Offering Medical Providers Capacity And Competence In Caring For Transgender And Non-Binary Patients: Evaluation Of A Pilot Digital Training Program, Lexis Manzara

Master's Projects and Capstones

Purpose: Stigma and discrimination in health care settings contribute to health disparities for transgender and non-binary (TGNB) people. Evidence suggests that a lack of training on the care for transgender and non-binary TGNB patients in medical school curricula has contributed to providers feeling unprepared to provide quality care for this population. Health care providers have the opportunity to play a key role in the reduction of health disparities for TGNB patients.

Methods: Twenty-five health care providers completed the eight-module digital training program. Pre- and post-tests assessed provider knowledge, self-efficacy, preparedness, and behavior. Paired samples t-tests were conducted to compare pre-and …

Redefining Trauma: Utilizing Restorative Justice To Repair Care Systems, Emebet Aklilu

Master's Projects and Capstones

This project examined the ways in which restorative justice programming can improve trauma informed care among the African American population in Oakland, CA. With 23% of African American men and women living at or below the poverty line in the United States, this project assesses gaps in current trauma informed care practices as evident in the literature. Following a rigorous document review the author coded and organized key programming components following six factors detailed by Rowher, Schoones, and Young (2014). Further examination of these program components was conducted using Bloom’s taxonomy levels to assess program outcomes associated with specific modules …

Art-Based Health Education For Homeless And Marginally Housed Women In San Francisco, Trineca R-N Godfrey

Master's Projects and Capstones

San Francisco currently has the highest rate of unsheltered homeless persons in the United States. Between limited resources and stigma many women included in this most vulnerable population are left with little to no support. Cis women as well as trans and non- binary people are at high risk for negative mental health outcomes due to violence (physical and psychological), stigma, lack of social support, societal marginalization, and the lack of healthcare. Lyon-Martin Health Services and the Women’s Community Clinic, in San Francisco’s Mission Neighborhood, caters to this community through its Outreach Department. Following a staff and outreach client needs …

Assessment Of Structural Competency In Baccalaureate Nursing Students: A Descriptive Study, Elle J. Del Gallo

Senior Honors Projects, 2010-2019

Cultural competence has been investigated extensively in nursing education to better prepare nurses to care for individuals of diverse backgrounds. While developing cultural competence is important to address individual care needs, it may not address the social and structural factors that influence health. Structural competency describes the ability to assess not only cultural factors that affect health disparities, but also structural inequalities and stigmas that can alter a patient’s presenting symptoms and risk for certain diseases.

Affordable Care Act And Preventive Care Usage: A Mixed Method Analysis Of Cardiovascular Care, Brit Peek

Theses & Dissertations

It is a commonly held belief that access to health insurance affects the level of utilization of preventive care services, and thus plays a crucial role in the effective management of avoidable chronic illnesses, decreasing levels of premature mortality, and enabling individuals to live wholesome long lives. Based on this belief, among other goals, the Affordable Care Act (ACA) was designed to increase access to health insurance and related medical services for the population of the United States. This dissertation attempts to identify whether this belief is valid or not by testing whether the usage of preventive care changed between …

Extracting Patterns In Medical Claims Data For Predicting Opioid Overdose, Ryan Sanders

Graduate Theses and Dissertations

The goal of this project is to develop an efficient methodology for extracting features from time-dependent variables in transaction data. Transaction data is collected at varying time intervals making feature extraction more difficult. Unsupervised representational learning techniques are investigated, and the results compared with those from other feature engineering techniques. A successful methodology provides features that improve the accuracy of any machine learning technique. This methodology is then applied to insurance claims data in order to find features to predict whether a patient is at risk of overdosing on opioids. This data covers prescription, inpatient, and outpatient transactions. Features created …

Examining Racial & Ethnic Disparities In The Reach Of The Medicare Shared Savings Program, Lindsey Arneson

Capstone Experience

It is important to understand the quality of health care for racial and ethnic minorities covered under the largest U.S. government-run insurance program, Medicare, because the demographics of the U.S. are becoming older and more diverse. A new value-based program under Medicare is the Shared Savings Program (MSSP), which creates incentives to improve care quality and health outcomes for Medicare beneficiaries with a specific focus on increasing the provision of preventive care services. This capstone project aims to understand the representation of racial/ethnic minority Medicare beneficiaries, namely African Americans/Blacks and Hispanics/Latinxs, that receive care from providers or facilities (i.e., Accountable …

Preserving Ancient Cultures Through Medicinal Narratives, Mckenzie Jewel Moss

Honors Projects

“Preserving Ancient Cultures through Medicinal Narratives” is a comprehensive project that takes an interdisciplinary approach to understanding the effects that culture has on health. The project as a whole includes the initial work and readings I performed to better understand differences in healing between the cultures found throughout South America, where Inca culture is still prevalent, and that of the Unites States, as well as an independent documentary. The documentary contains my own personal commentary complemented by video clips of interviews I performed with individuals living in South America.

Pharmacist Perceptions Toward Screening, Brief Intervention, And Referral To Treatment For Prescription Opioid Misuse: Initial Instrument Reliability And Validity, Tara Fouts

Boise State University Theses and Dissertations

Prescription opioid misuse has become a growing problem in the United States, and there has been a significant increase in the number of nonfatal overdose and overdose deaths since the 1990s. Idaho has also experienced an increase in the number of drug-induced deaths over time, increasing nearly 30% from 2012 to 2016. The Centers for Disease Control and Prevention indicates overprescribing and dispensing of prescription opioids is a main driver to the increase in overdoses. Evidence-based early intervention methods, such as screening, brief intervention, and referral to treatment (SBIRT), can be utilized in health care settings to identify risky behaviors …

The Acute Effect Of Water Intake On Glucose Regulation In Low Drinkers, Adam David Seal

Graduate Theses and Dissertations

Previous evidence suggests the hormone arginine vasopressin (AVP) may be a modifiable factor contributing to hyperglycemia. Significant differences in urine concentration and copeptin, a marker for AVP, have been observed between low and high water drinkers. Purpose: The purpose was to investigate the acute effect of adequate water intake on glucose regulation in low drinkers. Methods: 7 healthy (5 males, 2 female) low drinkers were recruited using a water frequency questionnaire (WFQ), spot and 24-h urine sample (age 43±6 y, BMI 30.9±3, WFQ volume 823±403 mL∙d-1, 24 h Uosm 961±105 mmol∙kg-1, copeptin 8.17±3.05 pmol∙L-1). During two experimental protocols, participants remained …

Condom Dispenser Program, Madilynn Turner

Capstone Projects and Master's Theses

Health and Wellness Services (HWS) at California State University Monterey Bay (CSUMB) takes an integrative health approach to support the CSUMB campus community. There six entities that make up HWS, however, the Condom Dispenser Program (CDP) was implemented under Health Promotion and Education (HPE). The mission of HPE is to ensure that CSUMB community members are reaching holistic wellness through the adoption of healthy behaviors. This goal is met through programming, outreach, and education that is provided.

The need that was discovered through analysis of the National Collegiate Health Assessment (NCHA) was that students are not using condoms to prevent …

Diabetes And Effectiveness Of Gym Usage, Roberto Moore

Capstone Projects and Master's Theses

The Central Coast YMCA’s Diabetes Prevention Program (DPP) exists to support community members who are diagnosed as pre-diabetic. DPP participants are provided a free membership to the YMCA’s gym, but are under utilizing this resource. Some reasons that participants may not be utilizing the gym are lack of time, work schedules, the language barrier in utilizing the equipment and childcare concerns. If participants are not utilizing the gym they may not complete the program and may be at risk of contracting diabetes and possibly losing a limb. In order to understand the specific barriers for this group in utilizing this …

Improving Access To Mental Health Care With Nurse Practitioners, Jessica Whelan

Dissertations

Problem: Over 40% of those with mental illness are untreated since the supply of psychiatrists does not meet the demand. The psychiatric mental health nurse practitioner (PMHNP) may be an adjunct in providing those services. The purpose of this quality assurance study was to evaluate outcomes of care between a PMHNP and a psychiatrist (medical doctor [MD]).

Methods: An observational, descriptive design with a retrospective medical record review of adult patients over a six-month period in a suburban, Midwestern, privately owned psychiatric practice.

Results: A total of 787 individual patients encountered at least one visit (N=787) although 3,679 …

Going Behind The Scenes: Understanding And Organizing A Corporate Fitness Center, Rachael Griffith

Masters Theses/Capstone Projects

The author learns best practices and how to organize a corporate fitness center. Area companies are explored.

Improving Chinese Mothers’ Health Literacy: A Wechat Intervention, Qiong Chen

Doctoral Dissertations

The health literacy and eHealth literacy of women during the reproductive age is crucial, as it can affect their health and the health of their children. Promoting health literacy is essential to achieve mothers’ empowerment by improving access to and capacity of using health information effectively. However, functional, interactive, and critical health literacy and eHealth literacy have never been assessed among Chinese women. The first study during this dissertation assessed functional, interactive, and critical health literacy and eHealth literacy among 421 of Chinese mothers with children under 3 years old. The results revealed overall less than optimal level of health …

Understanding Young Adult Survivors Of Childhood Cancers’ Participation In Late Effects Screening: A Mixed Methods Approach, Kristen Trost Mantlo

Health Services Research Dissertations

Significant advancements in the treatment of childhood cancers have helped to increase the 5-year survival rate from 56% in the early 1970s to approximately 80-85% in the early 2000s (Greenlee, Murray, Bolden, & Wingo, 2000; Hampton, 2005). Treatment modalities such as chemotherapy and radiation have led to many serious long-term side effects, known as late effects. Between 60% and 90% of survivors develop some form of long-term chronic condition due to their treatment and up to 40% of those conditions will be life-threatening (Howlader, N. et al., 2013). While the majority of young adult survivors of childhood cancer are at …

Implementing Screening To Assess Readiness To Change In Overweight And Obese Patients At A Patient-Centered Medical Home, Jarrod Gant

Doctoral Projects

Obesity is at epidemic levels within the United States (U.S.), but the Southern U.S. has some of the most obese states. Mississippi (MS) is the most obese state in the country (Robert Wood Johnson Foundation, 2018). Factors such as diet, sedentary lifestyle, cultural influences, and socioeconomic status contribute to the state’s citizens being overweight and obese.

Contributing to the state’s obesity is the fact that MS has more people living in poverty than any other state (Center for American Progress [CAP], 2018). Lacking the ability to afford healthy foods and the ability to afford quality healthcare adds to the state’s …

Timely Access To Maternal, Neonatal And Child Healthcare For Rural Communities In Rwanda: The Role Of Community Health Workers, Jean Bosco Bigirimana

Electronic Thesis and Dissertation Repository

Abstract

Introduction: In Rwanda, although there has been some progress in health care delivery as expressed in the reduction in maternal and child mortality, rates are still high and geographically variable. Improving equitable access to quality healthcare services for maternal, neonatal and child healthcare (MNCH), community-based maternal, neonatal and child healthcare (CBMNCH) depends upon using “community health workers” (CHWs). Yet CHWs program faces difficulties that upset delivery of the quality of the comprehensive package of services. Unfortunately, little is known about CHWs` performance and job satisfaction in the provision of CBMNCH.

Goal: The study aimed to provide insight into …

Using The Re-Aim Framework To Evaluate The Feasibility Of A Parent-Focused Pilot Intervention Targeting Childhood Obesity, Daniel Briatico

Electronic Thesis and Dissertation Repository

Background: Childhood obesity is a major public health concern. Community-based childhood obesity treatment interventions have the potential to improve health behaviours and outcomes, but require effective evaluation to facilitate translation of research into practice. The purpose of the current study was to determine the feasibility of a parent-focused pilot intervention (“C.H.A.M.P. Families”) targeting childhood obesity using the RE-AIM framework, an evaluation tool for community-based health interventions.

Methods: A single-centre, single-group, non-randomized, repeated measure feasibility study was conducted over the course of 10 months. Participants (n = 16 parents/caregivers representing 11 children with obesity) completed a 13-week parent-focused education intervention. …

Wellness For One, Healthy Community For All: Improving A Multidimensional University Wellness Programlth, Shea Gaier

Master's Projects and Capstones

Background: Evidence suggests that college students are often unaware of the seven

dimensions of wellness (Social, emotional, environmental, financial, physical, intellectual, and spiritual). According to interviews, most students think of physical wellness only when it comes to wellness. Besides the dimensions of wellness, students have shown to gain substantial benefits from increasing their knowledge of school resources regarding personal health.

Methods: This was a quality improvement project for the Wellness Matters Program that encompassed a Plan, Do, Study, Act cycle. The goal was to improve the program by adding a comprehensive educational workshop and optimizing the one-on-one sessions. Pilot tests …

Health Literacy Changes In A Technology-Enhanced Diabetes Prevention Program, Cody Goessl

Theses & Dissertations

Background: In 2001, the Diabetes Prevention Program was published evaluating the efficacy of a pharmaceutical intervention, Metformin, and a behavioral lifestyle intervention (LI) to reduce incidence of Type 2 diabetes mellitus. The LI was observed to reduce the incidence of the disease by 58% relative to 31% in the medication treatment. Amongst technology based LIs, little has been done to address different health literacy populations.

Objectives: This dissertation evaluated how teach-back and teach-to-goal can influence the uptake of information obtained in each health education lesson, behaviors and its influence on engagement and weight loss.

Methods: Four hundred forty-two participants …

Paging Dr. Strong: A Call To Action Towards Addressing Occupational Stress And Burnout Among Primary Care Health Professionals, Carmen Olmedo

Master's Projects and Capstones

Purpose: Within a rapidly evolving industry, occupational stress and burnout among healthcare clinicians and staff is becoming a pervasive public health crisis across all subspecialties. The purpose of this project was to use the Compassion Satisfaction-Compassion Fatigue (CS-CF) Theory as a method to assess burnout among primary care health professionals, in addition to developing recommendations to assist the promotion of a staff wellness initiative at an urban community clinic.
Methods: A needs assessment was conducted at a Community Health Center (CHC) in San Francisco. Data collection consisted of anonymous distribution of the Professional Quality of Life (ProQOL) Survey and semi-structured …

Heat Waves And Heat-Related Mortality In East Tennessee, Taiwo Adesoba

Electronic Theses and Dissertations

Heat waves represent a public health challenge that requires multiple responses and warnings to protect vulnerable populations. Although studies have reported an increasing trend of heat wave occurrence in many areas of the world, no clear trend exists in East Tennessee. Using data from Parameter-elevated Relationships on Independent Slope Models (PRISM), CDC WONDER and the United States Census Bureau, the relationship between mortality rates and year was estimated during heat wave events between 1999 and 2010. Five heat wave definitions were tested. Overall, 2007 and 2010 stand out as the years with the highest number of heat wave days in …

Evaluation Of Family Inc.'S Home Visitation Program, Brooke A. Linnenbrink

Capstone Experience

FAMILY, Inc. is a nonprofit that provides public health and family support services to women, children, and families in Pottawattamie and Mills counties. It's home visitation program provides health education information to families in the communities that are expecting a child or have a child less than five years of age. This project looked at FAMILY, Inc.’s database regarding the health of children enrolled in their home visitation program and use that information to help develop health education tools as they prepare to expand their programming to include Early Head Start (EHS). Currently FAMILY uses the Parents as Teachers curriculum, …

Uptake Of Colorectal Cancer Screening Tests By Ontario Physicians., Owen Litwin

Electronic Thesis and Dissertation Repository

This population-based study used administrative healthcare data to examine the uptake of tests recommended for colorectal cancer screening by eligible Ontario physicians and non-physicians, and to examine if testing of primary care physicians is associated with greater testing in their patients. Physicians (n=11,434) were matched 1:4 to non-physicians (n=45,736) on age, sex, and geographic location as of April 21, 2016. Uptake of colorectal tests was similar in physicians (67.9%, 95% CI, 67.0–68.7%) and non-physicians (66.6%, 95% CI, 66.2–67.1%). Physicians were more likely than non-physicians to undergo colonoscopy and less likely to undergo fecal occult blood testing. Uptake of colorectal tests …

Resedent Study- Reducing Sedentary Behaviour May Slow Cognitive Decline In Older Adults With Mild Cognitive Impairment: A Pilot Study, Kirsten B. Dillon

Electronic Thesis and Dissertation Repository

Physical activity (PA) has been shown to slow down dementia. Unfortunately, older adults spend most of their day in sedentary behaviours (SB). Breaking up prolonged bouts of sitting with intermittent bouts of light intensity PA may reduce glycemic variability in the brain; potentially mitigating cognitive decline. This study investigated how interrupting SB with 10 min bouts of light intensity PA 3x a day would affect mild to moderate cognitive impairment progression (primary outcome) in older adults residing in an assisted living facility. Participants (n=25) were assigned in clusters into a two arm 10-week single site pilot randomized controlled trial. Secondary …

A Vaccine Administration Training Program To Increase Adolescent Vaccination Rates, Claire Jensen

Dissertations

Abstract

Immunizations have been proven to control life-threatening diseases. Often Registered Nurses (RNs) administer vaccines but are unsure how to discuss vaccines with vaccine hesitant patients. Missouri’s adolescent vaccination rates are below its neighboring states. This initiative’s purpose was to increase adolescent vaccine administrations at a Missouri County Health Department (MCHD).

This quality improvement initiative had an observational, cross-sectional, descriptive design. RNs employed at three MCHD clinics attended an adolescent vaccine administration training program (VAT) and completed pre-/post-tests regarding the Advisory Council on Immunization Practices recommendations. Medical record reviews from March 1-April 30, 2018 and March 1-April 30, 2019 compared …

A Behavioral Weight Loss Program For Low-Income Adults With Obesity And Hiv, Sophai Thach

Dissertations

Problem: Obesity, having a body mass index (BMI) of 30 kg/m² or greater, increases the risk for cardiovascular disease. For people living with HIV (PLWH), this increases their risk for myocardial infarctions by 50% and causes this life-threatening event to occur at a younger age compared to those who are not diagnosed with HIV.

Methods: With obesity disproportionately affecting people with low income, this study aims to evaluate the effects of a 12-week behavioral weight loss program that utilizes journaling as a self-monitoring tool, weekly educational classes, and individualized goal-setting on PLWH with obesity who live in …

Optimizing The Carrot Rewards App: An Examination Of Team-Based Financial Incentives To Increase Walking, Emma Pearson

Electronic Thesis and Dissertation Repository

Mobile health applications (mHealth apps) targeting physical activity (PA) have increased in popularity, yet effectiveness is often limited by low engagement. This study examined the impact of adding a team-based feature, Step Together Challenges (STCs), to an existing incentive-based mHealth app (i.e., Carrot Rewards) on PA. A 24-week retrospective matched pairs study was conducted (n=61,170; pre-intervention: weeks 1-12; intervention: weeks 13-24). Participants who used STCs (experimental group) were matched with those who did not (controls). STC users could earn team incentives for collaboratively reaching individual daily step goals 10 times in seven days. Controlling for pre-intervention mean daily step count, …

We Are Constantly Expected To Disregard Ourselves And Our Personal Needs: Addressing The Daily Stressors Of Private Emergency Medical Services, Erich Jimenez Bonilla

Electronic Theses, Projects, and Dissertations

ABSTRACT

Background Private Emergency Medical Services serve a vital role in the community, as such they are subject to job related stress. Currently, there is a limited amount of research related to the stressors related to the job.

Objective The purpose of this study was to define the type of daily stressors faced by Private EMS personnel and investigate how they impact their Sense of Coherence.

Study Design A mixed methods approach was used in this study to obtain the necessary data. Semi-structured one-on-one interviews were conducted with current employees of an EMS agency that provides 911 service in their …