Health Policy Commons^™

Determinants Of Corporal Punishment And Severe Physical Punishment In Egypt: A Mixed-Methods Analysis For Child Protection Policy, Marwa Moustafa Nassef

Theses and Dissertations

Corporal punishment (CP) and severe physical punishment (SPP) remain a major public health, child rights, and child protection policy concern. In Egypt, despite legislative reforms, survey-weighted analysis of the 2021 Egypt Family Health Survey (EFHS) 2021 (CAPMAS, 2022) reveals prevalence rates of 60.5% for CP and 27.4% for SPP among children aged 1–14 (author’s calculations using EFHS-2021, n=7623), yet evidence distinguishing the determinants of routine corporal punishment from escalation to severe physical punishment remains limited in low- and middle-income contexts. Guided by Bronfenbrenner’s ecological framework, this mixed-methods study identifies key drivers of CP and its escalation to SPP among Egyptian …

Self-Medication And Pharmaceutical Dispensing In Egypt: Practices, Policies, And Regulatory Challenges, Lobna Fawzy Ali Shaheen

Theses and Dissertations

Access to safe and appropriate medications is a critical component of public health, particularly in low- and middle-income countries. In Egypt, self-medication and informal pharmaceutical dispensing have become deeply embedded practices shaped by systemic, economic, and cultural factors. This research explores the complex interplay between self-medication behaviors, pharmaceutical regulation, and healthcare access in Egypt. Through qualitative interviews with policymakers, pharmacists, physicians, industry professionals, and citizens, the research uncovers widespread informal dispensing of prescription-only medicines, driven by high out-of-pocket costs, limited insurance coverage, and high public reliance on pharmacists as primary care providers. Despite the presence of regulatory frameworks, weak enforcement, …

Adapting To Inflationary Pressures: Household Coping Strategies In Urban Egypt (2016– 2025), Mohamed Mohamed Ashraf Kamal

Theses and Dissertations

Over the past decade, Egypt has faced persistent economic challenges including repeated currency devaluations, high inflation rates, subsidy reforms such as the gradual reduction of food and energy subsidies, and the ripple effects of global crises that have significantly impacted household well-being, especially in urban areas. These pressures have eroded purchasing power and heightened food insecurity, especially among low- and middle-income families. Although substantial attention has been paid to macroeconomic indicators, there remains a critical gap in understanding how households adapt on a daily basis to manage financial stress and sustain their livelihoods. This inquiry is especially timely, as household …

The Social Standing Versus The Mind Standing Of Older Adults In Egypt: Cross-Sectional Analysis Of The Relationship Between Social Capital And Cognitive Functions, Shaza H. Shinaishen Dr

Theses and Dissertations

Introduction: Egypt's population, much like that of other countries, is expected to age considerably over the course of the coming decades. Although biological and socioeconomic predictors of cognitive function have been studied widely, personal level social capital remains unexplored, especially in LMICs.

Purpose: This study primarily investigates the relationship between individual social capital and cognitive functioning among older adults aged 65 years and older in Egypt using the structural and cognitive components of social capital, including group membership, civic engagements, and caregiving roles.

Methods: A cross-sectional survey on 363 older individuals in different geographical and demographic segments of Egypt using …

The Right To Gender-Affirming Care, Justin J. Soulas

Theses and Dissertations

As of recent, twenty-four states have enacted bans on gender-affirming care, restricting minors from accessing medically necessary treatment. Existing scholarship has begun to explore the profound impact of these bans on transgender youth, their parents or guardians, and the medical professionals who support them. However, the body of literature on this rapidly evolving issue remains limited. This thesis aims to fill that gap by offering a legal defense of gender-affirming care, grounded in judicial precedent. It argues that parental rights to make medical decisions for their children—recognized in constitutional jurisprudence—extend to decisions involving gender-affirming treatment. Additionally, it draws on anti-discrimination …

Determinants Of Physicians' Brain Drain In Egypt, Mennatallah Elbeheiry

Theses and Dissertations

Egypt is enduring a significant shortage of physicians, despite the annual graduation of approximately 10,000 medical students from its 27 medical schools. In 2016, the physician density was alarmingly low, with only one doctor per 12,285 people. This shortage is exacerbated by a physicians’ brain drain, as Egypt is a leading exporter of physicians to countries like the United Kingdom and Australia. As of 2020, the Egyptian Medical Syndicate reported 212,835 registered physicians, yet 56 percent of them work abroad, and only about 62,000 are actively employed in public hospitals, serving a population of over 110 million. The government’s efforts …

Predictors Of Mental Health Clinic Staff Self-Efficacy In Recognizing And Responding To Suicide Risk, Hannah Ritz

Theses and Dissertations

Staff self-efficacy is critical to suicide prevention, yet its predictors within Zero Suicide initiatives are not well understood. Among 1,038 CCBHC staff, perceived organizational support, response-focused training, and lower suicide myth endorsement most strongly predicted self-efficacy. Clinical role and prior experiences contributed modestly, highlighting multilevel influences on workforce readiness.

The Influence Of Gender Identity And Healthcare Delivery Experience On Hiv Screening, Delton Harris

Theses and Dissertations

This dissertation examines the roles of gender identity, healthcare experience, and practitioners' scope of healthcare services in the uptake of annual HIV screening among the understudied population of transgender individuals. Transgender individuals are about half as likely to have an annual HIV screening despite having similar risk profiles to men who have sex with men (MSM). The current HIV guidelines for MSM recommend annual HIV screening because of the risky sexual practice, anal sex with other men. Similar to MSM, transgender individuals who have anal sex with men are at higher risk than the general population for HIV acquisition because …

Implementing Universal Health Insurance: Case Study Of Stakeholders' Perspectives In Port Said, Egypt, Rana Hetta

Theses and Dissertations

This research delves into the multifaceted dimensions of healthcare access through the lens of stakeholders in Port Said, Egypt, following the implementation of Universal Health Insurance (UHI) policies. The central research question explores the impact of UHI policies on healthcare access in Port Said. A set of investigative questions guides this exploration, focusing on beneficiary experiences, healthcare staff perspectives, and the alignment of UHI system implementation with beneficiaries’ healthcare needs. This study seeks to comprehend the institutional and policy context of UHI in Egypt, providing insights from policymakers, healthcare workers, and beneficiaries. Port Said serves as a case study, given …

Budget Capping Health Care: Its Impact On Health, Susan Chen

Theses and Dissertations

The goal of a budget cap on healthcare is to constrain total healthcare expenditure without compromising quality. This paper examines the impacts of budget capping on health and behavioral health outcomes, exploiting the completed Maryland All-Payer Model and the ongoing, extensional Maryland Total Cost of Care model, both of which capped healthcare budgets in Maryland. I use data from 2011-2021 surveys of the Behavioral Risk Factor Surveillance system and generalized difference-in-difference regression models to find that budget capping improves health and behavioral health outcomes with a greater favorable effect during the Maryland Total Cost of Care model.

Variability In Perceptions Of Complementary Health Approaches Among Graduate Student Trainees, Delaney C. Bilodeau

Theses and Dissertations

Complementary Health Approaches (CHAs) encompass a diverse range of practices which are often used both independently and alongside conventional medical treatments. Understanding how graduate students training in different fields perceive CHAs is important because these professional trainees will go on to occupy roles as healthcare practitioners, researchers, policy makers, and consumers. This study used sequential rank agreement methods (Ekstrøm, Gerds, & Jensen, 2019) to investigate variations in perceptions of CHAs in a sample of graduate students (N = 416) from 140 possible training programs. Ratings of CHA familiarity, perceptions of CHA legitimacy, and willingness to recommend CHAs were compared …

Historical Trauma: Literary And Testimonial Responses To Hiroshima, Mariam Ghonim

Theses and Dissertations

The concept of trauma is controversial in literature. While one may be able to come up with ways to describe trauma in fiction, representing historical trauma is a hard task for writers. Some argue that trauma can not be described through those who did not experience it, while others claim that, provided some elements are added, one can represent trauma to the reader. This thesis focuses on twentieth-century historical traumas related to a nuclear catastrophe and explores the different literary and testimonial responses to the catastrophic man-made event of Hiroshima (1945). In this thesis, Kathleen Burkinshaw’s historical fiction The Last …

The Relationship Between The National Family Caregiver Support Program (Nfcsp) And Help Received By The Elder Population, Symone Biggerstaff

Theses and Dissertations

The rising elder American population is causing an increased demand for elder support. Elder support often comes from informal caregivers. There are economic implications of elder care, such as increased government funding for elder care facilities and economic strain on caregivers and care recipients. The National Caregiver Support Program (NFCSP) was the first federal program, implemented in 2000 under the Older Americans Act re-authorization, designed to unburden caregivers. This paper aims to analyze the connection between NFCSP eligibility and the aid provided to elderly care recipients with ADL and IADL challenges. Using Health and Retirement Study (HRS) data and a …

Investigating The Feasibility Of Creating A Disease Registry In Egypt: A Case Study Of Dementia, Shimaa Adel Heikal

Theses and Dissertations

The increased interest in evidence-based medicine led to the emergence of disease registries worldwide to help tackle the impact of chronic diseases by providing accurate data on several aspects of the disease care process. Age-associated diseases, particularly dementia, are growing worldwide with several implications and increased economic burden, especially in lower-income countries. In Egypt, there is a lack of accurate dementia prevalence and statistics data which hinders the establishment of appropriate disease management and care strategies. A national dementia registry would provide a massive valuable source of patient data that will significantly advance the disease management strategies and quality of …

Impact Of Social Media  On Public Perception Of Government Covid-19 Response Efforts, Taher Taher

Theses and Dissertations

This research aims to understand this phenomenon to provide insights into how governments can perform better in times of crisis regarding social media and its impact on public opinion. This research aims to understand how social media impacts public perception of government COVID-19 response efforts by studying Facebook comments, likes, and reactions (emoticons).

The study was based on data gathered from Facebook comments on the daily infographic COVID-19 statistics from the official site of the Ministry of Health and Population. The sampling frame is the 52 weeks of 2020, January to December, through random sampling resulting in 546 comments. The …

Motivations And Conflicts In Prison Medical Contracting, Meagan D. Sok

Theses and Dissertations

State correctional departments are responsible for all medical care incarcerated individuals require. Many systems outsource their medical

State correctional departments are responsible for all medical care incarcerated individuals require. Many systems outsource their medical program. Literature indicates that many of these contracts experience significant issues that negatively impact state resources, including both personnel and money.

This dissertation explores the relationship between prison administrators' motivations and the structure, outcomes, efficiencies, and partner conflicts that arise in the contractual process. Using a framework developed from Incomplete Contract Theory, Contracts as Reference Points Theory and the concept of “essential tension,” this dissertation hypothesizes …

Assessing The Relationships Between Direct And Vicarious Exposure To Healthcare Discrimination And Erasure, Mistrust In Healthcare, And The Healthcare Utilization Behaviors Among Transgender And Gender Independent Individuals, Kyle L. Mason

Theses and Dissertations

Healthcare inaccessibility through direct exposure (i.e., personal) to myriad forms of gender identity-related discrimination and erasure among the Transgender and Gender Independent (TGI) population has been documented by prior studies. The myriad barriers that individuals who embody TGI identities encounter to accessing healthcare are associated with the underutilization of healthcare, which may further exacerbate the health disparities that exist between this population and cisgender individuals in the United States (U.S.). Although the impacts of the harm that direct exposure to healthcare discrimination and erasure may have on TGI individuals are known, their exposure to such harm vicariously (i.e., through observation …

Academic Health Science Centers And Health Disparities: A Qualitative Review Of The Intervening Role Of The Electronic Health Record And Social Determinants Of Health, Wies Rafi

Theses and Dissertations

Literature on the magnitude of negative health outcomes from health disparities is voluminous. Defined as the health effects of racism, environmental injustice, forms of discrimination, biases in science, and sociological or socioeconomic predictors across populations, health disparities are part of an ongoing and complicated national problem that health equity programs are specifically designed to address. Academic Health Science Centers (AHC) institutions are a complex and unique educational-healthcare ecosystem that often serves as a safety net for patients in vulnerable and lower-income communities. These institutions are often viewed as one of the most uniquely positioned entities in the U.S. with an …

Do Coverage Expansion And Patient-Centeredness Care Delivery Improve Patient Health Outcomes And Care Quality?, Shiva Salehian

Theses and Dissertations

Although correlated, improvement of patient health outcomes and quality of care is a result of health care delivery, performance, and healthcare policies that intend to impact health outcomes (Porter, 2010; AHRQ, 2015). This dissertation focuses on a special model of care delivery (Patient-Centered Medical Homes (PCMH)) and two programs (Addiction and Recovery Treatment Services (ARTS) and Medicaid expansion) to examine the correlation and impact of these programs on cardiovascular-related preventive care, healthcare expenditures, and health behavior hospitalizations as patient outcomes.

Tummy Time In Infancy: Real-World Assessments And Associations With Developmental Outcomes In Early Childhood, Ketaki Inamdar

Theses and Dissertations

Tummy time or awake, supervised, prone play is an important developmental play position in infancy. Engaging in more than 15 minutes of tummy time per day is associated with a lower risk of plagiocephaly, lower body mass index, and achievement of higher motor scores in full-term and at-risk preterm infants. However, there are significant gaps in the measurement of tummy time in current literature. Conventionally used subjective parent reports have not been validated against gold standard direct observation, and the feasibility and real-world validity of objective solutions such as wearable sensors has not been examined in full-term and at-risk preterm …

Associations Between Social Determinants Of Health And Chlamydia Infections Among Georgia Counties, Bre'auna K. Beasley

Theses and Dissertations

Chlamydia is a growing public health concern that disproportionately impacts southern states. While social determinants of health are not direct causes of chlamydia infections, studies have found that these determinants do influence infections by creating environments that promote or hinder health seeking behaviors, as well as exposure to risk factors. Guided by the Social Ecological Model of Public Health and the Healthy People 2030 Social Determinants of Health Conceptual Framework, this dissertation study aimed to examine the associations between social determinants of health and chlamydia infections among Georgia counties. This study employed a correlational research design. Aggregate-level secondary data for …

Cost-Effectiveness Of Interventions Targeting Hard-To-Reach Populations Living With Hiv In Eastern And Southern Africa, Deo Mujwara

Theses and Dissertations

In Eastern and Southern Africa, hard-to-reach populations (e.g., long distance truck drivers and female sex workers), defined as populations that are difficult to interact or engage with due to their unique behaviors and characteristics, are disproportionately affected by the HIV epidemic and are at high-risk of acquiring and transmitting HIV. Further, these populations have substantially low uptake of HIV testing services, and those that have been diagnosed with HIV and on antiretroviral therapy experience high loss-to-follow-up from treatment programs.

Hard-to-reach populations face unique barriers in accessing and utilizing routine HIV care such as provider stigmatization towards sex workers and highly …

Preventing Obesity: A Social Ecological Exploration Of Centers For Disease Control Prevention Strategies And Guidance Toward Healthy Eating, Physical Activity, And Communities, Ryan Kelly

Theses and Dissertations

Abstract

Obesity has reached nearly 40% of the adult public in the United States, costing the citizen taxpayer over $200 billion annually in healthcare costs. Those suffering from obesity deal with multiple physical and mental repercussions. Through a content analysis of four Centers for Disease Control (CDC) documents and guided by the conceptual framework of the social ecological model, this research explores the federal approach to preventing obesity. The analysis finds that CDC solutions to obesity involve connecting people to each other and healthier choices, an orientation toward local public administration, and an emphasis on environmental and infrastructure improvements. The …

“Insurance Doesn’T Care About The Patient”: An Institutional Ethnography Of The Influence Of Professional Autonomy On The Provision Care For Medicaid Dental Patients With Disabilities, Stephanie Lau

Theses and Dissertations

In terms of unmet needs for people with disabilities (PWD), dental care is number three behind residential care and employment (Fisher, 2012). Regardless of disability, oral healthcare traverses all disability diagnoses and can be a significant factor in quality of life (Deckler, 2011; Griffin et al., 2007; Norwood & Slayton, 2013). When attempting to secure oral healthcare, people with disabilities face many challenges, including lack of access, lack of provider education on proper care of PWD, and difficulty finding a willing dental provider (Deckler, 2011; Fisher, 2012; Kennedy, 2009).

The purpose of this study was to investigate professional practices and …

Access To Behavioral Health Services: Supply, Coverage, And Health Insurance Literacy, Heather Saunders

Theses and Dissertations

This dissertation examines policy and individual barriers to behavioral health (BH) service utilization. The full reach of federal policies like the Affordable Care Act (ACA) and the Comprehensive Addiction and Recovery Act (CARA) may be limited by state policies and the supply of the workforce available to deliver these services. Further, individual factors, such as low health insurance literacy, may influence patterns of behavioral healthcare utilization. Despite efforts to increase access to behavioral health services, treatment rates remain low, suggesting that barriers remain. To explore the effectiveness of these policies and examine remaining barriers, this dissertation explores three main research …

Homeless With Breast Cancer On Skid Row, Los Angeles: A Review Of Services For Women, Eva Dittrich

Theses and Dissertations

This study reviews the literature on breast cancer in general and narrows to within the context of the homeless population of Skid Row, Los Angeles, positing that the experience of breast cancer while homeless is a compounded traumatic experience with complex and numerous practical challenges. It poses the following question: What services are available to homeless women on Skid Row, Los Angeles, the information about which can be found online? Which and how many services are dedicated to breast cancer screenings and treatment? Are other types of cancer screening and treatment services advertised on the included service organizations' websites? A …

The Effect Of Citi Bike Introduction On Injury Rates In New York City, Masakazu Hiruma

Theses and Dissertations

This paper tests the hypothesis that the introduction of Citi Bike influences bicycle injuries by observing the gradual expansion of the bike share system in NYC. Data is analyzed from 2012-2018 New York Police Department (NYPD) Motor Vehicle Collisions and Citi Bike Station Feeds (NYC Open Data).

The Association Of Rural Hospital Closures With In-Hospital And 30-Day Post Hospital Discharge Mortality From Emergency Care Sensitive Conditions, Melinda A. Merrell

Theses and Dissertations

Purpose

Over 100 rural hospitals have closed in the U.S. since 2010. Continuous pressures on the rural health care delivery system suggest that the trajectory of closures will continue in at least the short-term. While the causes of rural hospital closures have been described in the literature, the effects on the health outcomes of populations that experience these closures are still poorly understood. The purpose of this study was to determine associations between rural hospital closures and in-hospital and 30-day post hospital discharge mortality rates for affected residents experiencing time-sensitive emergencies in two U.S. states.

Methods

Rural hospital closures were …

The Effect Of Change In Medi-Cal Dental Coverage On Dental Care Utilization Among Medi-Cal Beneficiaries, Min H. Zhang

Theses and Dissertations

One of the most important factors in accessing dental care is having dental insurance. For people with low incomes, Medicaid is the main source of health insurance. Medi-Cal is California’s Medicaid program. Adult dental services were mostly eliminated in Medi-Cal in 2009 due to the economic downturn and partially restored in 2014. The objective of this study is to evaluate the effect of change in Medi-Cal dental coverage, specifically the partial restoration of adult dental coverage in 2014, on dental care utilization among Medi-Cal beneficiaries. The partial restoration significantly increased the utilization rates in dental clinics from 2014 to 2017 …

Patient-Centered Medical Homes And Hospital Value-Based Purchasing: Investigating Provider Responses To Incentives, Lauryn Walker

Theses and Dissertations

Provider incentives are a commonly used policy tool to mold provider behaviors.¹ However, while we frequently measure the change in patient outcomes, failure to consistently produce changes in outcomes does not mean that providers are not changing their behavior. This paper focuses on two programs with null or inconsistent quality outcomes to try to identify why such inconsistency occurs. The two programs, both ratified in the Affordable Care Act, are 1) patient-centered medical homes (PCMHs), and 2) the Medicare Hospital Value-Based Purchasing (HVBP) program.

Chapter 1: Using data from the Medical Expenditure Panel survey (MEPS), I match provider characteristic …