Graduation Year


Document Type




Degree Granting Department

Public Health

Major Professor

Martha Coulter

Co-Major Professor

Lianne Estefan


elementary school, health-education-family triad, Panama, Public health program, unmet healthcare recommendation


Background: The School Health Program (SHP) in the Republic of Panama includes preventive healthcare services delivery and referral issuing at elementary schools nationwide. Despite these early prevention efforts, a majority of referrals are apparently not achieving their desired outcome. This idea is supported by the SHP data showing preventable diseases on the rise. Thus, learning the outcome rates of particular referral outcomes may provide a basis for appropriately targeted action.

Methods: Three focus groups were conducted with health workers, medical records staff, and teachers, respectively. Following systems thinking and framework analysis, a pilot plan for referral tracking and referral outcome rates obtainment was developed. Finally, the SHP team was surveyed for their perception on the effectiveness and feasibility of the plan, for future implementation.

Results: Themes related to referral tracking led directly to the development of a referral tracking pilot plan (RTPP). Survey data analysis revealed that the SHP team perceived the RTPP as an effective way to obtain complete referral tracking and referral outcome rates, and they also found it feasible to implement.

Conclusion: Keeping referral records and tracking the SHP referrals is perceived, by those that will be involved in its delivery, as achievable by implementing a RTPP developed from their own recommendations. Once implemented, the resulting obtainment of referral outcome rates may allow them to know if the SHP preventive objective for issuing these referrals is being properly achieved, and to prioritize for targeted action where needed.

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Public Health Commons