Digital Commons Network^™

Demystifying The Nuances Of The Lipid Patient: A Guide For Primary Care Providers, Merle Myerson, Kyle Gillett, James O'Hara, Richard Potter, Neil Skolnik

Abington Jefferson Health Papers

Atherosclerosis, a major cause of mortality and morbidity in the United States (US), is driven by complex factors, including the cumulative burden of low-density lipoprotein cholesterol (LDL-C) and other atherogenic lipids and lipoproteins. Lipid management in US primary care aims to prevent atherosclerotic cardiovascular disease (ASCVD) events through screening and LDL-C lowering to risk-based goals. However, lipid screening and ASCVD treatment is often inadequate, with few patients meeting LDL-C goals in clinical practice. Primary care providers have a vital role in identifying patients most at risk of ASCVD to prevent ASCVD events and improve patient outcomes. There are multiple different …

Rna Sequencing Reveals Inflammatory And Metabolic Changes In The Lung And Brain After Carbon Black And Naphthalene Whole Body Inhalation Exposure In A Rodent Model Of Military Burn Pit Exposures, Allison M. Haaning, Brian J. Sandri, Henry L. Wyneken, William T. Goldsmith, Joshua P. Nixon, Timothy R. Nurkiewicz, Chris H. Wendt, Paul Barach, Janeen H. Trembley, Tammy A. Butterick

College of Population Health Faculty Papers

Military personnel deployed to Iraq and Afghanistan were exposed to emissions from open-air burn pits, where plastics, metals, and medical waste were incinerated. These exposures have been linked to deployment-related respiratory diseases (DRRD) and may also impact neurological health via the lung-brain axis. To investigate molecular mechanisms, adult male rats were exposed to filtered air, naphthalene (a representative volatile organic compound), or a combination of naphthalene and carbon black (surrogate for particulate matter; CBN) via whole-body inhalation (six hours/day, three consecutive days). Lung, brain, and plasma samples were collected 24 h after the final exposure. Pro-inflammatory biomarkers were assessed using …

Contributions Of Occupational Therapy In Sport Provider Training Using A Health-Promoting Environment For Positive Youth Development, Jennifer Papenfuse Otd, Otr/L, Chc, Camille Skubik-Peplaski Phd, Otr/L, Faota, Shirley P. O'Brien Phd, Otr/L, Faota

Student Journal of Occupational Therapy

Rising youth public health disparities can be attributed to the social determinants of health that influence health and wellness. Youth sport providers can be influential in creating healthier environments that facilitate positive youth development and social emotional learning, thus positively impacting life-long health behaviors choices and public health. The purpose of this study was to explore the impact of an education module developed by an occupational therapist on sport’s providers perceptions of their capacity to implement positive youth development programming and to create a health-promoting environment.

A qualitative descriptive approach was used in this study allowing for purposive sampling, inductive …

Cocoa Polyphenols Modulate The Mouse Gut Microbiome In A Site-Specific Manner, Abby D. Benninghoff

Browse all Datasets

Background/Objectives: Dietary modulation of the gut microbiome is a promising strategy for mitigating gastrointestinal diseases, such as inflammatory bowel disease (IBD) and colitis-associated colorectal cancer (CAC). Cocoa powder is rich in polyphenols, including (-)-epicatechin and (+)-catechin, which have been associated with beneficial effects on gut health and microbiome modulation. Importantly, changes in the bacterial populations associated with the gut mucosal layer may have different health impacts compared to changes in cecal or fecal microbiomes. This study investigated the effects of cocoa polyphenol supplementation on microbiome composition across the cecal, fecal, and mucosal compartments in a mouse model of colitis. Methods: …

Epigenetic Profiling Of Cell-Free Dna In Cerebrospinal Fluid: A Novel Biomarker Approach For Metabolic Brain Diseases, Kyle Sporn, Rahul Kumar, Kiran Marla, Puja Ravi, Swapna Vaja, Phani Paladugu, Nasif Zaman, Alireza Tavakkoli

SKMC Student Presentations and Publications

Due to their clinical heterogeneity, nonspecific symptoms, and the limitations of existing biomarkers and imaging modalities, metabolic brain diseases (MBDs), such as mitochondrial encephalopathies, lysosomal storage disorders, and glucose metabolism syndromes, pose significant diagnostic challenges. This review examines the growing potential of cell-free DNA (cfDNA) derived from cerebrospinal fluid (CSF) epigenetic profiling as a dynamic, cell-type-specific, minimally invasive biomarker approach for MBD diagnosis and monitoring. We review important technological platforms and their use in identifying CNS-specific DNA methylation patterns indicative of neuronal injury, neuroinflammation, and metabolic reprogramming, including cfMeDIP-seq, enzymatic methyl sequencing (EM-seq), and targeted bisulfite sequencing. By synthesizing current …

Concordance Of Management Of Early And Locally Advanced Esophageal And Esophagogastric Junction Tumors With National Comprehensive Cancer Network Guidelines, Kanchan Gupta, Melissa Kratz Rn, Msn, Aocn, Sean Quinlan-Davidson Md, Savitri Skandan Md

Research Scholars

No abstract provided.

Skin Care Excellence: Increasing Rn Skin Check Frequency To Prevent Hapis, Yu Jian Kwan

Master's Projects and Capstones

Background:
This quality improvement project was implemented in the Transitional Cardiac Unit (TCU), a 32-bed telemetry unit primarily serving older adults recovering from cardiac procedures. A microsystem assessment revealed a hospital-acquired pressure injury (HAPI) rate of 1.49 per 1,000 patient days, exceeding the regional target of 0.82. Key barriers included limited skin assessment frequency, inconsistent documentation, and gaps in staff training.

Problem:
From June to December 2024, six HAPIs occurred in the TCU. Despite existing protocols requiring two-RN skin assessments at admission, transfer, and discharge, early detection of skin breakdown remained insufficient. Contributing factors included inconsistent surveillance, varied assessment skills, …

Food Literacy Program Among Adults In A Primary Care Setting, Marie K. Williams

Student Scholarly Projects

Practice problem: The increase in preventable chronic diseases is associated with food illiteracy, which arises from a lack of understanding of nutritional value and dietary guidelines (Silva et al., 2023).

PICOT: (P) In adult primary care patients aged 30-75 years, (I) does the implementation of evidence-based food literacy program (C) compared to standard practice (O) improve food literacy (T) in eight weeks?

Evidence: Using a validated food literacy questionnaire effectively measures improvements in food literacy. Customized programs that fill knowledge gaps are essential for enhancing overall food literacy. Intervention: Customized educational tools were provided to participants based on their knowledge …

Public Understanding Of And Engagement With Community Health Workers And Promotores De Salud: Findings From Two National Surveys, Elizabeth A. Rohan, Julie S. Townsend, Andrea Torres, Hope L. Thompson, Dawn M. Holman, Avid Reza, Felicia Solomon Tharpe, Erin Caple, Ashley Wennerstrom

School of Public Health Faculty Publications

INTRODUCTION: Community health workers (CHWs) can improve health by helping people navigate health care services and systems and connecting them to community services that address nonmedical factors such as food insecurity, housing, and transportation. While CHWs have long been part of the US public health system, there are no data, to our knowledge, on the public's familiarity and interactions with CHWs. METHODS: We analyzed data from the 2022 Porter Novelli FallStyles and Estilos surveys, online market research surveys of the general public delivered in English (FallStyles) or primarily Spanish (Estilos). Each survey asked the same 4 questions on familiarity and …

Choline-An Essential Nutrient With Health Benefits And A Signaling Molecule, Brianne C. Burns, Jitendra D. Belani, Hailey N. Wittorf, Eugen Brailoiu, G. Cristina Brailoiu

College of Pharmacy Faculty Papers

Choline has been recognized as an essential nutrient involved in various physiological functions critical to human health. Adequate daily intake of choline has been established by the US National Academy of Medicine in 1998, considering choline requirements for different ages, sex differences and physiological states (e.g., pregnancy). By serving as a precursor for acetylcholine and phospholipids, choline is important for cholinergic transmission and the structural integrity of cell membranes. In addition, choline is involved in lipid and cholesterol transport and serves as a methyl donor after oxidation to betaine. Extracellular choline is transported across the cell membrane via various transport …

From Surviving To Thriving: The Oxygen Mask Approach For Middle Management, Lydia Marque

Master's Projects and Capstones

Problem: Middle managers in healthcare experience high levels of stress, heavy workloads, and burnout. At a large medical center in Northern California, middle managers reported low perceptions of organizational support for well-being despite an abundance of available resources.

Context: Baseline data indicated a perceived support score of 6.5 out of 10 on the Employee Interest Survey and a People Pulse Culture of Health score of 60 for assistant nurse managers (ANMs), both below regional benchmarks. These findings suggested inadequate engagement with organizational well-being resources.

Interventions: A six-month performance improvement initiative, guided by the ADKAR change model and …

Temporal And Generational Changes In Depression Among Young American Adults, Ashley W. Kranjac, Dinko Kranjac, Valentine Chung

Sociology Faculty Articles and Research

The prevalence of depression among young American adults has risen significantly over the past two decades, but the mechanisms that underlie the population-level changes in depressive symptoms severity remain unclear. We used data from the 2005–2023 National Health and Nutrition Examination Survey (NHANES) and hierarchical age–period–cohort (HAPC) analysis to examine developmental (i.e., age), life stage (i.e., period), and generational (i.e., cohort) distribution of depressive symptoms among American adults aged 20–30 years old over an 18-year period. Our model results indicate that the probability of either mild, moderate, or severe depression increased among young adult females and males between 2005 and …

Association Between Homelessness And Maternal Health Outcomes Among Non-Hispanic Black Women In Georgia, Miranda Weaver

Walden Dissertations and Doctoral Studies

Maternal health disparities among homeless non-Hispanic Black women in Georgia represent a critical public health concern, driven by inequitable access to care and elevated risks of adverse pregnancy outcomes. This study examined how homelessness influences perinatal care utilization (timing and frequency of prenatal visits and postpartum checkups) and pregnancy complications (gestational diabetes, hypertension, and depression), and whether these associations differ by geographic context (urban versus rural). Grounded in the Social Determinants of Health framework, the study used a quantitative cross-sectional design, analyzing secondary data (n = 1,540; weighted ≈ 203,571) from Phase 8 (2017–2021) of the Pregnancy Risk Assessment Monitoring …

The Covid-19 Lockdown And Diabetes Self-Management In Esan Northeast Area Of Edo State, Esther Ehivbaun Rapu

Walden Dissertations and Doctoral Studies

The COVID-19 lockdown impacted chronic diseases care globally, but there is limited research on how individuals in rural Nigerian communities managed diabetes during this period. This qualitative phenomenological study explored the lived experiences of self-management with diabetes during the COVID-19 lockdown among adults in Esan Northeast. The socioecological model (SEM) served as the guiding conceptual framework, allowing for the exploration of the impact of individual, interpersonal, community, and institutional factors on self-care behaviors. The research explored how cultural, social and economic factors impacted how adults with diabetes in Esan Northeast managed their condition during the COVID-19 lockdown. Semi-structured interviews via …

Predicting Dietary Behavior In Obese Adult Diabetics Using Social Cognitive Theory, Precious Mueller

Walden Dissertations and Doctoral Studies

Predicting Dietary Behavior in Obese Adult Diabetics Using Social Cognitive Theory by Precious Mueller MA, University of Phoenix, 2009 BS, University of Iowa, 2006 Dissertation Submitted in Partial Fulfillment of the Requirements for the Degree of Doctor of Philosophy Public Health Walden University November 2024 “ Diabetes mellitus Type II is a prevalent and serious condition affecting millions globally, particularly among obese adults. The association between dietary behaviors and diabetes management is critical, as it directly impacts health outcomes and quality of life for affected individuals. This study aims to identify the determinants of dietary behaviors that influence Type II …

Policy Review Of The Aha Clinical Practice Guideline For Congestive Heart Failure: Evaluating Best Practices, Brenda E. Garcia

Student Scholarly Projects

Practice Problem: Congestive heart failure (CHF) is a significant public health challenge that impacts various populations and contributes to rising hospital admission rates.

PICOT: The PICOT question that guided this scholarly project was: For healthcare policymakers and interprofessional teams (P), how does a policy review of the American Heart Association’s Clinical Practice Guidelines for Heart Failure (I), guided by the CDC’s Polaris Framework (C), conducted over a 12-week period (T), evaluate alignment with evidence-based practices and potential for adoption in the care of patients with congestive heart failure (O)?

Evidence: This scholarly project focused on reviewing the current clinical guidelines …

Clinicopathologic Risk Factors For Post-Operative Complications After Enucleation Of Pancreatic Neoplasms, Isheeta Madeka, Steven Yi, Julia S. Evans, David Baek, Haresh V. Naringrekar, Harish Lavu, Charles J. Yeo, Avinoam Nevler, Wilbur B. Bowne

Kimmel Cancer Center Faculty Papers

BACKGROUND: Pancreatic enucleation is a parenchymal-sparing procedure used for highly select patients with pancreatic neoplasms. We aim to utilize a multi-institutional health research network platform (TriNetX) and a single, high-volume center to assess complications and identify risk factors associated with post-operative pancreatic fistulas (POPF) after pancreatic enucleation.

METHODS: A two-tiered retrospective study was conducted. We identified 423 patients from TriNetX, and 34 patients from a single-institution IRB-approved database who underwent pancreatic enucleation between 2004-2025 and 2012-2023, respectively. Univariate and multivariate analyses were performed to determine risk factors associated with post-operative complications and occurrence of POPFs.

RESULTS: In the TriNetX cohort, …

No Evidence Of Pitavastatin Effect On Muscle Area Or Density Among People With Hiv, Kristine M Erlandson, Triin Umbleja, Heather J Ribaudo, Michael T Lu, Jana Taron, Marissa R Diggs, Pamela S Douglas, Kathleen V Fitch, Carl J Fichtenbaum, Markella V Zanni, Judith A Aberg, Maria C Rodriguez-Barradas, Katharine Breaux, Rosalba Gomez Morones, Craig A Sponseller, Judith S Currier, Gerald S Bloomfield, Sarah M Chu, Alex B Lu, Carlos D Malvestutto, Steven K Grinspoon, Todd T Brown

Faculty, Staff and Students Publications

Background: Skeletal muscle area (MA) and muscle density (MD) are key determinants of physical function and typically decline with increasing age. Statins have well-known musculoskeletal effects but whether statins impact MA or MD is not well established, especially in the setting of randomized treatment.

Methods: REPRIEVE is a double-blind randomized trial evaluating the effect of pitavastatin for primary prevention of major adverse cardiovascular events in people with HIV (PWH). Thoracic paraspinal, pectoralis, and infraspinatus MA and MD were assessed among Mechanistic Substudy participants with CT at baseline and month 24.

Results: Of 804 substudy participants, 510 remained on study treatment …

No Evidence Of Pitavastatin Effect On Muscle Area Or Density Among People With Hiv, Kristine M Erlandson, Triin Umbleja, Heather J Ribaudo, Michael T Lu, Jana Taron, Marissa R Diggs, Pamela S Douglas, Kathleen V Fitch, Carl J Fichtenbaum, Markella V Zanni, Judith A Aberg, Maria C Rodriguez-Barradas, Katharine Breaux, Rosalba Gomez Morones, Craig A Sponseller, Judith S Currier, Gerald S Bloomfield, Sarah M Chu, Alex B Lu, Carlos D Malvestutto, Steven K Grinspoon, Todd T Brown

Faculty, Staff and Students Publications

Background: Skeletal muscle area (MA) and muscle density (MD) are key determinants of physical function and typically decline with increasing age. Statins have well-known musculoskeletal effects but whether statins impact MA or MD is not well established, especially in the setting of randomized treatment.

Methods: REPRIEVE is a double-blind randomized trial evaluating the effect of pitavastatin for primary prevention of major adverse cardiovascular events in people with HIV (PWH). Thoracic paraspinal, pectoralis, and infraspinatus MA and MD were assessed among Mechanistic Substudy participants with CT at baseline and month 24.

Results: Of 804 substudy participants, 510 remained on study treatment …

The Protective Factors Of Trauma-Informed Care For Parents With Autistic Children, Carolynn J. Redd-Recksiek

Doctoral Dissertations and Projects

The purpose of this current phenomenological study is to understand the experience of parents with autistic children and their lack of trauma-informed care from direct care providers in Northern Utah. This study is guided by trauma-informed theory, which is a model of care delivery created by Maxine Harris and Roger D. Fallot (2001). Trauma-informed care recognizes how adverse experiences can impact a person and have a negative impact on the health and well-being of that person and how those negative experiences have a direct impact on the health and well-being of the family, which directly impacts the health and well-being …

Injury And Illness: An Analysis Of Team Usa Athletes At The 2024 Winter Youth Olympic Games, Ashley N. Triplett, Eric G. Post, Travis Anderson, Olivia Samson, Alexis D. Gidley, Francisco Silva, Lea Thomann, Amber T. Donaldson, Jonathan T. Finnoff, Eric L. Dugan, Jeffrey S. Shilt, William M. Adams

Department of Pediatrics Faculty Papers

BACKGROUND: Injury and illness surveillance is essential for understanding the relative risks of sports participation to develop effective strategies to optimize athlete health, wellness, and performance. Epidemiological studies examining injuries and illnesses among Team USA youth athletes are limited, particularly among athletes competing in Winter sports. The purpose of this study was to characterize the injury and illness incidence rate among Team USA athletes participating in the 2024 Winter Youth Olympic Games (YOG).

METHODS: Injuries and illnesses among 101 Team USA youth athletes (40.6% female; age, 17 ± 1 years) were prospectively documented. Injury and illness prevalence, and incidence rate …

Black Men And Health Literacy: Strategies For Improvement In A Digital Age Through The Adaptation Of A Chronic Disease Self-Management Program, Evelina Weidman Sterling, Laura Stevens, Vanessa Robinson-Dooley, Tyler Collette

Faculty Articles

Health literacy is a critical determinant of health outcomes, yet it is often overlooked, particularly among marginalized groups. This paper explores the significance of health literacy, with a particular focus on low-income African American and Black (AA/B) men, a population that faces unique challenges due to intersecting factors such as race, gender, socioeconomic status, and educational disparities. We examine how these factors contribute to health literacy gaps, highlighting adverse effects on health outcomes for AA/B men compared to the general population. Additionally, we stress the growing importance of digital literacy in an increasingly technology-driven world. Not actively addressing digital health …

Dietary Nitrogen And Its Role In The Gut Microbiome And Inflammatory Bowel Disease: A Narrative Review, Matthew Herrera, Lauri O. Byerley

School of Medicine Faculty Publications

In recent years, gut microbiota has emerged as a critical regulator of gastrointestinal health and disease, with its role in inflammatory bowel disease (IBD)—including Crohn’s disease and ulcerative colitis—being particularly significant. Among the many factors influencing the gut microbiota, dietary components such as fibers, fats, and polyphenols have received substantial attention. However, nitrogen-containing compounds, such as amino acids, nitrates, urea, and even nucleic acids, such as purines, remain underexplored despite their integral role in shaping microbial ecology, host metabolism, and immune responses. Some of these compounds are metabolized by gut bacteria into bioactive molecules such as short-chain fatty acids, ammonia, …

Community And School Programs, Policies And Environments Related To Child Dietary Intake:The Healthy Communities Study, Gail Woodward-Lopez, Alexander C. Mclain, Edward A. Frongillo Jr., Natalie Colabianchi, Vicki Collie-Akers, Lorrene D. Ritchie

Faculty Publications

Background

To reverse the epidemic of unhealthy eating and related chronic disease in the United States, intervening early in life is essential.

Objective

Identify features of community- and school-based programmes, policies and environments related to child intake of fruits and vegetables (FV) and sugar-sweetened beverages (SSB).

Methods

Dietary intake of children 4–15 years old (n = 5138) from elementary and middle schools in 130 US communities was collected by survey (of parent and/or child) in 2013–2015. Features of community programs and policies (CPPs) and school environments were collected by staff surveys, direct observation, key informant interviews, and/or document review. …

Acute Respiratory Distress Syndrome In Patients With Lymphopenia: Results From The National Inpatient Sample (2017-2021), Arnav Garyali, Trishna Parikh, Dhruv Kumar, Ishan Gupta, Adishwar Rao, Akriti Agrawal, Sabiha Armin, Rishi Panjala, Rohan Patil, Nikhil Sriram, Sruthi Parthasarathy, Aarohi Parikh, Bindu Akkanti

Faculty, Staff and Student Publications

Background: Lymphopenia has been associated with in-hospital, early, and late mortality. We aimed to elucidate differences in baseline characteristics in patients with lymphopenia with and without acute respiratory distress syndrome (ARDS) and determine predictors of in-hospital mortality in this patient population.

Methods: Patients ≥ 18 years of age with lymphopenia were identified in the National Inpatient Sample (2017-2021) and stratified according to ARDS diagnosis. Predictors of in-hospital mortality were determined using multivariate analyses with a logistic regression model.

Results: From 183,185 patients with lymphopenia, 10,420 (5.7%) had ARDS, of which 92.8% had coronavirus disease 2019. The patients with ARDS suffered …

Controlling Hypertension In The African American Population Through Dash Diet Education, Tanya K. Mccaskill

Doctor of Nursing Practice Projects

Hypertension disproportionately affects African Americans, contributing to elevated risks of stroke, cardiovascular disease, and kidney failure. Despite the well-established benefits of the Dietary Approaches to Stop Hypertension (DASH) diet, its adoption remains limited due to cultural, socioeconomic, and health literacy barriers. This Quality Improvement (QI) project aimed to evaluate the effectiveness of a culturally tailored DASH diet education intervention in improving nutritional knowledge among African American adults with hypertension (HTN). Using a quasi-experimental pre-post intervention design, 50 participants received a structured educational session during a single clinic visit, which included counseling, printed materials, and sample menus. The intervention was guided …

A Cancer Education Needs Assessment: Informing Middle-Aged Female Patients About The Relationships Between Obesity And Women’S Health Concerns In The Reproductive System, Breast, And Endometrial Health, Batul Mirza

MUSC Theses and Dissertations

Obesity significantly impacts women’s health, particularly among middle-aged women, by increasing the risk of hormone-sensitive cancers such as breast, endometrial, and reproductive system cancers. This study examines the educational needs of this demographic group regarding obesity-related cancer risks and explores effective intervention strategies. Obesity-induced mechanisms – hormonal imbalances, chronic inflammation, and insulin resistance – drive cancer susceptibility, emphasizing the need for targeted health education. The study employs a qualitative design, which includes interviews with subject matter experts (SMEs) and surveys of middle-aged women. The goal is to assess awareness, perceived barriers, and preferred learning methods. Findings suggest that with many …

State-Level Immigrant Policies And Diabetes Prevalence In Latino And Asian American Groups: A Weighted Multilevel Analysis, Md Towfiqul Alam, Jennifer Toller Erausquin, Erica Payton, Elizabeth Vásquez, Sandra Echeverria

Faculty Scholarship

Introduction: Growing literature has shown that immigrant-related policies influence population health by limiting or enhancing immigrants’ rights. However, less is known about the role of state-level immigrant policies shaping chronic health conditions such as type 2 diabetes (T2DM). This cross-sectional study examined the association between state-level immigrant policies (both criminalising and inclusive) and prevalence of T2DM among individuals of Latin American and Asian American origin.

Method: We included adults aged 18+years sampled in the 2014–2018 behavioral risk factor surveillance system (BRFSS) (n=201 824), a survey design that allows the calculation of state-level estimates. Using existing policy measures, states …

What Drives Weight Status Among Female University Students? A Machine Learning Analysis Of Sociodemographic, Dietary, And Lifestyle Determinants, Radwan Qasrawi, Abir Ajab, Leila Cheikh Ismail, Ayesha Al Dhaheri, Sharifa Alblooshi, Razan Abu Ghoush, Stephanny Vicuna Polo, Malak Amro, Suliman Thwib, Ghada Issa, Haleama Al Sabbah

All Works

Background: Obesity and underweight are increasingly common among young adult women, often resulting from complex interactions between diet, lifestyle, and socioeconomic factors. This study addresses that gap by applying machine learning to a wide range of behavioral, dietary, and demographic data. The main research question asks: What are the key factors influencing weight status among female university students, and how accurately can machine learning models identify them? We hypothesize that different factors are significantly associated with underweight, overweight, and obesity, and that machine learning can reliably detect these patterns. The aim is to identify the strongest predictors and support more …

Allied Health Student's Attitudes And Beliefs On Health Literacy Issues Focused On The Non-Native English-Speaking Community, Amy I. Thompson

Graduate Theses, Dissertations, and Capstones

Today's allied health students and their professors are faced with many challenges, including the low level of health literacy among the United States population. Healthy People 2020 defined health literacy as “the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions” (Healthy People 2030). This definition was expanded in Healthy People 2030, to include concepts related to personal and organizational health literacy. Social determinates, such as a language barrier, further complicates an already complex situation with health literacy levels. This focus group, interview-based qualitative …