Author

Anita Kothari

Date of Award

4-2002

Degree Type

Thesis

Degree Name

Doctor of Philosophy (PhD)

Department

Health Research Methodology

Supervisor

Stephen Birch

Abstract

Researchers are being encouraged to consider contextual influences on health-related outcomes. To support this perspective, two context-sensitive studies were conducted. The first study explored the utilization of a research report by Ontario public health units, and examined whether utilization differed by involvement in the research process. Research utilization was conceptualized as a three stage process (reading, information processing and application). Using a case study design, results from three "involved" public health units and three "uninvolved" units demonstrated that inclusion in the research process led to a greater understanding of the analysis and increased the value associated with the report. Involvement did not, however, lead to greater research utilization. An associated contextual analysis provided a rich backdrop, highlighting the general challenges of implementing research-based guidelines given front-line workers' current realities. The second study examined the influence of contextual level (e.g., health region level) socioeconomic status on a woman's lifetime mammography screening uptake. A secondary data analysis was conducted using Ontario data from the 1996 National Population Health Survey. Logistic hierarchical multilevel modelling was used to examine the regional variation in mammography uptake, and to examine the role of contextual and individual level variables on regional variation. The estimated average proportion of Ontario women, aged 50-69, who reported ever having had a mammogram was 0.86. Results demonstrated modest variations among health regions in ever having had a mammogram. These variations could not be explained by the variables considered in this study. Individual level variables demonstrated an association with mammography uptake, as did regional level education and regional median family income. Furthermore, each of these latter two contextual variables demonstrated interaction effects with the individual level variable, "social involvement." Thus, contextual variables played a significant role in mammography uptake. Contextual circumstances ought to be considered during the development of breast health promotion programs and policies.

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