Community Health and Preventive Medicine Commons^™

A Multi-Modal Intervention To Decrease Hpv Vaccine Hesitancy And Increase Uptake In Young Adult Women, Rylee Cartales

Evidence-Based Practice Project Reports

Human Papillomavirus (HPV) is the leading cause of cervical cancer worldwide and the most common sexually transmitted disease, yet hesitancy towards the HPV vaccine remains high and uptake of the HPV vaccine remains remarkably low (CDC, 2021b). The purpose of this evidence-based practice (EBP) project was to determine if the implementation of a multimodal intervention including a motivational interview, strong provider recommendation, and educational materials will decrease HPV vaccine hesitancy and consequentially increase uptake of the vaccine. Eleven young adult women ages 18-26 from a rural outpatient Obstetrics and Gynecology (OBGYN) clinic in Indiana participated in this project. After agreeing …

A Multimodal Approach To Decreasing Hesitancy Of The Influenza Vaccine In The Family Care Setting, Carley J. Ellenberger

Evidence-Based Practice Project Reports

The uptake of the influenza vaccine is the most effective and proactive action an individual can take to defend themselves against the influenza outbreak each season; therefore, it is recommended that everyone at least six months of age and older should receive the annual flu vaccine (CDC, 2022; WHO, 2023). Unfortunately, influenza vaccine hesitancy is demonstrated on a global level affecting the uptake compliance annually each influenza season despite the millions of people that experience influenza symptoms annually (CDC, 2022, WHO, n.d.; Healthy People 2030, n.d.). The PICOT question for this project was in adults, over the age of 18, …

Effectiveness Of Antibiotic Stewardship For Healthcare Providers At Urgent Care Clinics, Helen T. Adewole

Electronic Theses and Dissertations

Antibiotics have revolutionized modern medicine; however, the overuse in urgent care and primary care significantly contributes to the global burden of infections resistant to available antimicrobial medicines. Approximately 30% of the antimicrobials prescribed in acute care settings are unnecessary. Patient demand for antibiotics has seemingly skyrocketed following the recent COVID-19 pandemic. Practitioners must be knowledgeable about antibiotic stewardship initiatives, such as the wait-and-see approach, to reduce antibiotic overuse and improve the trajectory of antibiotic resistance and patient health outcomes. The gap in practice was the limited awareness of scientific evidence-based tools to partner with patients and improve antibiotic prescription patterns. …

Assessing Social Determinants Of Health In Primary Care, Vicki Carpenter

Doctoral Projects

The social determinants of health encompass the various circumstances and environments in which individuals reside, develop, labor, and experience aging (Social Determinants of Health, 2022). These variables significantly contribute to the existence of health inequities and disparities within populations. In order to effectively mitigate health disparities, it is imperative to consider the various determinants that influence health outcomes, as this consideration is crucial for advancing the goal of achieving health equity. This public health concern encompasses multiple sectors within our society, necessitating the collaboration of various organizations and communities to effectively address and mitigate its impact.

The fundamental …

Assessing Virtual Versus In-Person Experiential Learning And Medical High-Fidelity Simulation In Medical Student Pediatric Clerkship Training, Andrew Mitchell Berry

Electronic Theses and Dissertations

Simulation and experiential training have been incorporated into medical school training for decades. The utilization of medical simulations has become an invaluable tool in healthcare education and training. However, circumstances such as limited resources, geographical constraints, or global health crises may hinder the feasibility of conducting in-person medical simulations. In these scenarios, virtual medical simulations emerge as a compelling alternative. While there are many ways to accomplish experiential-based learning, many faculty and students feel Socratic learning styles provide the best learning experience.

As medical students had just finished a predominantly virtual preclinical year due to the COVID-19 pandemic, the research …

The Relationship Between Parental Trauma History And Perceptions Regarding Their Child’S Healthcare And Utilization Of Healthcare Services, Krishna Patel

Theses and Dissertations

Abstract

TITLE: The Relationship Between Parental Trauma History and Perceptions Regarding Their Child’s Healthcare and Utilization of Healthcare Services

Adverse child events (ACEs) have been associated with a number of physical and mental health problems and have also been linked to increased health care utilization. While parents who have an ACE history may tend to seek healthcare services for themselves, limited studies have examined the impact of their trauma history on seeking healthcare services for their child. Healthcare utilization may also depend on the parents’ level of health anxiety, as well as their anxiety about their child’s health status. This …

About Dying And Death: Thanatology's Place In Medical Curriculum, Jill Dombroski

Electronic Thesis and Dissertation Repository

This study explored how healthcare providers engage in advance care planning and end-of-life care conversations. The research explored what shapes their understanding and the extent to which concepts from thanatology they intuitively bring in, explicitly bring in, and maybe fail to recognize. To achieve this, constructivist grounded theory (CGT) methodology guided the design, data collection, analysis, and interpretation of the findings, which allowed for iteration across interviews and analysis with existing theories and data in the literature. The CGT design encouraged further engagement with the literature in an ongoing iterative fashion as well as with the analysis of the data. …

Prevention Of Obesity-Related Morbidity & Mortality In Adults, Rachelle Virgin

Masters Theses/Capstone Projects

Poster presentation on the prevention of obesity related morbidity and mortality in adults.

Screening For Social Determinants Of Health In The Primary Care Setting: A Quality Improvement Project, Winifred Ann Shouse

Graduate Theses, Dissertations, and Capstones

Social determinants of health are the conditions in which individuals are born, age, work, and live that affect health status and outcomes (Rivich et al., 2019). These social and environmental factors can create barriers to patients being able to access and adhere to recommendations for chronic disease management (Gold, et al., 2019). Communication gaps between patients and primary care providers make it challenging for healthcare providers to be completely aware of the financial burdens their patients encounter (Patel et al., 2016). Research supports that identifying and addressing the barriers related to social determinants of health can improve the management of …

Quality Improvement: Piloting A Pediatric Obesity Prevention Screening Tool And Intervention In A Family Practice Setting., Erin Shaye Semeyn

Doctor of Nursing Practice Papers

Background: In the United States today, nearly one third of children fall into the category of overweight or obese. Because it is extremely difficult to treat childhood obesity once it occurs, prevention is the optimal approach to childhood overweight and obesity (Brown & Perrin, 2018; Cooper & Mandel, 2020). An ideal time to address obesity prevention health behaviors is during pediatric primary care visits. Since the COVID-19 pandemic began in the United States in 2019, visits to primary care offices, including visits to an urban university-based family practice clinic in Kentucky, dropped as some pediatric patients and their caregivers worried …

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 …

Increasing Staff Awareness And Screening Practices For Adverse Childhood Experiences At A Primary Care Clinic, Kayla Wright

Doctor of Nursing Practice Projects

Adverse childhood experiences (ACEs) are present in approximately 60% of the adult population in the United States. There is a correlation between adverse childhood experiences and chronic health conditions as adults. Despite the evidence showing this correlation, there is a lack of screening for ACEs in the primary care setting. Many primary care providers and staff are unaware of ACEs or the correlation with chronic health conditions and substance abuse and, therefore, do not understand how to or recognize the benefits of screening in primary care. With education for providers and staff, primary care is the ideal setting to perform …

Integrating Community Into Middle School Sexual Education, Sierra Miller, Margaret Aitken

College of Nursing and Health Sciences Doctor of Nursing Practice (DNP) Project Publications

Problem Statement: Most middle school sexual education does not include parents or community members. Evidence shows family and community attitudes towards sex and sexuality are significant factors in adolescent risky sexual and health practices.

Background: Comprehensive sex education (CSE) reduces risky sexual practices and negative health outcomes. National and local organizations have identified CSE as a public health goal. CSE works best when culturally relevant and the community is involved.

Methods: Interviews with the health educator identified community needs. Resources were created in line with the current curriculum focusing on sex education, its importance, and how to talk about …

The Primary Care Provider’S Role In Screening And Intervening In The Human Trafficking Of Adolescents: A Systematic Literature Review, Brittany Schmid

All Graduate Theses, Dissertations, and Other Capstone Projects

Human trafficking (HT) is a growing concern within the United States (U.S.) and internationally. With the alarming number of HT victims presenting for medical care, primary care providers (PCPs) are in a unique and privileged position to encounter HT victims within the healthcare system. Adolescents, in particular, are vulnerable to HT because of minimal life experiences, inadequate social support, and limited coping mechanisms (Ertl et al., 2020). Failure to recognize and intervene in cases involving HT victims who are minors is detrimental to the individual’s health, wellbeing, and safety. With the assistance of education and training, community resources, guideline adoption, …

Improving Colorectal Cancer Screening And Testing In A Primary Care Clinic, Leslie Michelle Dubois

Doctor of Nursing Practice

Colorectal cancer (CRC) is the third most common cancer and the second most common cause of cancer-related deaths worldwide (World Health Organization, 2019a). In the United States, CRC was the fourth most common cancer in 2016 (Centers for Disease Control and Prevention, 2019a). The American Cancer Society (2020a) estimated that there will be 147,950 estimated new cases and 53,200 estimated deaths of CRC in the U.S. in 2020. The purpose of the project was to improve CRC screening completion rates and follow up referrals from 27.5% to 35% for adult patients, 50-75 years of age, within a family medicine clinic …

Stroke Preventive In African American Women Ages 20-40 That Are Using Or Have Used Oral Contraceptives, Ashanti L. N. Coleman

Electronic Theses and Dissertations

This Doctor of Nursing Practice project will inform the audience of stroke awareness as it pertains to oral contraceptives. The study’s focus was to enhance the knowledge of African American women ages 20–40 that have used or are currently using an oral contraceptive. It has been identified that this patient population lacked the knowledge regarding stroke and oral contraceptives, and African American women continue to have the highest incidence of stroke. African American women also make up more than half of the consumers utilizing oral contraceptives. An oral contraceptive knowledge questionnaire was utilized from previous research to determine if any …

Exploring The Relationship Between Dietary Self-Monitoring With A Mobile App And Weight Change, Jason Payne

Electronic Theses and Dissertations

Background: Approximately 70% of the adult population in the United States has overweight or obesity and increased risk for developing chronic diseases. Dietary self-monitoring adherence using a paper diary is associated with weight loss; however, few studies have examined this association with dietary self-monitoring apps. Objectives: 1) explore if an association exists between app-based dietary self-monitoring and weight change among adults with overweight or obesity and 2) explore the relationships between the frequency, consistency, and completeness of self-monitoring and weight change. Methods: Participants self-monitored dietary intake for 8 weeks using the app Calorie Counter by FatSecret. Participants were assigned …

Provider-Led Intervention For Overweight Or Obese African American Women Ages 18-65 With A Bmi 25 Kg/ M₂, Tonya A. Harvey

Evidence-Based Practice Project Reports

Overweight and obese African American women tend to suffer most from the impacts of diseases, health disparities, disabilities, and decreased qualities of life (Sutton et al., 2016). Most weight loss programs are not culturally specific, despite the benefits of dietary changes and increased physical activity for all groups. The purpose of this EBP project was to implement a provider-led program including lifestyle, dietary, and activity components to decrease weight, BMI, waist circumference and blood pressure in African American women. The Iowa Model of Evidence-Based Practice to promote quality care was used to guide the EBP project, aimed to address obesity …

Mass Matters: Increasing Mammography Rates To Underserved Women, Ingrid N. Cooper

Evidence-Based Practice Project Reports

Breast cancer is the most frequently diagnosed cancer among women in Indiana and the United States (Indiana Cancer Organization, 2019). An estimated 268,000 new cases of invasive breast cancer were diagnosed and 41,760 women died due to breast cancer in 2019 (ACS, 2019). Substantial breast cancer-related morbidity and mortality disparities persist among the underserved. Disparities in breast cancer outcomes are due to lower mammography screening rates, lack of timely follow-up of abnormal results, and lack of timely treatment initiation among women with breast cancer (Highfield et al., 2015). The purpose of this evidence-based practice project was to address low mammography …

Living Sweet: A Multi-Functional Mobile-Phone Application Strategy For Adults With Uncontrolled Type 2 Diabetes Mellitus, Chantel K. Anderson

Evidence-Based Practice Project Reports

Type 2 Diabetes Mellitus (T2DM), one of the most common chronic diseases, is increasing worldwide, and once diagnosed, lifetime self-management is critical to maintain glycemic control (Vermeire et al., 2005; American Diabetes Association (ADA), 2018). Management of T2DM has been acknowledged as challenging due to the need for strict lifestyle adaptations. From a public health perspective, uncontrolled diabetes leads to increased healthcare costs, secondary complications, and ultimately severe disabilities (ADA, 2018). The purpose of this evidencebased practice (EBP) project was to evaluate the effectiveness of a diabetes-specific mobile health application (MHA) on glycated-hemoglobin (HbA1C), self-care perception (SCP), and self-care behaviors …

The Effect Of Home Blood Pressure Monitoring And Self-Titration On Achieving Blood Pressure Targets, Katina A. Varner

Evidence-Based Practice Project Reports

One-third of U.S. adults over the age of 20 are hypertensive, with an estimated cost of $47.5 billion in direct medical expenses and increased individual CVD risk (CDC, 2018). Routine office visits afford primary care providers a means of managing hypertension; however, time constraints limit the ability to accurately assess and track BP in most patients (Jung, 2015). The purpose of this project was to determine if implementation of HBPM and an algorithm for selftitration of antihypertensive medications increased the number of participants at guideline recommended BP goal over a 90-day period. The Health Promotion Model provided the theoretical framework …

Kangaroo Mother Care And Traditional Care, Arianna Smola, Kirsten Lawson

Williams Honors College, Honors Research Projects

Prematurity and low birth weight are leading causes of infant death. Throughout recent years care methods for this population have evolved from incubator care to Kangaroo Mother Care (KMC). The purpose of this systematic review was to answer the following PICO question: in the case of preterm and low birth weight (LBW) infants, how does the technique of Kangaroo Mother Care (KMC) compare to traditional incubator use, regarding long and short-term outcomes of preterm and LBW infant recovery. Methods of this study included the selection of twenty peer-reviewed articles that studied the effect of incubators and KMC on premature and …

Keep The Beat With Heart Failure Education: A Quality Improvement Project, Brenda L. Peterson

Master's Projects and Capstones

Abstract

Problem: Heart failure (HF), also known as congestive heart failure (CHF), is the number one diagnosis-related group (DRG) for people 65 years of age and older in the United States. This disease group is complicated and debilitating, requiring frequent hospitalizations with high mortality rates. The Joint Commission on Accreditation of Healthcare Organizations (JCAHO) has identified CHF as an area for improvement in hospitals.

Context: This was a quality improvement project for an integrated medical center in the Central Valley, California with over 19,000 HF patients. In 2018, for patients 65 years and older, HF is the third-most admitted DRG …

Sedentary Time And The Cumulative Risk Of Preserved And Reduced Ejection Fraction Heart Failure: From The Multi-Ethnic Study Of Atherosclerosis, Brandi Scot Rariden

UNF Graduate Theses and Dissertations

ABSTRACT

Purpose: The purpose of this study was to examine the relationship between self-reported sedentary time (ST) and the cumulative risk of preserved ejection fraction heart failure (HFpEF) and reduced ejection fraction heart failure (HFrEF) using a diverse cohort of U.S. adults 45-84 years of age.

Methods: Using data from the Multi-Ethnic Study of Atherosclerosis (MESA), we identified 6,814 subjects (52.9% female). All were free of baseline cardiovascular disease. Cox regression was used to calculate the hazard ratios (HR) associated with baseline ST and risk of overall heart failure (HF), HFpEF, and HFrEF. Weekly self-reported ST was dichotomized …

Increasing Pneumococcal Vaccination Among Adults 65 And Older: The Development And Implementation Of A Pneumococcal Vaccine Administration And Documentation Protocol For A Small Primary Care Practice., Marina M. Ecklund

College of Nursing and Health Sciences Nursing Master Project Publications

This project focuses on the development of a protocol to increase administration and documentation of pneumococcal vaccination among patient 65 years and older in a primary care practice setting. The project entails reviewing immunization records of all patients age ≥ 65 years at Appletree Bay Primary Care (ABPC) practice to determine current pneumococcal vaccination rates among the specified age group within the practice. A single trial vaccination clinic was it established in collaboration with the Vermont Family Pharmacy wherein patients were contacted by phone by the primary investigator, informed that they may be due for one or more pneumococcal vaccination …

Screening For Alcohol Use/Abuse In The Primary Care Setting Using The Audit-C And Sbirt (Screening, Brief Intervention, Referral To Treatment), Whitney D. Spear

DNP Projects

PURPOSE: The purpose of this study was to examine the feasibility of alcohol screening in the primary care setting to detect alcohol abuse or misuse using the AUDIT-C standardized screening tool and SBIRT.

METHODS: This study design was a Quasi-Experimental intervention, one group post-test. Data was collected via retrospective chart review from the electronic medical records by the type of office visit; either new patient initial visit or annual well visit. The patient sample consisted of 25 participants for the study period of September 19^th through October 10^th, 2017.

RESULTS: There were 37 patients eligible to participate …

Improving Healthcare Provider Knowledge In Acute And Primary Transgender Health Needs: The Implementation Of A Clinical Education Program With Urgent Care And Emergency Room Staff And Providers, Tonia Lower

Doctor of Nursing Practice Scholarly Projects

The purpose of this project was to improve knowledge and identify personal bias and beliefs in the acute and primary healthcare needs of transgender persons, through the implementation of a clinical education program with healthcare providers and staff working within the urgent care and emergency department settings. The need for such a program exists due to the lack of suitable and accessible healthcare that may lead to misdiagnosis, delay of treatment and poor health outcomes. Including clinical education in the acute and primary healthcare needs of transgender persons that can be integrated into healthcare organizations may aid in the improvement …

Decreasing Cost Associated Medication Nonadherence, Shawn E. Raymond

Doctor of Nursing Practice Scholarly Project

An Abstract of the Scholarly Project by

Shawn E. Raymond

Medication cost is a major contributor for patient medication nonadherence. Take in the fact that a large population lives in poverty, many cannot afford to pay the retail prices associated with purchasing their medications. By incorporating wholesale medications into a charitable health clinic, the reduced cost of medications for treatment of both acute and chronic illnesses could be passed on to those in need thereby decreasing cost associated medication nonadherence. Nurse Practitioners in the state of Kansas are not afforded the privilege to purchase, repackage and distribute or resell wholesale …

Assessment Of Obesity Management In A Primary Care Setting, Katie Diffenderfer

DNP Projects

Purpose: The purpose of this study was to evaluate the current practices related to obesity in the primary care setting in University of Kentucky’s Healthcare System. The specific aims were to: 1) Determine the proportion of obese patients who had an ICD-9/10 diagnosis code for obesity, 2) Determine the proportion of obese patients who received interventions related to their obesity, 3) Determine whether obesity diagnosis and interventions varied based on patient demographics, and 4) Compare actual obesity interventions to those outlined in the clinical practice guidelines.

Methods: A retrospective chart review of male and female patients between the ages of …

Adhd Versus Ptsd In Preschool-Aged Children: Implications For Misdiagnosis, Klaudette D. Stewart

PCOM Psychology Dissertations

Attention Deficit Hyperactivity Disorder (ADHD) has been one of the most diagnosed disorders in children since it was included in the Diagnostic and Statistical Manual of Mental Disorders−III (DSM−III) in 1980. The number of children who have been diagnosed since that time has grown significantly, raising concerns about the overwhelming number of young children being diagnosed and prescribed medication. According to the literature, young children are diagnosed at a higher rate by pediatric primary care physicians (PCPs) than clinical child psychologists (CCPs) because they are taken to a PCP’s office by a parent, rather than referred from a school environment, …