Digital Commons Network^™

Multilevel Analysis Of Physical Activity Among Us Adults Across Us Census Regions: The Role Of Environmental Contexts, Sariyamon Tiraphat

Health Services Research Dissertations

This study uses nationally representative data to explain the variation in physical activity among U.S. adults across four geographic regions of Northeast, Midwest, South, and West. The purpose of the study is to investigate whether environmental conditions inclusive of natural amenity, built environment, urbanization, crime, and social economic neighborhood are associated with physical activity and whether these associations are modified by geographic region. The study also investigates whether the influences of environmental contexts vary by subgroup and whether they are modified by geographic region. Determining regional factors that influence physical activity is essential to planning appropriate physical activity interventions.

The …

Factors That Influence Nonadherence Outpatient Medical Follow-Up By African Americans With Hiv/Aids At An Outpatient Infectious Disease Clinic, Cynthia Burrell Banks

Health Services Research Dissertations

Human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS) does not discriminate among different races, ethnicities or genders; however, African Americans carry a larger burden related to the HIV epidemic than others (CDC, 2010c; Cunningham, Sanchez, Heller & Sohler, 2007; Mugavero, et al., 2009). Persons living with HIV/AIDS (PLWHA) who do not adhere to their medical regimen, including failure to maintain contact with their health care provider for health care monitoring, tend to have poorer health outcomes from the disease as compared to HIV/AIDS patients who adhere to their medical regimen (Cunningham et al., 2006; Lima et al., 2009). African Americans represent …

An Examination Of Factors Affecting Non-Urgent Use Of Emergency Department Services By Patients With "Universal" Healthcare, Gregory Smith Feltenberger

Health Services Research Dissertations

The purpose of this research is to examine the factors affecting non-urgent utilization of emergency department (ED) services by individuals with "universal" healthcare using the Behavioral Model of Health Services Use. Since Air Force Medical Service beneficiaries have free and unlimited use of the full-range of healthcare services, they are ideally suited for this study. The findings of this research may also apply to other populations with free or low-cost access to healthcare (i.e., universal or single-payer healthcare). Using secondary data extracted from the Air Force Medical Service's electronic health record system at several military hospitals, this study will present …

Intimate Partner Physical Violence Against Women In Saudi Arabian Primary Healthcare Clinics, Halah M. Eldoseri

Health Services Research Dissertations

Intimate partner violence against women (IPPVAW) is a serious public health concern. The Ecological Model provides a model to study several factors associated with IPPVAW. In Saudi Arabia, studies addressing IPPVAW are limited and do not cover the various aspects of the problem. The purpose of this study was to investigate the various factors associated with IPPVAW at the personal, interpersonal, community and societal levels. Methods: 200 ever-married women attending six PHC in Jeddah, Saudi Arabia were recruited via convenient sampling method. Women were interviewed on factors related to IPPVAW using an adapted version of WHO survey for violence against …

Early Diagnosis Of Pulmonary Embolism: Review And Cost-Effectiveness Analysis, Efstathios Polychronopoulos

Health Services Research Dissertations

Pulmonary embolism (PE) is a serious, life-threatening thrombotic disease, which results in considerable health and economic consequences each year for the United States. These consequences include a toll of 83,000 deaths and an economic impact between 1,5 and 5 billion. Approaches to strategy selection by physicians and other health-care specialists are based mainly upon cost, technology availability, and cultural tolerance regarding radiation exposure. The purpose of this study was to determine the most cost-effective diagnostic strategy with patients suspected of PE among several strategies currently used by examining their detection failure rates. This objective was met by (a) assessing parameter …

Using Modeling And Simulation To Improve Oral Health Services Delivery In Hampton Roads, Virginia, Mohammad J. Alzahrani

Health Services Research Dissertations

The purpose of this study is to examine the system performance in delivering oral health services in a public health district based on the Conceptual Framework to Measure Performance of the Public Health System (PHS). Using modeling and simulation, a predictive model based on the conceptual framework dimensions: mission, structural capacity, processes, and outcomes was developed to predict the performance of public health district in delivering oral health services.

This is a retrospective longitudinal study. The main objective of this study is to use a modeling and simulation approach to predict the performance of public health district dental clinic in …

Adoption Of Electronic Health Records By Admitting Physicians: A Heuristic Model, John Sharon Hudson

Health Services Research Dissertations

Background: Although hospital electronic health records (EHRs) are generally perceived to improve care, physician resistance may hinder EHR adoption.

Purpose: This study uses constructs from diffusion of innovations and resource dependence theories to predict adoption and rate of adoption of an EHR by admitting physicians from three of ten hospitals in a highly integrated health system in Virginia. Functions evaluated: computerized physician order entry (CPOE), electronic history and physical (EH&P) and electronic discharge summary (EDS). The study tested hypotheses that adoption would be associated with: working at larger, academic hospitals; financial alignment; larger physician groups; office EHR; youth; males; medical …

The Relationship Of Financial Performance, Quality Indicators, And The Role Of Nurse Executives In Virginia Nursing Homes, Jeany V. Murphy

Health Services Research Dissertations

Problem statement. The dynamic nature of the healthcare industry has triggered changes in nurse executive functions. The job has expanded into entrepreneurial roles to be able to provide the most cost effective services while maintaining good quality outcomes for the residents. The new responsibility requires a different set of knowledge and competencies that is usually achieved through advanced education. It is not known whether nurse executives in long term care in Virginia possess the skills to influence both the financial and quality outcomes of the facility.

Methods. This descriptive research study examined the relationship of the nurse executives' technical, human, …

A Gis Analysis Of The Environmental Variables Related To Rift Valley Fever Outbreaks, Jacqueline Florette Jackson

Health Services Research Dissertations

Rift Valley fever is a mosquito-borne disease that causes widespread febrile illness and mortality in domestic animals as well as humans (Gaff, 2007). Rift Valley fever virus was first isolated in 1931 (Daubney, 1931), and since then, outbreaks have occurred in sub-Saharan Africa, southern Africa, Egypt, Saudi Arabia, Yemen and Madagascar, proving it to be a virus able to invade ecologically diverse regions (Gaff, 2007). The potential introduction of Rift Valley fever into the United States suggests the potential for human infection and major economic disruption. It is important to understand the role environmental variables have played in historical outbreaks …

Patient Centered Care Approach To Adherence With Cardiovascular Medications: Self-Determination Theory Integration, David S. Li

Health Services Research Dissertations

Problem statement. Behavioral intervention is used to improve adherence with medication in patients with cardiovascular diseases (CVD), but the effect was not sustainable. Patient-centered care (PCC) as a consumer movement has gained acceptance, but it lacks a theoretical framework. Self-determination theory (SDT) may provide an alternative to improve patients' adherence to chronic cardiovascular medication, as well as a theoretical framework for PCC. Both approaches to CVD management have not been evaluated.

Methods. The study was a quasi-experimental pretest posttest comparison design with consecutive sampling of a hospitalized cardiac patient population. Sixty patients each for the usual care (UC) …

Predictors Of Developmental Screenings For Young Children, Janice Chandler Ranne

Health Services Research Dissertations

This study examines the usefulness of the New Model of Children's Health and its Influences for the identification of predictors for health service effectiveness. Health service effectiveness is measured by probability estimations of whether young children receive formal or informal developmental screenings. Screenings lead to prevention of communication delays in later childhood. Formal screenings with standardized questions are preferred over informal screenings, which are knowledgeable observations. The theoretical framework is a child-centered socio-ecological theory that is untested for use in health service effectiveness studies until the present one. Four developmental concepts of the theoretical framework, social environment, physical environment, biological …

Using The Andersen Behavioral Model Of Health Services Use To Examine Adult Uninsured Patient Health Services Use At A Community Health Center, Jewel Shonette Goodman

Health Services Research Dissertations

Prescription medications are essential to the treatment and management of chronic conditions (Smith et al., 2005). Lack of access can result in pain, worsening of the condition and increased risk of additional health problems. Health care expenditures in the United States were reportedly 1.7 trillion in 2003 (Smithetal.,2005) and exceeded" role="presentation" style="box-sizing: border-box; display: inline-table; line-height: 0; font-size: 16.66px; overflow-wrap: normal; word-spacing: normal; white-space: nowrap; float: none; direction: ltr; max-width: none; max-height: none; min-width: 0px; min-height: 0px; border: 0px; margin: 0px; padding: 1px 0px; position: relative;">1.7trillionin2003(Smithetal.,2005)andexceeded1.7trillionin2003(Smithetal.,2005)andexceeded2.3 trillion in 2008 (Centers for Medicare and Medicaid Services, 2010). Prescription medication costs …

Test Of A Multidisciplinary Health Behavior Model Of Medicare Elders' Antihypertensive Acquisitions, Ann Marie Kopitzke

Health Services Research Dissertations

This study examined the relative utility of the enhanced Health Belief Model as compared to the proposed Pharmaceutical Acquisition Model for Medicare Elders (PAMME) in describing antihypertensive acquisition with usage intentions for Medicare elders (65 years or older) in Southeastern Virginia. Data collection included record reviews to identify hypertensive Medicare elders. Consenting Medicare elders were randomly selected for invitation, with consenting Medicare elders contacted by telephone or in-person interviews. The survey instrument utilized open and closed ended questions. The target population for this study is Southeastern Virginia Medicare elders enrolled in a Part D plan and prescribed at least one …

Modeling Physical Activity In Working Adults: How Suitable Is The Expanded Parallel Process Model?, Adwoa B-H-Sam

Health Services Research Dissertations

This study is an assessment of the usefulness of the Expanded Parallel Process Model in predicting health enhancing physical activity as an outcome variable. The theory is tested in the context of risk for coronary heart disease and involves secondary analyses of a dataset from a group of working adults. These individuals had elected first to participate in a health plan ‘Quality Improvement Study’ and were then randomly selected to receive an intervention program designed to get people to be more active.

Data on self-reported demographics, physical activity levels, health status characteristics and perceptions measured on a Likert-type scale known …

Psychometric Evaluation Of An Instrument For Assessing Policy Outcomes For Families With Children Who Have Severe Developmental Disabilities: The Beach Center Family Quality Of Life Scale, Joni Taylor Mcfelea

Health Services Research Dissertations

The purpose of the study was to evaluate the psychometric properties of the Beach Center Family Quality of Life Scale (BCFQLS) in a sample of families with children who have severe developmental disabilities. The study sought to determine whether or not the scale could be used to measure the quality of life of such families and to differentiate between the quality of life of two family groups—those whose child lives in the family home and those whose child lives outside the family home.

The study used an observational, cross-sectional design and both qualitative and quantitative methods. Self-identified primary caregivers of …

Changes In Formal-Informal Caregiving In Elderly Stroke Survivors, Holly Anne Beard

Health Services Research Dissertations

The purpose of this study is to determine the extent to which the Andersen and Aday Model of Health Services Use to predict cross-sectional and longitudinal differences in the caregiving source among stroke survivors (n=477) over a six-year period. This study involves a secondary analysis of a longitudinal panel study focusing upon three waves of interview data from the HAS/AHEAD study spanning 1998 through 2002. Multinomial logistic regression was utilized to examine caregiving source cross-sectionally at each wave. Clustered multinomial logistic regression was used to examine relationships between predictor variables in the model and caregiving source across waves while holding …

The Use Of The Tripartite Model Of Attitudes To Explain Ems Providers' Attitudes About The Ems Agenda For The Future, Carolyn Angela Rinaca

Health Services Research Dissertations

A dynamic and revolutionary health care system compels the Nation to develop a more cohesive, unified healthcare workforce. The Emergency Medical Services (EMS) profession has contributed to this development with the publication of the EMS Agenda for the Future. The EMS Agenda for the Future describes the future direction for emergency medical services agencies and organizations within the nation. It is a vision that integrates EMS systems with other health care professions. The EMS Agenda for the Future is designed to assist EMS professionals in realizing their full potential for proficiency and contributes to the development of the EMS profession. …

Using Social Cognitive Theory To Model Health Behaviors Among Chinese Children, Yan Zhang

Health Services Research Dissertations

This study examined the usefulness of Social Cognitive Theory (SCT) to model fast-food intake, fruit/vegetable consumption, and regular physical activity among a group of Chinese-American children in a Southeastern Virginia urban area.

An observational cross-sectional survey research design and snowball sampling were used. The survey employed items from the Health Behavior Questionnaire, the Youth Risk Behavior Survey, and a 24-hour Diet Recall Form. Eighty-four children completed the self-administered survey; 54 of these were enrolled in a Chinese Weekend School. The mean age of the children was 10.5 years (range 6-18) and 43% were girls. Logistic regression models were used to …

The Great Pestilence: Yellow Fever In Portsmouth, Virginia, 1855, Burden Susan Lundgren

Health Services Research Dissertations

In 1855, the town of Portsmouth, Virginia was devastated by an epidemic of yellow fever. Most citizens fled. Of those who remained, most became infected and a thousand died. The municipal government collapsed. In their place, a small organization known as the Portsmouth Relief Association assumed responsibility for ensuring the survival of the town. This organization managed the care of the sick, the burial of the dead, and the care of orphans. It was the sole agent receiving and allocating the funds and resources that poured into the community. Scarce food, drugs and other supplies were available only through the …

Factors That Influence Mammography Use Of Community Health Workers, Cynthia M. Kratzke

Health Services Research Dissertations

Community health worker (CHW) interventions promote early detection of breast cancer and mammography use to help eliminate health disparities for minority and low-income women. Data trends show lower mammography use among this population although CHW interventions have been shown to promote mammography use. However, CHW interventions have not been tested sufficiently to examine the factors that influence mammography use of CHWs.

This cross-sectional study examined the factors that influence mammography use of CHWs and the relationship of self-efficacy, social norms, and mammography use of CHWs. The PRECEDE model served as the framework combining social factors, beliefs, attitudes, behaviors, and accessibility …

Application Of The Traditional Epidemiological Model To Predict Occupational Injury Rates In Manufacturing Industries, Gary A. Morris

Health Services Research Dissertations

This study was designed to test the usefulness of the Traditional Epidemiological Model of disease causation in modeling occupational injury rates and the presence of occupational illness in the manufacturing industry. More specifically, this research involved use of the agent, host, and environment constructs of the Traditional Epidemiological Model to examine the effects of five environmental-related workplace health and safety practices on occupational injury and illness. Data from the National Occupational Exposure Survey (NOES), conducted by the National Institute for Occupational Safety and Health (NIOSH) in 1981–1983, were used to ascertain the presence of specific workplace characteristics and to calculate …

Predictors Of Oral Health Behaviors: Examining The Effect Of Patient Perceived Humanistic Attitude In The Context Of The Health Belief Model, Linda Leigh Hawkins Carroll

Health Services Research Dissertations

The purpose of this study was to test the explanatory power of The Health Belief Model with the added environmental condition of perceived humanistic attitude of a dental hygienist in its ability to predict individual's performance of oral disease prevention behaviors. A cross section survey of an intact group of 1,943 full time employees of Old Dominion University was conducted. The response rate was 52% (n = 1001). An exclusionary rule eliminated respondents who did not have a dental hygienist provide preventive services during dental visits. Seven hundred and fifty four were included in the study analyses. The study participants …

Barrier To Utilization Of Primary Healthcare Resources In Children Two Years Of Age And Under, Ruth A. Waibel

Health Services Research Dissertations

This is a retrospective longitudinal study of health service utilization using the Immunization Practice Data Set obtained from the Center for Pediatric Research, Norfolk, Virginia. Cluster sampling was used to identify a cohort of children (n = 271), aged 0 to 24 months, from the city of Norfolk, Virginia. A two-year abstraction of medical records was used to determine utilization practice patterns for three categories of health: well-baby, acute and chronic care. The purpose of this study was to identify socio-demographic, need, and health system factors associated with under-utilization of primary care services using Aday's model. The proportion of children …

A Longitudinal Study Examining The Stability Of Occupational Stressors Identified By Nursing Home Administrators, Gay Lynne Andrucci-Armstrong

Health Services Research Dissertations

As a result of the ever changing and expanding role of the nursing home administrator in conjunction with the stricter legislation governing nursing facilities over the past decade and the graying of America, a study specific to this population was warranted. The purpose of this study is to determine the relative change in the self-reported occupational stressors of nursing home administrators over a five year period (December 1994 to June 1999) secondary to the increased regulatory climate of the nursing home industry.

This study was carried out in three phases and included all practicing nursing home administrators in Virginia. Phase …

A Health System Analysis Approach To Health Outcomes In Medicare Clients With Chronic Illnesses, Christine A. Elnitsky

Health Services Research Dissertations

Since 1863, outcomes measurement efforts have provided information to health care consumers, administrators, and policymakers in assessing concerns about access, quality and costs. With a growing population of older adults with chronic illnesses, cost-cutting strategies in health delivery systems, and federal endorsement of managed care systems, researchers have begun to evaluate the impact of different delivery system organizations on health. The current study combines two areas of health services research to provide the first published hierarchical analysis of the influence of delivery system factors, and a profile of population and community characteristics and utilization factors, on perceived health outcomes of …

A Study Of The Factors That Impact Female Military Beneficiaries Obtaining Preventive Health Services, Cynthia Andrea Chargois

Health Services Research Dissertations

The purpose of this study was to determine what factors predict whether female military retirees or the female beneficiary of a military retiree, ages 40 to 64, will obtain preventive health services, specifically, Pap smears, mammograms, and clinical breast examinations. Based on the findings of the study, it is suggested that it may be important for the Department of Defense to broaden their scope of interest to include those areas that are most prominent in affecting female military retirees or the female beneficiary of a military retiree, particularly those 40 to 64, in obtaining preventive health services.

The study comprised …

Explanatory Power Of The Behavior Model Of Utilization For Pediatric Asthma Health Care In An Urban Managed Care Setting, Kathie Marie Sawyer Zimbro

Health Services Research Dissertations

The Behavior Model of Utilization played a key role in explaining health services use for pediatric members with asthma in one urban, regional managed care company. The critical role the asthma management program played in promoting the health and well-being of enrolled members was elucidated. Information gleaned from this empirical study can be used to encourage appropriate resource utilization, formulate pediatric asthma health policy, and deliver cost-effective, quality health care. More importantly, managed care company administrators and clinicians can demonstrate the value of their efforts by achieving measurable improvements in the health and well-being of children in the communities they …

The Pediatric Breathing Survey, Linda J. Galloway

Health Services Research Dissertations

To ensure culturally-sensitive assessments, the researcher designed a Pediatric Breathing Survey (PBS) to measure quality of life for African-American children. The purpose of this study was to test whether the PBS is a reliable and valid instrument. Comparisons of group differences on race, income and parent's level of education based on parent responses to the questionnaires were conducted. More specifically, differences in Health Related Quality of Life (HRQOL) between Caucasian and African-American children were examined. The researcher-designed instrument was compared to Juniper's Pediatric Asthma Quality of Life Questionnaire. The sample consisted of parents of 84 school-aged children diagnosed with asthma. …

Factors Associated With Asthma Readmissions In Children's Hospitals, Maria Acedo Kronenburg

Health Services Research Dissertations

Asthma is the most common chronic illness of childhood. Pediatric asthma hospitalization rates and costs of care have risen in recent years. Readmissions, an adverse outcome often used to monitor quality of care, may account for the increase in asthma hospitalization rates. This research examined selected hospital and patient risk factors related to asthma readmissions, using Donabedian's framework for structure, process, and outcomes to assess the quality of care for children with asthma. Outcome measures included readmission for asthma within one year of initial hospitalization, readmission within 30 days, and multiple readmissions within one year. Structure factors measured were insurance …

Factors Which Affect Post-Hospital Resource Use And Patient Health Outcomes Among Taiwanese Older Adults, Chouh-Jiaun Lin

Health Services Research Dissertations

The purpose of this study was to explore relationships among population characteristics, patient post-hospital resource use and patient health outcomes in terms of the Andersen health behavioral model. An additional purpose of this study was to examine a discharge planning screening instrument used in a large urban hospital in Taiwan to determine if it predicts resource use and patient outcomes. A longitudinal research design was adopted for this study. Data were collected from the general medicine departments of an 800-bed university teaching hospital. Out of 109 patients who were interviewed, 78 participants qualified (participation rate = 71.6%).

The majority of …