Medicine and Health Sciences Commons^™

Expressive Arts Therapy To Support Positive Experiences Of Embodiment Among Rural Lgbtq+ Adults: A Literature Review, Ann Stromgren

Expressive Therapies Capstone Theses

This paper investigates the use of expressive arts therapy to support LGBTQ+ adult clients in rural communities. Caring professionals in rural areas often lack training on how to work with LGBTQ+ clients, and best practices for clinical mental health counseling with rural LGBTQ+ clients have yet to be defined. Some evidence suggests that using “metronormative” best practices with rural clients may be irrelevant or cause harm (Giano et al., 2020). Although some recommendations exist for using expressive therapies with LGBTQ+ clients, they are rarely evidence-based, as very few empirical studies exist evaluating the effectiveness of expressive therapy interventions with LGBTQ+ …

The Motherhood Crusade: Rural Low-Income Mothers, Support, And Empowerment, Christina Castellano

Dissertations

Previous research has shown that postpartum women with untreated mental health conditions are more likely to fail to manage their own health, have inadequate nutrition, abuse substances, experience abuse, be less responsive to their baby’s needs, have fewer positive interactions with their baby, experience difficulties breastfeeding, and question their abilities as a mother. Rural culture plays a complex role in the transition to motherhood, influencing whether mothers seek out and use resources. While more is known about location and access issues, less is known about how rural culture and, more specifically, how empowerment and social support impact postpartum experience. The …

Implementing The Who Caregivers Skills Training Program With Caregivers Of Autistic Children Via Telehealth In Rural Communities, Cecilia Montiel-Nava, Megan Tregnago, Jeanne Marshall, Kristin Sohl, Alicia Brewer Curran, Melissa Mahurin, Melissa Warne-Griggs, Who Cst Team, Pamela Dixon

Psychological Science Faculty Publications and Presentations

Background: For families with autistic children living in rural areas, limited access to services partly results from a shortage of providers and extensive travel time. Telehealth brings the possibility of implementing alternative delivery modalities of Parent Mediated Interventions (PMIs) with the potential to decrease barriers to accessing services. This study aimed to evaluate the feasibility and acceptability of implementing the World Health Organization-Caregivers Skills Training program (WHO-CST) via an online, synchronous group format in rural Missouri.

Methods: We used a mixed methods design to collect qualitative and quantitative data from caregivers and program facilitators at baseline and the end of …

A Pilot Randomized Controlled Trial Of Smoking Cessation Induction Treatment For Rural, Underserved Cancer Survivors Across The Continuum Of Motivation To Quit, William Bowling

Theses and Dissertations--Psychology

The United States’ smoking prevalence has decreased substantially, but this public health improvement is unevenly distributed across the population. A promising individual-level approach to cancer control equity is to develop more acceptable and efficacious interventions that are widely disseminated to rural and other disadvantaged cancer survivors. Smoking cessation induction focuses not on long-term abstinence, but on engaging people in the process of making quit attempts and may be ideal for hard-to-reach populations. The aim of this pilot randomized controlled trial was to evaluate the feasibility and acceptability of a smoking cessation induction intervention designed for rural cancer survivors. The treatment …

Physician Burnout Among West Virginia Primary Care Providers, Kevin S. Mccann, Adam Baus, Joanna Bailey, Laura Boone, Jennifer Boyd, Martha Cook-Carter, Dan Doyle

Marshall Journal of Medicine

Introduction

Work related burnout is highly prevalent in US physicians and linked to adverse effects on patients, providers and organizations. This study measures burnout in West Virginia (WV) primary care providers, allowing for comparison of results to a similar, recent study of US physicians.

Methods

Anonymous survey through email that included Maslach Burnout Inventory, demographic, workload, and practice characteristics. Responses were analyzed using JMP Pro 13. Analysis used JMP Pro 13 for descriptive statistics, chi-square and regression modeling.

Results

Subjects = 110, female/male ratio 1.4, all primary care physicians (PCP), or advanced practice registered nurses or physician assistants (APRN/PA). PCP …

Obstetric Patients And Healthcare Providers Perspectives To Inform Mobile App Design For Physical Activity And Weight Control During Pregnancy And Postpartum In A Rural Setting, Rachel Tinius, Cathryn Duchette, Sia Beasley, Maire Blankenship, Nancy Schoenberg

Behavioral Science Faculty Publications

Background: Mobile health technology offers the opportunity for women to engage with physical activity promotion programs without many of the barriers commonly associated with exercise during and after pregnancy (eg, childcare concerns, rigid schedules, fear of doing harm to fetus or self, access to fitness facilities, uncomfortable with body in front of others) which may be particularly useful in under-resourced rural environments. We conducted the first known study on perspectives of pregnant women, postpartum women, and obstetric healthcare providers in a rural setting on needs related to the development of a mobile app designed to increase physical activity during pregnancy …

Serious Mental Illness And Rural Primary Care: Provider Training, Attitudes, And Opinions, Lydia Eisenbrandt

Electronic Theses and Dissertations

Healthcare resources are especially limited in rural regions of the US. The lack of Primary Care Providers (PCPs) and mental/behavioral health services is problematic, as there are high rates of behavioral and medical concerns within rural populations. Special populations, such as rural persons with Serious Mental Illness (SMI), are medically complex and represent a vulnerable and underserved population. Healthcare outcomes for persons with SMI are poor compared to the general population and commonly lead to premature death. Various barriers prevent this population from accessing optimal healthcare, especially in rural areas, due to negative perceptions/stigma, a lack of understanding from PCPs, …

Utilization Of Telepsychiatry To Combat The Opioid Crisis In The United States, Haley Tallarico

Theses, Dissertations and Capstones

Introduction: In the past five years, the United States (U.S.) has experienced an unprecedented epidemic of opioid misuse, abuse and overdose related death, leading to a national public health crisis. Telepsychiatry along with medication-assisted treatment has been proposed as a viable solution. The purpose of this research was to examine the field of telepsychiatry as a practical means to combat the rapidly increasing opioid epidemic facing America and to determine the effect of telepsychiatry utilization on access to treatment received in an outpatient medical setting.

Methodology: The methodology for this study was a literature review including the use of …

An Exploratory Study Of Duty-Related Stress Among Conservation Officers, Logan Ledford

Electronic Theses and Dissertations

Research relating to police stress has typically focused on officers working in urban areas, neglecting their rural counterparts. This is especially true of conservation officers, who are tasked with enforcing laws in state parks and other recreational areas. To date, only a handful of studies have sought to better understand their experiences and perceptions. The current study seeks to further our understanding of conservation officer stress in three unique ways: (1) via applying McCreary and Thompson’s (2006) operational police stress scale (PSQ-Op) to the population, (2) determining whether officer characteristics (e.g., age, education, length of service) affect perceived stress, and …

Staying Out: Reentry Protective Factors Among Rural Women Offenders, Michele Staton, Megan F. Dickson, Martha Tillson, J. Matthew Webster, Carl G. Leukefeld

Behavioral Science Faculty Publications

The current study examines protective factors for women who transition from county jails to rural Appalachian communities, areas with limited health and behavioral health services. The study included drug-using women recruited from three jails in rural Appalachia and followed-up at 12-months post-release. Analyses focused on differences between women who remained in the community and those who returned to custody, as well as a multivariate model to determine protective factors for reentry success. At the bivariate level, staying out of jail was associated with being older, having a job, not using drugs, stable housing, receiving health treatment, and having prosocial peers. …

A Coordinated School Health Approach To Obesity Prevention Among Appalachian Youth: Middle School Student Outcomes From The Winning With Wellness Project, William T. Dalton Iii, Karen Schetzina, Elizabeth Conway-Williams

Karen E. Schetzina

The Winning With Wellness (WWW) project was a school-based obesity prevention program that was developed to promote healthy eating and physical activity in youth residing in rural Appalachia. The project was based on the Coordinated School Health model (Centers for Disease Control and Prevention (CDC), 2013a) and used a community-based participatory research approach with an emphasis on feasibility and sustainability. The purpose of this study was to examine self-reported health outcomes for middle school students across the course of the intervention. Sixth grade middle school students (N = 149; 52% girls) from four schools in Northeast Tennessee completed a …

Pharmacy Staff Perspectives On Alcohol And Medication Interaction Prevention Among Older Rural Adults, Faika Zanjani, Hannah Allen, Rachel Vickers Smith, Demetra Antimisiaris, Nancy E. Schoenberg, Catherine A. Martin, Richard Clayton

Behavioral Science Faculty Publications

Older adults are at high risk for alcohol and medication interactions (AMI). Pharmacies have the potential to act as ideal locations for AMI education, as pharmacy staff play an important role in the community. This study examined the perspectives of pharmacy staff on AMI prevention programming messaging, potential barriers to and facilitators of older adult participation in such programming, and dissemination methods for AMI prevention information. Flyers, telephone calls, and site visits were used to recruit 31 pharmacy staff members who participated in semistructured interviews. A content analysis of interview transcriptions was conducted to identify major themes, categories, and subcategories. …

A Rural/Urban Comparison Of Privacy And Confidentiality Concerns Associated With Providing Sensitive Location Information In Epidemiologic Research Involving Persons Who Use Drugs, Abby E. Rudolph, April M. Young, Jennifer R. Havens

Epidemiology and Environmental Health Faculty Publications

Background—Analyses that link contextual factors with individual-level data can improve our understanding of the "risk environment"; however, the accuracy of information provided by participants about locations where illegal/stigmatized behaviors occur may be influenced by privacy/confidentiality concerns that may vary by setting and/or data collection approach.

Methods—We recruited thirty-five persons who use drugs from a rural Appalachian town and a Mid-Atlantic city to participate in in-depth interviews. Through thematic analyses, we identified and compared privacy/confidentiality concerns associated with two survey methods that (1) collect self-reported addresses/cross-streets and (2) use an interactive web-based map to find/confirm locations in rural and …

Healthcare Contact And Treatment Uptake Following Hepatitis C Virus Screening And Counseling Among Rural Appalachian People Who Use Drugs, Dustin B. Stephens, April M. Young, Jennifer R. Havens

Behavioral Science Faculty Publications

Background—Hepatitis C virus (HCV) remains a major contributor to morbidity and mortality worldwide. Since 2009, Kentucky has led the United States in cases of acute HCV, driven largely by injection drug use in rural areas. Improved treatment regimens hold promise of mitigating the impact and transmission of HCV, but numerous barriers obstruct people who inject drugs (PWID) from receiving care, particularly in medically underserved settings.

Methods—503 rural people who use drugs were recruited using respondent-driven sampling and received HCV screening and post-test counseling. Presence of HCV antibodies was assessed using enzyme immunoassay of dried blood samples. Sociodemographic and …

Age Of First Arrest, Sex, And Drug Use As Correlates Of Adult Risk Behaviors Among Rural Women In Jails, Martha Tillson, Justin C. Strickland, Michele Staton

Center on Drug and Alcohol Research Faculty Publications

Incarcerated women frequently report initiation of substance use and sexual encounters at an early age, and often engage in high-risk drug use and sexual behaviors as adults. This study examined the timing of first sex, drug use, and arrest, as well as their unique influences on specific risky behaviors in adulthood, among a high-risk population of rural women recruited from jails. Ages of initiation were all positively and significantly correlated, and each independently increased the likelihood of several risky behaviors in adulthood. Implications are discussed for screening, intervention, and treatment targeting high-risk women and girls in rural areas, particularly within …

Mental Health Treatment Seeking Patterns And Preferences Of Appalachian Women With Depression, Claire Snell-Rood, Emily Hauenstein, Carl G. Leukefeld, Frances Feltner, Amber Marcum, Nancy E. Schoenberg

Behavioral Science Faculty Publications

This qualitative study explored social-cultural factors that shape treatment seeking behaviors among depressed rural, low-income women in Appalachia—a region with high rates of depression and a shortage of mental health services. Recent research shows that increasingly rural women are receiving some form of treatment and identifying their symptoms as depression. Using purposive sampling, investigators recruited 28 depressed low-income women living in Appalachian Kentucky and conducted semistructured interviews on participants’ perceptions of depression and treatment seeking. Even in this sample of women with diverse treatment behaviors (half reported current treatment), participants expressed ambivalence about treatment and its potential to promote recovery. …

A Randomized Controlled Trial Of A Faith-Placed, Lay Health Advisor Delivered Smoking Cessation Intervention For Rural Residents, Nancy E. Schoenberg, Christina R. Studts, Brent J. Shelton, Meng Liu, Richard Clayton, Jordan Baeker Bispo, Nell Fields, Mark Dignan, Thomas Cooper

Behavioral Science Faculty Publications

Introduction. Rural US residents smoke at higher rates than urban or suburban residents. We report results from a community-based smoking cessation intervention in Appalachian Kentucky.

Study design. Single-blind, group-randomized trial with outcome measurements at baseline, 17 weeks and 43 weeks.

Setting/participants. This faith-placed CBPR project was located in six counties of rural Appalachian Kentucky. A total of 590 individual participants clustered in 28 churches were enrolled in the study.

Intervention. Local lay health advisors delivered the 12-week Cooper/Clayton Method to Stop Smoking program, leveraging sociocultural factors to improve the cultural salience of the program for Appalachian smokers. Participants met with …

Colorectal Cancer Prevention: Perspectives Of Key Players From Social Networks In A Low-Income Rural Us Region, Nancy E. Schoenberg, Kathryn Eddens, Adam Jonas, Claire Snell-Rood, Christina R. Studts, Benjamin Broder-Oldach, Mira L. Katz

Behavioral Science Faculty Publications

Social networks influence health behavior and health status. Within social networks, “key players” often influence those around them, particularly in traditionally underserved areas like the Appalachian region in the USA. From a total sample of 787 Appalachian residents, we identified and interviewed 10 key players in complex networks, asking them what comprises a key player, their role in their network and community, and ideas to overcome and increase colorectal cancer (CRC) screening. Key players emphasized their communication skills, resourcefulness, and special occupational and educational status in the community. Barriers to CRC screening included negative perceptions of the colonoscopy screening procedure, …

Association Between Depression And Aggression In Rural Women, Laetitia Meyrueix, Gabriel Durham, Jasmine Miller, K. Bryant Smalley Phd, Psyd, Jacob C. Warren Phd

Journal of Health Disparities Research and Practice

Rural women represent approximately 20% of women living in the United States, yet research on the specific mental health needs of rural women is limited. Given the well-recognized gender-linked disparity in depression, its correlated symptoms in women still need much investigation. While emerging notions of depression in men embrace potential symptoms related to irritability and aggression, less research has focused on the potential role of aggression in depressed women. This connection may be particularly relevant for rural women who face unique mental health stressors in comparison to their urban counterparts. The purpose of this study was to examine if aggression …

A Coordinated School Health Approach To Obesity Prevention Among Appalachian Youth: Middle School Student Outcomes From The Winning With Wellness Project, William T. Dalton Iii, Karen Schetzina, Elizabeth Conway-Williams

International Journal of Health Sciences Education

The Winning With Wellness (WWW) project was a school-based obesity prevention program that was developed to promote healthy eating and physical activity in youth residing in rural Appalachia. The project was based on the Coordinated School Health model (Centers for Disease Control and Prevention (CDC), 2013a) and used a community-based participatory research approach with an emphasis on feasibility and sustainability. The purpose of this study was to examine self-reported health outcomes for middle school students across the course of the intervention. Sixth grade middle school students (N = 149; 52% girls) from four schools in Northeast Tennessee completed a …

Effects Of The Frontier Environment On Identity Development Among First Generation College Students, Kenli Ann Urruty

All Graduate Theses and Dissertations, Spring 1920 to Summer 2023

The unique experience of first generation college students from frontier communities as they transition to college has not yet been explored in the literature. The current study was designed to explore those experiences and the ways the frontier context and first generation status shape identity development once these youth have left their families and home communities and made the transition to college. To gain a rich understanding of the experiences of first generation college students from frontier communities, this study employed a phenomenological qualitative design and the findings were interpreted through a social constructionist lens. Eleven emerging adults were recruited …

Reassessing The Architecture Of The Health Beliefs Models In Low-Income Diverse Families, Krista B. Highland

Department of Psychology: Dissertations, Theses, and Student Research

Health beliefs contribute to health outcomes. These health beliefs extend to include health beliefs parents have regarding their children’s health. However, the role of parental health beliefs remains unexplored among a low-income population. This study aims to assess these beliefs and the effects they have on child health. Furthermore, this study aims to delineate potential belief differences between socioecological-level groups (e.g. population density, Latino identification, and insurance coverage). The long-term goal is to understand the relationships among various personal health beliefs and parental health beliefs, psychosocial factors, community factors, cultural factors, organizational factors, and healthcare perceptions among this at-risk population. …

Rural Adolescents’ Help Seeking Intentions For Emotional Problems: The Influence Of Perceived Benefits And Stoicism., Coralie Wilson

Coralie J Wilson

This paper is the second from a larger multi-cite study developed and led by the third author which explores factors that influence adolescents' help-seeking intentions. Specifically, this paper investigates the extent to which perceived benefits of help seeking, stoicism, gender and symptoms of psychological distress are associated with intentions to seek professional help for emotional problems. A cross sectional self-report questionnaire was administered to adolescents recruited from seven high schools in rural towns in the Riverina region of New South Wales. A total of 778 adolescents were recruited. The sample included 373 male and 404 female participants between 13 and …

Rural Adolescents’ Help Seeking Intentions For Emotional Problems: The Influence Of Perceived Benefits And Stoicism., Coralie J. Wilson

Frank Deane

This paper is the second from a larger multi-cite study developed and led by the third author which explores factors that influence adolescents' help-seeking intentions. Specifically, this paper investigates the extent to which perceived benefits of help seeking, stoicism, gender and symptoms of psychological distress are associated with intentions to seek professional help for emotional problems. A cross sectional self-report questionnaire was administered to adolescents recruited from seven high schools in rural towns in the Riverina region of New South Wales. A total of 778 adolescents were recruited. The sample included 373 male and 404 female participants between 13 and …

Brief Report: Impact Of Classroom Presentations About Health And Help Seeking On Rural Australian Adolescents’ Intentions To Consult Health Care Professionals., Coralie J. Wilson

Frank Deane

Building Bridges-GP-Team (Building Bridges-Team; Wilson et al., 2004c) is a variation of the Building Bridges to General Practice: GPs in Schools program (Building Bridges-GP; Wilson et al., 2004a), which promotes consultation with health care professionals who are local and available for rural and regional adolescent’ consultation. The first major component of Building Bridges-GP-Team involves structured health professional training that provides knowledge in three basic areas: (1) adolescents’ help seeking barriers and ways to address barriers in primary health care; (2) developmental issues relevant to adolescent’ help seeking; and (3) classroom management, presentation strategies, and elementary teaching skills. Training is based …

Brief Report: Impact Of Classroom Presentations About Health And Help Seeking On Rural Australian Adolescents’ Intentions To Consult Health Care Professionals., Coralie J. Wilson

Coralie J Wilson

Building Bridges-GP-Team (Building Bridges-Team; Wilson et al., 2004c) is a variation of the Building Bridges to General Practice: GPs in Schools program (Building Bridges-GP; Wilson et al., 2004a), which promotes consultation with health care professionals who are local and available for rural and regional adolescent’ consultation. The first major component of Building Bridges-GP-Team involves structured health professional training that provides knowledge in three basic areas: (1) adolescents’ help seeking barriers and ways to address barriers in primary health care; (2) developmental issues relevant to adolescent’ help seeking; and (3) classroom management, presentation strategies, and elementary teaching skills. Training is based …