Digital Commons Network^™

Associations Between Provider Type And Medicaid Overpayments, Kezia Hercules

Walden Dissertations and Doctoral Studies

Healthcare costs have been rapidly increasing in the United States and consume a significant percentage of the Gross Domestic Product (GDP). A percentage of these costs are attributed to increased incidences of healthcare overpayments to providers. This study examined the impact of these overpayments by provider type, and the underlying reasons which resulted in overpayments from the Medicaid perspective. The theoretical framework used in this study was Ostrom’s institutional analysis and development (IAD) framework. The study used all available data (N = 682) from New York State Medicaid Inspector General final audits of providers for Medicaid overpayments. A chi-square test …

Relationship Among Health Literacy Superstitious Beliefs And Self-Care Among Diabetic Patients In Warri, Nigeria, Nkemakolam Simpson Ukpabi

Walden Dissertations and Doctoral Studies

AbstractDiabetes imposes significant burdens in medical expenditures, medication use, outpatient visits, and treatment of its chronic complications. Self-care behaviors such as medication adherence and foot care have been shown to reduce hospitalizations and complications, and high health literacy levels have been positively associated with self-care adoption. However, the effect of superstition on this relationship has not been studied among diabetic patients in Warri, Nigeria. This study was conducted to determine the moderating effects of superstitious or cultural beliefs on the relationship between health literacy and self-care adoption among diabetes patients in Warri, Nigeria. A quantitative, observational, cross-sectional design guided this …

Exploring The Influences Of Culture On Hand-Hygiene Beliefs Of Foreign-Born Healthcare Workers, Sheila Blanche Davis

Walden Dissertations and Doctoral Studies

AbstractThe hand-hygiene practices of nonadherent health care workers (HCWs) are a major threat to patient safety and thus continue to be a concern for healthcare leaders and administrators worldwide. Healthcare-associated infections (HAIs), which are linked to HCWs' unclean hands, are prevalent throughout global healthcare settings. Global migration in the nursing profession and intercontinental travel among direct patient care providers make it challenging for healthcare leaders to sustain HCWs' adherence to hand-hygiene practices. The purpose of this grounded study was to explore the influence of the cultural beliefs about hand-hygiene practices of foreign-born HCWs. The theory of planned behavior was used …

Dental Hygiene Faculty Use Of Educational Technologies For Instruction, Natalie Michelle Delacruz

Walden Dissertations and Doctoral Studies

Faculty hesitancy to implement educational technologies for instruction is problematic in dental hygiene education. Little or no scholarly research has been conducted on faculty use of educational technologies for instructional practices in the dental hygiene field. Grounded in the technology acceptance model, the purpose of this inquiry was to explore the perceptions of dental hygiene faculty regarding their attitudes toward use, usefulness, and ease of use of educational technologies for instruction. The research questions focused on dental hygiene faculty attitudes toward use of educational technologies for instruction, the usefulness of educational technologies for instruction, and the ease of use of …

Master’S Level Mental Health Counselor Experiences Working With Offenders In Correctional Settings, Jennifer Bernard

Walden Dissertations and Doctoral Studies

Forensic mental health is considered a specialty at a doctoral level, yet a majority of mental health services in correctional settings are provided by master’s-level mental health counselors. These clinicians lack the specialized education, training, and experience needed to work with offenders in correctional settings. There is limited research on how master’s-level counselors experience providing mental health services in correctional settings and how they manage challenges. The purpose of this qualitative study was to understand the lived experiences of master’s-level mental health counselors working with offenders in correctional settings. A hermeneutic phenomenological approach was used to facilitate an understanding of …

Social Determinants Of Health And Type 2 Diabetes Among Enrollees Of California Children’S Services Program In Fresno County, California, Daniela Marie Aghadjanian

Walden Dissertations and Doctoral Studies

Despite extensive study in adults, Type 2 diabetes (T2D) has been the subject of little research concerning young adults or children. Doctors believed T2D to develop only in a person’s later years until health care providers found younger individuals developing this disease. The purpose of this cross-sectional quantitative analysis was to determine correlations between T2D and social determinants of health in Fresno County, California, based on children and adolescents. The 2017-19 data came from the Fresno County Department of Public Health. The theoretical foundation for the study was the socio-ecological framework focusing on individuals’ traits having a bidirectional impact on …

Challenges To Successful Health Care Transition Among Hiv Positive Youth With Perinatal Acquisition, Tyler Andrew Termeer

Walden Dissertations and Doctoral Studies

To ensure stability in the continuum of health care for HIV-positive youth with perinatal acquisition, there is a need for a successful transition from pediatric to adult primary care. However, there are a growing number of perinatally infected HIV-positive young persons remaining in pediatric care beyond the age of 21. Using Mohr’s program theory and a phenomenological approach, the lived experiences of Ohio HIV clinicians were examined to determine why many perinatally infected HIV-positive youths are remaining in pediatric care beyond the age of 21. Audio recorded video interviews via SKYPE were conducted with 12 participants, transcribed, underwent thematic analysis, …

Perceived Health And Preventative Care In The Transgender Population, Gregory Page Carpenter

Walden Dissertations and Doctoral Studies

Historically, the transgender community has been treated and studied myopically, using the lens of psychological illness. As treatment and research efforts have expanded in the past decade, the transgender population is becoming better understood. The purpose of the study was to examine the relationship between perceived health and preventative care in the transgender community. The health belief model was the theoretical framework for this cross-sectional study, which included data from the 2014–2018 Behavioral Risk Factor Surveillance System Survey. Chi-square tests and binomial logistic regressions were performed to investigate associations between perceived health and preventative care in the transgender community. The …

Hospital Emergency Room Visits For Heavy Menstrual Bleeding, Henry John Mead

Walden Dissertations and Doctoral Studies

Heavy menstrual bleeding (HMB) is a well-recognized health issue among women of reproductive age. The characteristics and demographics of women in the community with HMB who present at the emergency department (ED) are not well described. This research aimed to describe the cohort of women who seek treatment at the ED. The Healthcare Cost and Utilization Project 2016 National Emergency Department Sample was examined. The theory of reasoned action predicts that women who present at the ED are exhibiting health seeking behavior. From 32 million records, the inception cohort identified N = 111,555 cases. Using national estimation weights, this translates …

Association Between Bisphenols, Acrylamide, Glycidamide, Fast Food, And Obesity: An Obesogenic Perspective, Morgan Murphy

Walden Dissertations and Doctoral Studies

Endocrine disrupting chemicals (EDCs) are exogenous man-made substances that have the ability to interfere with hormone action and are believed to be a contributing factor to chronic illnesses, including but not limited to obesity. Recent studies have suggested that environmental agents (environmental obesogens), such as food additives, plasticizers, and personal care products are contributors that aid in the altering of hormone receptors and hormone mimicry. Such environmental obesogens have the potential to promote adipogenesis and fat accumulation. In this study, the social-ecological model was used to determine the factors that can influence the increased exposure to obesogenic chemicals at the …

The Relationship Between Quality Score, Generated Savings/Losses And Assigned Beneficiaries Among 2018 Mssp Acos, Crystal Crider

Walden Dissertations and Doctoral Studies

In 2018, Medicare spending in the United States accounted for 15% of the comprehensive federal budget forecasted to exceed $1.5 trillion by the year 2028. To help manage the spending in this sector, the Centers for Medicare and Medicaid Services implemented Medicare Shared Savings Program (MSSP) Accountable Care Organizations (ACOs). There is a need to understand current data as it relates to the correlation between MSSP ACO participants’ costs, quality, and assigned beneficiaries. The purpose of this quantitative study was to examine the relationship between Quality Score, Generated Total Savings/Losses and Total Assigned Beneficiaries for 2018 MSSP ACO participants. General …

Barriers To Effective Personal Protective Equipment Use In Public Health Workers, Sheila Storr-Mathis

Walden Dissertations and Doctoral Studies

Exposure to infections continues to be a significant concern for nursing practice and for other health care professionals. Personal protective equipment (PPE) minimizes occupational exposure; however, their use is subject to variability. This quality improvement project addressed the impact of an educational intervention on attitudes and barriers to proper use of PPE for public health workers at the study site. The health belief model and the literature review provided theoretical support for the project and evidence of current trends in PPE use. There were 44 employees who completed the preintervention survey and 22 who completed the postintervention survey to gauge …

The Impact Of Obesity, Race, Age, Education, Income, And Healthcare Coverage On Cervical Cancer Screening Among Mississippi Women, Henrietta Tamika Ross

Walden Dissertations and Doctoral Studies

The human papilloma virus is the necessary agent in the development of cervical cancer. It is through screening exams like the Papanicolaou (Pap) test that cervical changes can be identified, and cervical cancer can be diagnosed in the early stage of cancer. The Pap test has aided in decreasing the rate of cervical cancer and the morbidity of cervical cancer. However, cervical cancer rates and mortality rates from cervical cancer are still the highest among women in Mississippi. Additionally, obesity rates among those who reside in Mississippi are the second highest in the United States. The purpose of this quantitative …

Primary Care Providers’ Perceptions Of Adolescent Friendly Health Services In Relationship To Adolescent Pregnancy, Jill Marie Ensminger

Walden Dissertations and Doctoral Studies

According to recent research, adolescent health continues to be a public health concern. The purpose of this qualitative research was to identify the perceptions of primary care providers regarding adolescent friendly health services and the relationship to adolescent pregnancy. The theoretical and conceptual framework used for this research included the social ecological model and the recommendations of the World Health Organization (WHO) for providing adolescent friendly health services. Using a phenomenological qualitative research approach, interviews were conducted over the telephone. Data analysis included hand coding with emerging themes and subthemes in relationship to each research question. The results of the …

Reducing Recidivism Of Psychiatric Inpatient Clients In Behavioral Health Facilities, Cottrell Jacobs

Walden Dissertations and Doctoral Studies

AbstractResearch shows readmitting clients to inpatient psychiatric facilities within 30 days to one year of discharge can be costly for an organization and may represent less than optimal quality care for clients. The purpose of this study was to obtain an in-depth understanding of practices and barriers to reducing inpatient readmissions by completing a qualitative case study of readmission reduction strategies used by a large inpatient psychiatric facility in the southern United States. The Baldrige excellence framework was used to guide the assessment of the organization. Data collection consisted of five semi-structured interviews with organizational leaders, evaluation of internal archival …

Association Between Learning Methods And Analgesic Opioid Abuse, Nicole Marie Blanchard

Walden Dissertations and Doctoral Studies

Opioids are an extremely addictive class of medication used to treat pain; overprescribing practices and chronic misuse has led to an epidemic that continues to grow. The opioid epidemic not only has the potential to cause injury or even death but also has a large impact on the U.S. economy. Research regarding determinants of abuse are needed to improve safeguards for opioid abuse prevention. The purpose of this quantitative study was to determine if learning capabilities and/or learning medium preference are correlated with analgesic opioid abuse. The social-ecological model was used to evaluate the social levels of influence for abuse …

Examining Nursing Home Staff Turnover Rate In Long-Term Care Organizations In The United States, Dandrea Vanettra Kittles

Walden Dissertations and Doctoral Studies

AbstractEvery year, many nursing assistants in the United States leave their positions. The high level of turnover can be disruptive to patient care and costly to organizations needing to replace workers; another consequence can be increased job dissatisfaction among remaining staff. Despite the high turnover in nursing facilities, there remains a research gap regarding the factors that promote employee retention. The purpose of this study was to examine nursing assistants’ beliefs about job satisfaction as an approach to prevent job turnover and retain high-achieving staff in nursing homes in the United States among the older adult population. Herzberg’s motivation-hygiene theory …

Prevention And Self-Care Education For Osteoporosis In A Rural Orthopedic Clinic, Jean Sanford

Walden Dissertations and Doctoral Studies

Abstract Osteoporosis affects 25 million people in the United States causing over 1.5 million fractures every year. The gap in practice at a rural southeast orthopedic clinic was a lack of patient education on prevention and self-care management of osteoporosis and osteopenia. The purpose of the project was to develop a program to educate clinic providers on prevention and self-care management for osteoporosis and osteopenia. The Knowles theory of adult learning framed the project components. A 10-question pretest/posttest assessing knowledge was administered to 10 registered nurse participants. For the presurvey, five participants demonstrated a lack of knowledge of medication administration …

A Systematic Review Of Tobacco Cessation Strategies Tailored For Military Personnel, Ni Ketut Supiyati

Walden Dissertations and Doctoral Studies

AbstractA Systematic Review of Tobacco Cessation Strategies Tailored for Military Personnel by Ni Ketut Supiyati

MS, Walden University, 2000

Project Submitted in Partial Fulfillment of the Requirements for the Degree of Doctor of Nursing Practice

Walden University August 2021

The Complete Care Model: Improving Diabetic Patient Outcomes In Correctional Facilities, Chad Williams

Walden Dissertations and Doctoral Studies

Diabetes is a growing problem, becoming an increasing concern within prisons. Research suggests that as many as 4.9% of the inmate population is diagnosed with diabetes. To provide constitutionally required healthcare to the inmate population, corrections officials must identify a validated diabetes treatment modality geared toward improving diabetes outcomes. The purpose of this quantitative study was to evaluate the impact of a patient centered medical home (PCMH) based model of healthcare within the California Correctional Health Care Services (CCHCS) on diabetic prisoners. Using the social construct theory as the framework, the research questions were focused on determining whether there was …

Mandibular Attachment Device Effects On African American Veterans With Heart Failure, Tracey T. F. Carter

Walden Dissertations and Doctoral Studies

Heart failure is a growing epidemic that affects people nationwide and is disproportionate to African Americans. The purpose of this quantitative repeated measures study was to determine whether mandibular attachment device (MAD) therapy impacts symptoms of heart failure in African American male veterans diagnosed with obstructive sleep apnea (OSA). The oxidative stress theory was applied in this study to assess whether MAD therapy received from Veterans Affairs (VA) dental clinics impacted heart failure symptoms, after controlling for patient body mass index (BMI) levels and smoking status. Research questions examined whether MAD had a significant effect on symptoms of heart failure …

Predictors Of Intention To Use Health Literacy Strategies Among Physicians In Grenada, Arlette Wildman

Walden Dissertations and Doctoral Studies

Low health literacy is linked to poor health outcomes. Adequate health literacy depends on effective communication between patients and their healthcare providers, so it is important physicians use health literacy strategies. Grounded in the theory of planned behavior, the aim of this quantitative correlational study was to investigate the relationship between health literacy knowledge, health literacy experience, gender, the region of training, years of practice, and intentions to use health literacy strategies among physicians in Grenada. One hundred and eighteen physicians were sampled using a cross-sectional survey method. The results of the multiple linear regression analysis were significant, F(5, 112) …

Stress And Job Satisfaction As Predictors Of Teacher Turnover Intentions, Alrick Thompson

Walden Dissertations and Doctoral Studies

High teacher turnover is problematic because of the costs associated with recruiting and training new hires. However, some of the factors originating outside of the working environment that may influence teacher turnover intentions are not fully understood. The purpose of this quantitative correlational design study was to examine the extent to which job satisfaction, commuting stress, and financial stress are predictors of teacher turnover intentions. The study involved a purposive sampling of 227 teachers within a school district in the South Eastern part of the United States. Hobfoll’s conservation of resources theory provided the theoretical framework for the study. Validated …

Environmental Barriers To Accessing Tertiary Prevention Among Hispanics Diagnosed With Type 2 Diabetes, Stella B. Biira

Walden Dissertations and Doctoral Studies

In the United States, Hispanics diagnosed with type 2 diabetes (T2DM) have not accessed tertiary level prevention, which is critical in diabetes management and the prevention of further complications. The purpose of this quantitative study was to examine the association between neighborhood crime, the absence of community health centers, the lack of culturally competent providers, the lack of public transportation, the residential setting, the distance to T2DM education classes, and access to tertiary prevention among Hispanics diagnosed with T2DM. The research was guided by the Andersen behavioral model. A sample size of N = 4,977 was used in the study, …

Impact Of Social Economic Factors On U. S. Veterans’ Access To Care, William Kwaku Adjei Ofori

Walden Dissertations and Doctoral Studies

Coronary heart disease (CHD), the leading cause of death worldwide, affects about 8.45 million United States veterans, individuals honorably discharged from the active military, naval services, and air services. The purpose of this study was to determine whether veterans’ access to care is associated with income level determinants, such as job status, education level, and location. Using the social cognitive theory as the framework, the study examined the extent to which income level and the other social determinants, impacted access to care for veterans with CHD. The 2016 Behavioral Risk Factor Surveillance System, the nation’s leading data system was the …

Changes In Operating Performance In Rural Hospitals From 2012 To 2019, Oluwaseyi Tami Young-Harry

Walden Dissertations and Doctoral Studies

Rural hospitals treat patients while dealing with the challenges of an inadequate workforce, limited financial resources, and an isolated geographic location, leading to difficulties in achieving financial viability. The purpose of this quantitative study was to analyze the operating performance of rural, general, medical and surgical hospitals in the United States and to determine if performance had changed from 2012 to 2019. Guided by x-efficiency theory, this study addressed whether hospital ownership explained variation in performance and if performance had changed from 2012 to 2019. A random sample of 394 rural hospitals was used, with data drawn from the American …

Recovering Illicit Substance Users' Perspective About Mandatory Drug Testing In Schools, Julie Bowser

Walden Dissertations and Doctoral Studies

The purpose of this exploratory qualitative study was to examine recovering substance

abusers' perceptions about the usefulness of mandatory drug testing in schools for adolescent substance abuse. Illegal substance abuse has reached epidemic proportions as more than half of U.S. adolescents, aged 12 to 17 years, have engaged in illicit drug use. Substance abuse information has been a part of school health education programs since the United States Drug Free Schools and Communities Act of 1986. Despite substance abuse education and school programs about the effects of drug use, many high school students abuse illicit drugs. Face-to-face interviews were conducted …

Strategies For Reducing Adverse Medical Events From Implanted Medical Devices, Gary John Zack

Walden Dissertations and Doctoral Studies

Managing medical device monitoring processes is challenging and lacks a realtime, life cycle tracking strategy to reduce adverse medical events and revision costs for hospital administrators, physicians, and patients. Understanding the malfunctions of medical devices for cardiac and orthopedic patients could save lives and reduce hospital liability. Grounded in the business process reengineering conceptual framework, the purpose of this single qualitative case study was to explore strategies hospital managers used to redesign the implant recall surveillance process at one hospital in Pennsylvania. The 5 participants selected successfully implemented a medical device surveillance process that reduced adverse medical events and revision …

Obesity, Snoring, Sleep Apnea, And Coronary Heart Disease, Maryam Khalilah Muhammad

Walden Dissertations and Doctoral Studies

Coronary heart disease (CHD) is a significant public health issue that affects communities across all socioeconomic and demographic groups. Risk factors for CHD include sleep apnea and snoring. Obesity with short sleep duration also places individuals at higher risk for CHD. Although limited research has been conducted on CHD and its relationship to obesity, sleep apnea, and snoring as individual risk factors for CHD, a gap exists as these factors had not been studied as paired in this study. The purpose of this quantitative, cross sectional study was to determine if a significant relationship existed between obesity, snoring, sleep apnea, …

Factors Associated With Hepatitis B Vaccination Among Asian Adults (≥ 18 Years) In The United States., Naana Abena Ohemeng-Tinyase

Walden Dissertations and Doctoral Studies

In the United States, hepatitis B disproportionately affects Asian and Pacific Islanders (AAPIs). Hepatitis B related liver cancer is the leading cause of cancer deaths among Asian Americans. Despite the proven significant economic, health, and social effect of hepatitis B virus, immunization rates remain low. The purpose of this study is to examine the association between sociodemographic factors (age, marital status, gender, work experiences), health status factors (chronic disease, nonchronic disease), health behavior factors (smoking, alcohol intake, tobacco use, physical activity), and hepatitis B vaccination among Asian adults (≥ 18 years) in the United States. The main theory that frames …