Sponsor
OHSU-PSU School of Public Health. Health Systems and Policy Ph. D. Program
First Advisor
Sherril Gelmon
Term of Graduation
Spring 2024
Date of Publication
5-28-2024
Document Type
Dissertation
Degree Name
Doctor of Philosophy (Ph.D.) in Health Systems and Policy
Department
Health Systems and Policy
Language
English
Subjects
College health, COVID-19, Primary Care, Student health services
DOI
10.15760/etd.3779
Physical Description
1 online resource (xiii, 268 pages)
Abstract
In 2020, the COVID-19 pandemic disrupted operations across the settings of primary care and higher education institutions (HEI). HEIs faced sudden decreases in revenue because of reduced enrollments and external pressures to rapidly adapt delivery methods to accommodate the inability to provide in-person classes. Similarly, most primary care settings experienced major reductions to in-person visits and fee-for-service revenues. Student health services (SHS) exist within both primary care and higher education settings and are a unique and poorly understood aspect of primary care. This research set out to explore this under-studied primary care setting by answering the question: "How has COVID-19 influenced the structures and processes used by a selection of Oregon's postsecondary institutions to maintain delivery of primary care through student health services (SHS)?"
This research was framed by the study's aims which identified components of primary care within SHS before and following the onset of the pandemic, explored environmental factors that influenced the components of primary care within SHS, and articulated how SHS leaders demonstrated aspects of organizational resilience by adapting to the pandemic and maintaining primary care services for students. The findings of this qualitative multiple-case study led to an improved understanding of a minimally studied primary care setting, and the development of a model of promising practices for primary care delivery for student health services.
Eligible SHS organizations were identified from among Oregon's four-year public HEIs and SHS executive leadership gave consent to participate. Data were collected from a range of sources and materials related to SHS operations before and after the onset of the pandemic. These sources included public websites, internal documents collected from participating SHSs, and individual interviews conducted with eligible SHS leaders from each participating SHS organization. Data were organized by the domains of the Consolidated Framework for Implementation Research (CFIR), a commonly used framework within the field of Implementation Science that supports the identification of multi-level relationships between contextual factors and practice changes within complex, multi-level, transient, and interacting environmental states in healthcare settings. The use of CFIR allowed for synthesis and triangulation of data from a variety of sources and across cases culminating in the development of a model of primary care delivery within the higher education setting.
Study results were condensed into three overarching themes. The first theme is the participating SHS organizations contained elements of care that were aligned with current definitions of high quality primary care. Second, the COVID-19 pandemic affected SHS organizations similar to other primary care settings. Finally, in alignment with Donabedian's Structure-Process-Outcome model, the unique interactions between HEI and SHS structures influenced how and why SHS leaders adapted to the pandemic's effects to maintain primary care delivery.
The interactions of HEI and SHS structures documented within the study's findings led to the identification of six promising practices of SHS primary care delivery. These were: the extension of SHS governance structures that overlap with HEI governance; the alignment of student health insurance structures with SHS financial structures; the centralization of SHS leadership and sensemaking structures for connecting facility infrastructure (clinical data) and the workforce (staff) during information interpretation during crisis; incorporation of other student health-related services available within the HEI setting for meeting students' health needs; the creation of data-gathering capabilities for monitoring the contextual environment in reference to SHS outcomes; and centering the four pillars of primary care at the core of the primary care delivery process.
Findings from this research informed recommendations spanning the overlapping settings of primary care and higher education. Recommendations were directed toward SHS leaders, HEI policy and decision-makers, and researchers in the fields of healthcare and higher education. This dissertation offers important contributions to academic research and health policy by establishing the student health services setting as a unique and valuable setting for the study and practice of primary care and identifying existing relationships between higher education policies and student health and wellbeing. Further contributions of this research include the use of CFIR and the lens of implementation science within its design to explore a unique primary care setting. The study explored concepts of health system resilience through experiences of sensemaking by SHS leadership in adapting to the tumultuous primary care and higher education environments following the onset of the COVID-19 pandemic. The findings lead to recommendations of topics for future research to expand the depth of knowledge within higher education, primary care, organizational resilience, and change management fields of study.
In conclusion, this research sheds light on SHS organizations as an important setting of primary care delivery, influencing the health and wellbeing of tens of thousands of adolescents and young adults in Oregon. This unique setting of primary care shares the known complexities and dynamics involved with primary care delivery in the broader health system context, with the additional environmental influences of the higher education setting which create properties and characteristics unique to SHS. This study provided a perspective which may be generalizable to Oregon's SHS organizations and comparable organizations in other jurisdictions following a major disruptive event and identified unique structures and aspects of the organizational process of adaptation to maintain primary care delivery that continued to meet the needs of students.
Rights
© 2024 D. Chad Johnson
In Copyright. URI: http://rightsstatements.org/vocab/InC/1.0/ This Item is protected by copyright and/or related rights. You are free to use this Item in any way that is permitted by the copyright and related rights legislation that applies to your use. For other uses you need to obtain permission from the rights-holder(s).
Persistent Identifier
https://archives.pdx.edu/ds/psu/42278
Recommended Citation
Johnson, D. Chad, "Primary Care in the University Setting After COVID-19: A Multiple Case Study of Student Health Services in Oregon" (2024). Dissertations and Theses. Paper 6647.
https://doi.org/10.15760/etd.3779