Age, Paula C. Carder

Dissertations and Theses

Why is independence a central theme for proponents of assisted living facilities? How do assisted living providers respond to this theme? These questions are pursued in an ethnographic study centered on Oregon's assisted living program. Assisted living facilities (ALF), defined and monitored by Oregon's Senior and Disabled Services Division (SDSD), are a type of housing for disabled, primarily elderly, persons. Oregon Administrative Rules (OAR-411-56) define independence, requiring ALF providers to support resident independence.

Using social worlds theory as a sensitizing concept, assisted living is treated as a distinct social world. The activities of key groups, including SDSD staff, an ALF …

The Effects Of Mentoring On Work-Parenting Gains And Strains In A Sample Of Employed Predominately Female Afdc Recipients, Charlene Rhyne

Dissertations and Theses

Nationally, as well as locally, the emphasis in public assistance is to assist clients in becoming job ready. To this end, Oregon received waivers necessary to implement an innovative welfare reform effort, JOBS Plus Program (JPP), in 1994. The JPP provided subsidized employment for welfare recipients through the cashing out of public assistance benefits and Food Stamp monies. Employers were required to provide an on-site mentor for subsidized employees as a condition of agreement to participate in the Program.

Mentoring has been shown to positively impact employee overall job satisfaction, tenure, salary and promotion. While mentoring has been seen traditionally …

Cost-Benefit Analysis Of Physician Assistants, Roderick Stanton Hooker

Dissertations and Theses

This study examined if physician assistants (PAs) are cost-beneficial to employers. In an era of cost accountability, questions arise about whether a visit to a PA for an episode of care differs from a visit to a physician, and if PAs erode their cost-effectiveness by the manner in which they manage patients.

Four common acute medical conditions seen by PAs and physicians within a large health maintenance organization were identified to study. An episode approach was undertaken to identify all laboratory, imaging, medication and provider costs for these diagnoses. Over 12,700 medical office visits were analyzed and assigned to each …

Behavioral And Community Impacts Of The Portland Needle Exchange Program, Kathleen Joan Oliver

Dissertations and Theses

Research questions were: 1: Will Drug Injectors Use An Exchange In A StateWhere Syringes Are Legal? 2: Will Drug Injectors Using An Exchange Decrease Risky Behavior? 3: Will Frequent Clients Change Risk Behaviors More Than Infrequent Clients? 4: Will Drug Injectors Using An Exchange Change Risk Behaviors More Than A Comparison Group Not Using An Exchange? 5: Does An Exchange Have An Impact On The Number Of Discarded Syringes On The Streets? 6: Is There A Difference In The Rate Of Spread Of HIV Infection Among Users And Non-Users Of The Exchange. Drug injectors will use needle exchange programs, even …

Physical And Environmental Features That Contribute To Satisfaction With Hospice Facilities, Arezu Movahed

Dissertations and Theses

Improving the quality of remaining life for individuals who are terminally ill and their families is an issue that has become increasingly important in recent years. This issue has evolved from perceived deficiencies of conventional health care institutions in meeting the needs of people who are in the final stages of their life, when curative measures are no longer deemed appropriate. In response to deficiencies in care of the terminally ill and their families, there has been a movement toward humanizing conventional health care and making it more holistic. Hospice care, which is consistent with this movement, has evolved as …

The Impact Of Collective Bargaining On The Civil Service Merit System In Oregon, David K. Blanchard

Dissertations and Theses

This study examines the impact of collective bargaining on the civil service merit system in the State of Oregon. Four topics of current interest are explored. The first is a discussion of the status of collective bargaining and the civil service merit system legislation. The second topic is an analysis of the extent to which the day-to-day administration of public sector personnel functions is determined by the relative influence of collective bargaining agreements and civil service rules. The third is the impact of the collective bargaining model on the integrity of the merit principle. The final topic addressed by this …

Oregon Primary Care Physicians' Support For Health Care Reform, Timothy Alan Baker

Dissertations and Theses

This dissertation studies Oregon primary care physicians' attitudes toward health care reform. Two models of reform are examined: one, health care rationing such as that proposed by the Oregon Health Plan (OHP); and, two, support for national health insurance (NHI).

This work examines the necessity for changing the present health care system, traced from the early origins of the medical profession to the present day health care "crisis." The high cost of health care is examined and an overview of the OHP is provided, including citations from John Kitzhaber, M.D., author of the plan.

Overall, Oregon primary care physicians overwhelmingly …