The Impact Of Social Determinants Of Health And Acculturation On Quality Of Life In Older Chinese American Adults With Chronic Pain: A Quantitative Study, Chi Lam

Dissertations

Despite a rapid increase in the older Chinese American adult population, there are very few research studies examining the impact of social determinants of health and acculturation on the quality of life in older Chinese American adults. The purpose of the study was to determine the impact of social determinants of health and acculturation on quality of life in older Chinese American adults with chronic pain. This quantitative, descriptive correlational study utilized Madeleine Leininger’s Transcultural Theory as its theoretical framework. Two research questions guided this study: (1) Was there a difference in the quality of life in older Chinese American …

Intimate Partner Violence Screening In The Emergency Department, Rebecca Stuerman

Dissertations

Problem: Intimate partner violence [IPV] is a public health concern that affects one in three women worldwide. IPV can be addressed through identification and early intervention with minimal risk to the patient. The emergency department is an important setting for screening given the frequency with which people who experience abuse may present with IPV-related injuries and other related concerns (depression, suicidality, etc.). Successfully implementing a validated tool for screening and providing early access to resources and referrals may help to mitigate the longterm negative impacts of IPV. The need for increased staff education was a major barrier to screening for …

Encouraging Human Papillomavirus Vaccine Uptake: A Healthcare Improvement Project, Lauren E. Woll

Dissertations

Abstract

Problem: Human papillomaviruses are the causative agents of >95% of cervical cancers, most oropharyngeal and anogenital cancers, yet the vaccination status of the population remains critically low despite Gardasil9 offering robust protection against HPV-related disease.

Methods: This quality improvement project utilized a descriptive, observational design to assess the effect of the HPV Encouragement Bundle, a two-step intervention to improve HPV vaccine uptake. Quantitative data was collected via retrospective chart review to assess the effect of the intervention on first-dose administration of Gardasil9 (series initiation), as well as overall Gardasil9 vaccine uptake.

Results: Following implementation, Gardasil9 first dose uptake increased …

Evidence-Based Practices And Self-Efficacy: A Quantitative Study Of Mental Health Counselors Treating Clients With Substance Use Disorder, Carl Bastien

Dissertations

Substance use disorder affects a substantial number of individuals in the United States. The specific problem of this research is that it was not known to what extent their use of evidence-based practices is driven by their sense of self-efficacy. The purpose of this quantitative correlational research was to examine to what extent the use of evidence-based practices covary with a sense of self-efficacy for mental health counselors treating individuals diagnosed with a substance use disorder. The study population was 121 mental health counselors who specialized in substance use disorder treatment who completed a digital survey. The study findings did …

Twitter Sentiment Analysis: Applications In Healthcare And Finance, Jiali Wang

Dissertations

This research explores the influence of Twitter sentiment on healthcare and finance industries. It assesses how Twitter sentiment and culture measure influence COVID-19 statistics, and it investigates the impact of Twitter sentiment on S&P 1500 stock mispricing. Furthermore, it examines how tweet sentiment predicts major industry returns.

The first part examines how Hofstede’s Culture Dimensions (HCD) and Twitter economic uncertainty index (TEU) relate to COVID-19 infection rate and death rate. The results show certain aspects in HCD, such as power distance index (PDI) and masculinity (MAS) both are negatively and significantly associated with the infection rate, while indulgence (IVR) and …

Using The Social-Ecological Model To Better Understand Sexual Assertiveness Among Undergraduate Women At An Institution Of Higher Education In The Southeastern United States, Lisa Wright

Dissertations

This study examined sexual assertiveness among female undergraduate students at an institution of higher education in the southeastern United States from the context of the social-ecological model. An online survey instrument examined sexual assertiveness, sexual communication self-efficacy, campus climate, and sexual scripts. Structural equation modeling was used to examine the relationships between these variables and all variables significantly predicted sexual assertiveness individually, but when examining the relationships collectively, only sexual communication self-efficacy and campus climate remained significant predictors of sexual assertiveness.

Infertility Characterization, Factors Associated With Primary Infertility, And Seroprevalence Of Genital Infections: A Cross-Sectional Survey In Abu Dhabi, United Arab Emirates, Noor Motea Abdo

Dissertations

Worldwide, infertility affects 8%–10% of couples and it could be primary or secondary. In the United Arab Emirates (UAE), one in every six couples are facing difficulties in conceiving. However, there is a noticeable lack of epidemiological studies and empirical data characterizing populations seeking infertility treatment in the UAE. Therefore, to inform health policy planning, evidence-based data is required to understand the most common type of infertility and the burden of exposure to genital pathogens. To characterize fertility-treatment-seeking patients, investigate factors associated with primary infertility, and to estimate the seroprevalence of six pathogens known to be transmitted genitally and associated …

Life Matters, Marina Fischer

Dissertations

Problem: One of the challenges facing many primary care providers is managing hypertension. Hypertension contributes to cardiovascular disease events. Consequently, the high occurrence of hypertension related visits signifies a clinical practice gap in hypertension management resulting in substandard blood pressure outcomes. The purpose of this clinical scholarship project was to assess the difference of pre and post Quality of Life Scale (QOLS) scores in a hypertensive population.

Methods: This quality improvement project used a longitudinal, observational design with prospective data collection. The sample included newly diagnosed hypertensive adults ages 21 to 64 years old. The sample was administered the World …

The Mission System: An Electronic Health Record For Medical Treatment In Guatemala, Tawniece M. Curry

Dissertations

Abstract

Problem: The introduction of an electronic health record (EHR) system has become an essential component in monitoring and tracking patient information in most developed countries but are difficult to implement in underdeveloped countries. Guatemala is a country with poor health care and limited resources for patient tracking and monitoring. An organization in Guatemala, Nursing Heart Inc. (NHI), provides care to over 40 underserved rural communities but lacks the ability to monitor and track patient information. In order for NHI to properly monitor and evaluate their programs and track patients’ continuity of care, the introduction of an EHR system is …

Utility Of The Motivation To Change Lifestyle And Health Behaviors For Dementia Risk Reduction Scale (Mclhb-Drr) Based On A North American Sample, Angelina E. Witbeck

Dissertations

As the population ages, the prevalence rates of dementia continue to increase. Without a cure or promising treatment for dementia, the best course of lowering the prevalence rates of dementia is through preventative measures. Through an electronic survey, the study utilized the MCLHB-DRR scale to determine whether (1) gender, age, educational background, and socioeconomic status will impact the motivational factors to change lifestyle and health behaviors to reduce the risk of developing dementia and (2) direct experiences with individuals that have a dementia diagnosis are likely to impact one's motivational factors to change lifestyle and health behaviors to reduce the …

Improving Postpartum Hypertension Discharge Education: A Pilot Project, Kathryn Barth

Dissertations

Problem: Hypertensive disorders of pregnancy (HDP) are a leading cause of maternal morbidity, mortality, and postpartum readmission. Several evidence-based algorithms and protocols have been implemented in the inpatient setting to treat severe blood pressure and prevent complications. However, there remains an opportunity to improve the postpartum care transition and discharge education for patients with these conditions in an attempt to decrease 30-day postpartum hypertension readmissions.

Methods: This pilot project utilized a descriptive design and took place on a postpartum unit at a Midwest metropolitan high-risk obstetrical teaching hospital. Interventions included patient-specific discharge education, distribution of a home blood pressure …

A Case Study In Resiliency: How A University Survived A Pandemic, Mary Ellen Stewart

Dissertations

This case study was conducted to investigate how the COVID-19 pandemic affected the campus of a small private university in central Mississippi, where traditionally, relational community and interaction were key contributors to campus culture. Through document analysis, individual interviews with campus leaders, and focus groups consisting of members of key departments, the role of resiliency was examined during the early days of the COVID-19 pandemic. Emerging from the data were the four thematic categories of leadership, campus culture, engagement and interaction, and challenges. Key components in each category revealed the significance of resiliency of university leaders, faculty, and staff as …

Evaluating Hospital Community Benefit And Community Health Improvement Requirements, Shelly Johnson

Dissertations

The Internal Revenue Service's (IRS) hospital community benefit standard aims to improve the community's health, it is a test the IRS uses to determine whether a hospital is organized and operated for the charitable purpose of promoting health. Participation in this program is required of all not-for-profit hospitals in the US, who spend billions of dollars annually in community benefit in place of taxes. Hospitals must annually submit IRS form 990 Schedule H and are required to report costs associated with their provision of community benefit spending. In addition, a hospital must conduct community health needs assessment (CHNA) and implementation …

Testing Barriers To Non-Suicidal Self-Injury With College Students: Narcissistic Traits As Moderators, Philip Stoner

Dissertations

Research on non-suicidal self-injury (NSSI) has produced mixed findings, resulting in a lack of clarity regarding these behaviors (Klonsky & Meuhlenkamp, 2007). To address this, Hooley and Franklin (2018) developed the Benefits and Barriers Model (BBM) to provide a comprehensive understanding of NSSI, in which they identified the barriers that commonly prevent people from engaging in these behaviors (e.g., self-esteem, shame, and peer-bonding motivations/social norms). They also identified adverse childhood experiences (ACEs) as a distal predictor of NSSI, which aids people in overcoming the barriers to engaging in these behaviors. Recent NSSI literature has shown that college women in the …

Rural Pregnant Women’S Experiences With Substance Use Disorder: A Qualitative Study, Cami Weber

Dissertations

Rural pregnant women with substance use disorder (SUD) are an understudied vulnerable population that often experiences poor pregnancy outcomes (Higgins et al., 2019; Jumah, 2016; Kramlich et al., 2018; Shaw et al., 2015). Despite the high prevalence and high burden associated with SUD, rural women are less likely than non-pregnant women to seek addiction treatment and complete an outpatient treatment program during pregnancy (Shaw et al., 2015). This study aimed to give voice to rural Missouri women with SUD. The research questions explored the life experiences and motivations for seeking treatment using a qualitative, descriptive research design with grounded theory …

Differences In Health Literacy And Healthcare Utilization For Uninsured Patients With Type Ii Diabetes, Whitney Key Towey

Dissertations

Un- and under-insured individuals have lower access and less health literacy than their insured counterparts. This is a major public health problem as lower health literacy leads to unhealthy communities which have higher chronic disease rates. This quantitative dissertation uses data from a public health hospital system to understand the relationship between health literacy and healthcare utilization. The Andersen Model has been applied to determine whether, or to what extent, health literacy explains the relationship between the identified predisposing and enabling factors and the outcomes of appropriate utilization of care by controlling for variables associated with health literacy. A sample …

Childhood Obesity Interventions In The Republic Of Trinidad And Tobago: A Qualitative Study Exploring Government Policies And Their Implementation By Health Practitioners, Phyllis Woolford

Dissertations

Because of the rising prevalence of childhood obesity and overweight in the Republic of Trinidad and Tobago, and the observation that efforts to address the problem were showing disappointing results, this study seeks to explore the experiences and views of policymakers, health practitioners, and parents of overweight and obese children, in order to inform leaders and policy makers regarding the current interventions.

Method

A qualitative research case study methodology is the research design used, which, with my research questions, I considered would best uncover knowledge and provide perspectives that would provide an increased understanding of the issues arising from the …

Multi-Stage Stochastic Optimization And Reinforcement Learning For Forestry Epidemic And Covid-19 Control Planning, Sabah Bushaj

Dissertations

This dissertation focuses on developing new modeling and solution approaches based on multi-stage stochastic programming and reinforcement learning for tackling biological invasions in forests and human populations. Emerald Ash Borer (EAB) is the nemesis of ash trees. This research introduces a multi-stage stochastic mixed-integer programming model to assist forest agencies in managing emerald ash borer insects throughout the U.S. and maximize the public benets of preserving healthy ash trees. This work is then extended to present the first risk-averse multi-stage stochastic mixed-integer program in the invasive species management literature to account for extreme events. Significant computational achievements are obtained using …

Essays On Health Care Quality: Timeliness, Equity, And Efficiency, Abubakar-Sadiq Bouda Abdulai

Dissertations

According to the National Academy of Medicine (NAM) (formerly called the Institute of Medicine), a quality health care system embodies six attributes: timeliness, equity, safety, efficiency, effectiveness, and patient-centeredness. Timeliness is to avoid unnecessary delays in care delivery for patients and caregivers; equity is to ensure that the quality of care that patients receive does not vary based on their personal characteristics; safety is to ensure that the care that is intended to help patients does not harm them; efficiency is to avoid waste and optimize resource allocation to improve care delivery; effective care is one that relies on sound …

An Examination Of Types Of Health Insurance And The Reported Prevalence Of Autism In The United States, Jennifer L. Thompson

Dissertations

The prevalence of Autism Spectrum Disorders continues to rise despite barriers of changes to diagnostic criteria and lack of insurance coverage. Increases in prevalence affect costs associated with a disorder since cost of health care services are often estimated based on utilization of services. This can also affect an individual’s ability to access to health care services. To equitably distribute autism services to individuals an accurate estimation of the true prevalence of autism is needed.

Access to health care can be influenced by the type of insurance coverage a person holds. Other factors, such as socio-economic status, ethnicity, location of …

Exploration Of Patient Variables And Characteristics Best Suited For Medical Marijuana Treatment For Anxiety And Depressive Disorders, Corey Gazoo

Dissertations

Individuals with posttraumatic stress, anxiety and depressive disorders are currently being prescribed medical marijuana as a treatment in many states across the United States. However, marijuana is still considered a schedule one narcotic by the Drug Enforcement Administration and federal government, which provides several barriers and challenges to conduct research such as approval from the U.S. Food and Drug Administration and following guidelines from the National Institute on Drug Abuse issued by the DEA. Additionally, individuals prescribed medical marijuana for mental health disorders are not always thoroughly instructed on the type of medical marijuana, the dosage, and how frequently to …

Implementation Of Pediatric Adverse Childhood Experiences Screening In Primary Care, Alexzandra Hillyer

Dissertations

Implementation of Pediatric Adverse Childhood Experiences Screening in Primary Care

Problem: Over half of children worldwide have experienced abuse in the past year. In 2012, The American Academy of Pediatrics released a policy statement emphasizing the importance of primary care providers implementing Adverse Childhood Experience (ACE) screening into all well-child examinations.

Methods: This quality improvement project was a descriptive, observational pilot study in which Center for Youth-Well ACE Questionnaire (CYW-ACE-Q) was implemented into a large, metropolitan pediatric primary care clinic. A convenience sample was utilized composed of pediatric patients between the ages of 5 and 18 being seen for a …

Intimate Partner Violence Education For High School Students, Morgan Foster

Dissertations

Problem Adolescents are at risk for experiencing intimate partner violence (IPV). As early as seventh grade, over half of adolescents have reported being in a romantic relationship. Adolescent screening for and education of IPV is minimal, and only the Healthy Relationships Quiz developed by the U.S. Department of Health and Human Services [HHS] screens young adolescents across all aspects of IPV, including psychological and sexual violence. The purpose of this project was to develop an IPV education plan for high school students in a health course.

Methods An educational lesson plan for IPV was created for high school teachers.

Results …

Developing A Diagnostic Tool Of A Community’S Health, Ruth Kurtycz

Dissertations

Where we live can affect nearly every aspect of our lives, including how long those lives will be. Previous studies have demonstrated large health disparities between communities in the United States; since the health of a community can significantly impact its residents, evaluating and predicting community health is of interest to many people. Currently the Federal government collects and publishes data on community-level demographics, housing, crime rates, and disease. State-level and non-governmental agencies track and share community housing prices, school performance, neighborhood safety, and other characteristics. In short, there is a wealth of information but the work being done around …

The Associations Of Chronic Stress, Social Support, Health Behaviors And Metabolic Syndrome Among Hispanic Women, Edna Esquer

Dissertations

The Associations of Chronic Stress, Social Support, Health Behaviors and Metabolic Syndrome Among Hispanic Women

Background: Metabolic syndrome (MetS) prevalence is 25% among Mexican American women 30 – 49 years of age, compared to 22% among non-Hispanic Whites in the United States. Little is known about the additional contributions of chronic stress, social support and health behaviors to the development of MetS among this population.

Purpose: Describe the associations between chronic stress, social support, and health behaviors and the presence of MetS in Hispanic women living in an underserved community.

Methods: A retrospective cohort study design. The Adult Treatment Panel …

Behavioral Economic Modeling Of The Effects Of Symptom, Severity, And Cost On Seeking Medical Care, Mark J. Rzeszutek

Dissertations

While the United States has some of the highest healthcare spending in the world, it has some of the worst health outcomes. For example, maternal mortality in the United States is almost five times as high as in other similarly wealthy countries. It also has the highest rates of avoidable deaths. One of the reasons for this may be the cost of accessing healthcare due to privatized insurance. For example, Americans may avoid important preventive medical visits and other health screeners due to cost. While lack of health insurance has been correlated with decreased health utilization, a precise understanding of …

Life Satisfaction: Aging Female Informal Caregivers Of Persons With Dementia, Deborah Ann Monson

Dissertations

Purpose/Aims

The purpose of this study was to describe the relationship between aging female informal caregivers of persons with dementia (PWD) and care recipients’ PWD demographic factors, aging female informal caregivers of PWD social support factors, positive and negative feelings, a sense of flourishing, stress, and life satisfaction.

Background/Rationale

Older adults with dementia are living longer and the majority are receiving care by aging female informal caregivers. Dementia incrementally worsens over time impacting informal caregiver life satisfaction. Most studies have focused on negative aspects of informal caregiving. Therefore, this study investigated both positive and negative aspects of caregiving.

Conceptual Basis …

Healthcare Leadership In The Context Of Cognitive Diseases Of Aging: A Community-Based Participatory Research Model, Dean Sherzai

Dissertations

The Problem

The world is facing a tsunami of chronic diseases of the brain such as dementia, Parkinson's, and stroke. But all populations are not affected equally. Though we are all at greater risk of developing these diseases, minority communities such as the Black and Hispanic populations are at much greater risk of succumbing to these conditions. To date we have spent billions of dollars on research and public health measures that have repeatedly failed, but over the last decade it has become evident that much of these diseases can simply be averted through effective public health and community-based measures …

Community Health Nurse Educators And Disaster Nursing Education, Jody Spiess

Dissertations

Abstract

The world is struggling with the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic and the need for disaster nursing education has never been more clear. Recently, the American Nurses Association reported that of the over 32,000 nurses surveyed; only 11% felt well prepared to care for a COVID-19 patient (ANA, 2020). Community health nurse educators are tasked with educating future nurses on disasters, yet, little is known about this population’s perceived competence in disaster preparedness. The purpose of this study is to describe community health nurse educators' perceived competence in disaster preparedness.

The study is a descriptive, correlational …

The Impact Of Medicare Insurance Plans Upon Healthcare Services Utilization Considering Patients' Characteristics And Their Access To Medical Care, Steven Stout

Dissertations

The annual average cost of healthcare for services utilization by a Medicare beneficiary is projected to grow from about $10,000 to over $16,000 by 2023. As an ongoing initiative to address this trend, the federal government contracts with private insurance companies and other entities, called Medicare Advantage Organizations (MAOs), to develop and administer alternative health insurance plans designed to contain service utilization and costs. One feature of some Medicare Advantage plans is the presence of risk-bearing contracts with primary care physician organizations that voluntarily accept financial responsibility for the overall cost of care for patients attributed to them. In this …