Digital Commons Network^™

Optimizing Initial Screening For Colorectal Cancer Detection With Adherence Behavior, Sarah Yini Gao, Yan He, Ruijie Zhang, Zhichao Zheng, Shao Wei Lam Lam, Emile Tan

Research Collection Lee Kong Chian School Of Business

Background: Two-stage screening programs are widely adopted for early colorectal cancer (CRC) detection, where individuals receiving positive outcomes in the first-stage (initial) test are recommended to undergo a second-stage test (colonoscopy) for further diagnosis. Methods: We study the initial test design—the selection of cutoffs for reporting test outcomes—to balance the trade-off between screening effectiveness (i.e., CRC and polyp detection) and efficiency (i.e., colonoscopy costs), incorporating the fact that not all individuals follow up with a colonoscopy after receiving positive outcomes. We integrate the Bayesian persuasion framework with information avoidance to model this problem and apply it to Singapore's CRC screening …

Public Support For And Reactive Behavior Toward Technological Risk Interventions: An Extension Of Secondary Risk Theory, Hye Kyung Kim, Rui Gu, Fiona Goh, Sonny Rosenthal, Shirley S. Ho

Research Collection College of Integrative Studies

Project Wolbachia is a dengue control initiative in Singapore. Guided by Secondary Risk Theory, this study examined how primary (dengue) and secondary (Wolbachia) threat and coping appraisals shape public support and reactive behavior toward the project. A nationally representative survey of 1,000 Singaporeans showed that support was positively linked to the perceived primary risk, the efficacy of the project and the government, while negatively related to the perceived secondary risk. Reactive behavior was positively associated with perceptions of both primary and secondary risk. Media attention and trust in the government indirectly influenced support and behavior moderated by knowledge.

Iot Sensors As A Tool For Assessing Spatiotemporal Risk To Extreme Heat, Kijin Seong, Seung Jun Choi, Junfeng Jiao

Research Collection College of Integrative Studies

The safety of urban populations sensitive to extreme heat is under increasing threat. Few studies examine the potential benefits of deploying IoT environmental sensors in the urban context and their integration with large-scale human activity data. This paper examines the deployment of IoT sensors in high-resolution extreme heat risk assessment in the case of Seoul, South Korea. This study conducted spatiotemporal analysis on heat exposure with IoT sensors, compared it with an existing land surface temperature map for validation, combined it with human activity data for risk assessment, and finally discussed the benefits of IoTs in detecting abnormal weather events. …

Old Frames On New Media: Health Misinformation In Black Digital Communities, Merriah Croston

Brown School Graduate Student Theses and Dissertations

Growing evidence suggests that health misinformation has the potential to proliferate on social media. However, our understanding of the problem’s magnitude continues to evolve. Despite several studies on health misinformation and Black communities in the United States (U.S.), few of these studies characterize misinformation within digital settings. This dissertation seeks to address this gap by: 1) synthesizing the literature on health misinformation and Black communities to identify prevalent misinformation topics and claims, characteristics of exposure to and belief in these topics and claims, and successful intervention strategies; 2) quantifying and characterizing the volume of COVID-19 misinformation on Black Twitter during …

Routine Antenatal Ultrasound By Nurse-Midwives In Rural Kenya: A Pragmatic Trial Assessing Feasibility And Effects Of The Mimba Yangu (My Pregnancy) Project, Claudia Hanson, Lucy Nyaga, Nidhi Leekha, Michaela Mantel, Sarah Kedenge, Caroline Gitonga, Violet Naanyu, Jasmit Shah, Marleen Temmerman

Centre of Excellence in Women and Child Health

Introduction: Task-sharing of obstetric ultrasound between nurse-midwives and doctors has the potential to operationalize the World Health Organization’s recommendation of at least one ultrasound before 24 weeks of gestational age for every pregnant woman. Here, we report on the feasibility, acceptability, and effects of the Mimba Yangu (My Pregnancy) task-sharing approach in rural Kenya.

Methods: We conducted a pragmatic trial including 28 primary care facilities between April 2021 and March 2022, selected based on feasibility criteria. Fourteen facilities received the ultrasound intervention composed of (i) task-sharing with nurse-midwives, (ii) the use of portable ultrasound devices (Lumify™) connected to a tablet, …

A Fascination With Gastrointestinal Viruses, Mary Kolb Estes

Faculty, Staff and Students Publications

My arrival into this world came quickly, according to my mother, and it feels like my life has mirrored that rapid beginning. I have enjoyed a rich, varied, and stimulating life and career that have gone through several phases. I credit genetics, my family, technological advances, and many environmental factors for shaping my career. Being a virologist allowed me to be curious and creative and to make several unexpected discoveries. This has been a fun and rewarding journey, but it wasn't always easy. I am not accustomed to talking about myself, but I am happy to share some scientific achievements …

Patient-Centered Management Of Heavy Menstrual Bleeding While On Anticoagulation: A Survey Study, Benjamin Barnett, Rushad Patell, Dana Angelini, Leben Tefera, Jordan K Schaefer, Ang Li, Alejandra Gutierrez Bernal, Shruti Chaturvedi, Anjlee Mahajan, Leslie Lake, Jori May, Anna L Parks

Faculty, Staff and Students Publications

Background: Nearly three-quarters of women experience heavy menstrual bleeding (HMB) during anticoagulation treatment for venous thromboembolism (VTE). HMB can lead to medical interventions, impact school or work and diminish quality of life (QOL). While there are several management options for HMB in patients with VTE, we lack information on how patients approach HMB treatment decisions.

Objectives: We examined patients' experience with, perceptions of, and preferences for treatment of HMB while on anticoagulation.

Methods: Clinicians and patient advocates developed a web-based survey that was distributed via patient advocacy organizations and social media between May and June 2024, targeting participants 18 years …

Nursing Students’ Sociodemographic Characteristics And Consumer Preferences’ Prediction Level Of Perceived Food Literacy, Sinan Duru

Makara Journal of Health Research

Background: Food literacy, which is a critical competency for nursing students, plays a pivotal role in promoting evidence-based nutrition behaviors and contributes effectively to public health. This study aimed to determine the level of perceived food literacy among nursing students.

Methods: This cross-sectional study involved 488 nursing students from two universities in the south of Turkey. The research data were collected face to face via the Personal Information Form, the Consumer Preferences Form, and Self Perceived Food Literacy. The data was analyzed using the Independent Sample t Test, One Way ANOVA, and multiple linear regression.

Results: The …

Enhancing Patient Outcomes: Developing A Comprehensive Database For Tracking Post- Dural Puncture Headache Incidence And Contributing Factors, Meredith B. Auge, Brittany Bogonovich

Doctor of Nurse Anesthesia Practice (DNAP) Manuscripts

Post-dural puncture headache (PDPH) is a debilitating complication following labor analgesia, often resulting from unintentional dural puncture (UDP). While national incidence is approximately 1.5%, institutional rates may vary due to provider experience, documentation practices, and patient factors. This Doctor of Nurse Anesthesia Practice (DNAP) quality improvement project aimed to improve identification and monitoring of UDP and PDPH through a revised tracking tool, retrospective review of 2024 data, and planning for an electronic registry. A multidisciplinary team of anesthesiologists, Certified Registered Nurse Anesthetists (CRNAs), Student Registered Nurse Anesthetists (SRNAs), and IT and quality specialists revised an existing tracking tool to better …

Improved Obstetric Hemorrhage Care Through Toolkit Revision: A Quality Improvement Project, Samantha Kalkstein, Amber Woodring

Doctor of Nurse Anesthesia Practice (DNAP) Manuscripts

Obstetric hemorrhage (OBH) remains a leading cause of preventable maternal morbidity and mortality in the United States. Accurate risk identification is critical for initiating timely interventions; however, current risk assessment practices vary significantly. This quality improvement (QI) project aimed to implement the California Maternal Quality Care Collaborative (CMQCC) OBH Risk Assessment Tool on the labor and delivery (L&D) unit of a community-based hospital to standardize risk stratification and improve interdisciplinary communication. Guided by the Johns Hopkins Nursing Evidence-Based Practice model, the project involved a gap analysis, staff education, and the introduction of a paper-based CMQCC tool formatted for visibility and …

Atypical Dengue Fever Presentation With Severe Leukopenia: A Case Report From An Endemic Border Region, Elias Arellano Villanueva, Alhasan Asaad, Jose E. Campo Maldonado

School of Medicine Publications

Dengue virus infection is increasingly recognized in South Texas, particularly in areas bordering Mexico. Although many cases are mild and self-limiting, dengue can present with atypical features, including hematological abnormalities and bleeding, even in the absence of plasma leakage. A 22-year-old Hispanic woman presented to a hospital in South Texas with hematemesis, fever, and gastrointestinal symptoms following travel to northeastern Mexico (Monterrey, Nuevo Leon). Initial laboratory workup revealed severe leukopenia and neutropenia, mild thrombocytopenia, and elevated liver enzymes, but no evidence of plasma leakage. A bone marrow biopsy was performed due to persistent cytopenias, revealing a reactive process consistent with …

Exploring Stunting In South Kalimantan Province Using R Programming-Based Data Visualization, Muhammad Hudaya, Wahyudin Nor, Mellani Yuliastina, Muhammad Nordiansyah

Kesmas

South Kalimantan Province continues to face the challenge of relatively high stunting prevalence despite being endowed with abundant coal resources that could serve as a source of funding for public health. Therefore, this study aimed to examine differences in stunting prevalence among cities, mining districts, and non-mining districts in South Kalimantan to raise stakeholder awareness of disparities across these regional types. This study was conducted between April and December 2024, using secondary data obtained from the Indonesian Ministry of Health and the South Kalimantan Provincial Government. R programming was used to process the data, generate visualizations, and perform analysis of …

Has Regional Hospital Autonomy Achieved Its Goals? Lessons Learned From Indonesia: A Systematic Review, Masyitoh Basabih, Indriaswari Widhakuswara

Kesmas

This study examined the impact of hospital autonomy implementation on the performance of regional public hospitals in Indonesia, particularly in terms of efficiency, effectiveness, and governance. A systematic review of 32 peer-reviewed studies published between June 12 and September 6, 2023, was conducted using Garba Rujukan Digital and Google Scholar, following PRISMA guidelines. Studies addressing financial performance, service outcomes, and challenges related to implementing autonomy were included. The findings indicated that while autonomy led to improvements in infrastructure, service types, visit volumes, and hospital revenues, it had only a marginal impact on improving key health performance outcomes, such as service …

Barriers To Implementing Comprehensive Sexuality Education As A Strategy To Prevent Adolescent Pregnancy In Indramayu District, Indonesia, Een Kurnaesih, Chahya Kharin Herbawani, Nelly Febriani

Kesmas

The implementation of comprehensive sexuality education (CSE) is not optimal. This qualitative study aimed to identify and contextualize barriers to CSE implementation, specifically in Indramayu District, Indonesia. Conventional content analysis procedures were used. Seven participants, consisting of relevant authorities, were interviewed. A purposive sampling technique was employed to select participants. Data were collected through in-depth, semi-structured interviews. All interviews were recorded and transcribed verbatim. Data were analyzed using conventional qualitative content analysis. The barriers to CSE implementation in Indramayu District were identified across five themes: advocacy, technical considerations, coordination and collaboration, integration with other sexual and reproductive health projects, and …

Understanding User Needs In Health Crisis Risk Monitoring Information System Development: A Lesson From Tasikmalaya District, Indonesia, Arief Tarmansyah Iman, Hari Kusnanto, Ariani Arista Putri Pertiwi

Kesmas

A health crisis risk monitoring information system needs to be developed, especially during the pre-disaster phase; therefore, understanding the needs of prospective users is crucial. This study aimed to investigate the needs of potential users regarding the development of this system. This study employed a qualitative, exploratory approach to gather user needs from stakeholders through interviews (n = 7) and one focus group discussion (n = 12). The data were audio-recorded, transcribed verbatim, and then thematically analyzed using qualitative content analysis. The need for information was related to disaster preparedness and its preferred format. The system should be targeted, multiplatform, …

Experiences Of Elderly Living With Noncommunicable Diseases In Utilizing Health Services In Myanmar During The Covid-19 Pandemic, Nway Eint Chei, Kwanjai Amnatsatsue, Natkamol Chansatitporn, Ariya Bunngamchairat

Kesmas

The COVID-19 pandemic and armed conflicts in Myanmar have intensified the challenges in accessing and utilizing health services, particularly for noncommunicable diseases (NCDs) among older adults. This qualitative study explored the experiences of the elderly with NCDs regarding health service accessibility and utilization in secure areas with fully operational health facilities by conducting in-depth interviews with 20 eligible older adults in Myanmar; data were analyzed using content analysis. Four key themes emerged: NCD service utilization patterns; unmet needs; preferences and hesitancy toward NCD services; and disparities, barriers, and opportunities. The findings revealed widespread underutilization of NCD services due to several …

Government Health Spending And Life Expectancy: Evidence From Cities And Districts In Indonesia, Kurnia Sari, Budi Hidayat, Amal Chalik Sjaaf, Mardiati Nadjib

Kesmas

Life expectancy is widely recognized as a fundamental indicator of population health, and its improvement is often linked to government health spending, particularly in decentralized health systems. This study aimed to investigate the relationship between local government health expenditures and life expectancy in decentralized Indonesia. Data from 492 cities and districts, spanning from 2015 to 2019, were analyzed using a two-way fixed effects regression model to control for time-invariant district characteristics and common temporal shocks. The findings indicated that a 10% increase per capita in government health expenditure was associated with a 0.01% increase in life expectancy. This association was …

Associations Between Factors Of Unhealthy Lifestyle, Mental Health Issues, Chronic Illnesses, Environmental Health Risks, And Infertility In Females: A Cross-Sectional Study, Richard L. Huang

Doctoral Dissertations and Projects

Infertility has risen rapidly in recent decades and has become the third-largest public health concern in the world. It has significantly threatened individuals’ psychological, physical, and social well-being, and it could be an early sign of severe health problems in the future. Furthermore, it also threatens the continuation of life and human civilization. The purpose of this study was to examine the relationship between individuals’ daily lifestyle behaviors, mental health status, chronic conditions, environmental health factors, and infertility by using cross-sectional quantitative methods. It benefits the public as the study raised awareness of potential risks and provided guidance to avoid …

Social Media And Mental Health According To Generation Z: A Health Belief Model-Based Cross-Sectional Evaluation Of Generation Z Adults’ Attitudes And Perceptions Of Problematic Social Media Use And Its Relationship With Depression And Anxiety, Michael Chad Gann

Doctoral Dissertations and Projects

Purpose: This study aimed to examine Generation Z adults’ attitudes and perceptions of problematic social media use (PSMU) as they relate to mental health problems (depression and anxiety) through the lens of the Mental Health Belief Model.

Methods: A cross-sectional, web-based survey gathered data from a convenience sample (N = 353) of Generation Z adults (age 18-30) after receiving approval from the LU IRB. The previously validated instrument battery included the Bergen Social Media Addiction Scale (BSMAS), the Patient Health Questionaire – 9 (PHQ-9), the Generalized Anxiety Disorder – 7 (GAD-7), and the Greene (2012) MHBM subscales for perceived susceptibility …

Evaluating Inclusion Rates Of Oral-Systemic Health Connection Coursework In Dental And Medical Professional Programs' Admissions Requirements, Wendy Marie Carry

Doctoral Dissertations and Projects

Oral systemic health connections (OSHC) are bidirectional, life-threatening, and a significant public health concern. Studies have identified over 200 OSHCs; however, the prevalence of foundational OSHC education in dental and medical professional programs remains unknown. This quantitative descriptive comparative pilot study aimed to explore the prevalence of predictor variables, dental and medical professional programs in the United States, and the criterion variable, including an OSHC admissions requirement for the 2025 academic year. The point-in-time count methodology served as the theoretical framework guiding this study and the development of the PiT-PARCI instrument. The proposed testing was replaced with alternative testing based …

Time Ticks Slowly For Kidney Transplant Reform: Eskd Patient Challenges And Opportunities, Gregory P. Hess

College of Population Health Faculty Papers

No abstract provided.

Partner Collective Impact Survey Final Evaluation Report, Courtney A. Fitzgerald, Theresa H. Cruz, Havana Maisano

Reports & Documents

The Healthy Here coalition, based in Bernalillo and Santa Fe Counties, brings together over 30 organizations working across four key areas: healthy eating, active living, family healthy weight, and vaccinations. In summer 2025, the coalition conducted a PARTNER Collective Impact Survey to evaluate its network structure, contributions, and effectiveness. The survey, completed by 29 organizations (87.9% response rate), provided insights into how member organizations collaborate, the resources they contribute, and how trust and value are perceived across the network.

Findings show that coalition members most frequently contributed community connections, content expertise, and information sharing, with Presbyterian Community Health and the …

Impact Of Mental Illness On Colon Cancer Screening Participation, Stephanie Tejada

Walden Dissertations and Doctoral Studies

This study analyzed the impact of mental illness on colon cancer screening participation. The research problem centers on the under-screening of colorectal cancer (CRC) in psychiatric patients, leading to delayed diagnoses and poorer treatment outcomes. This quantitative retrospective cohort study examined how demographic factors (age, gender, ethnicity), healthcare access, and support group participation influenced CRC screening among individuals with mental illness. The research used data from 571 adults aged 50 and older from the National Health Interview Survey (NHIS). The Social Ecological Model served as the guiding theoretical framework for this study. Statistical analyses included t-tests, chi-square, logistic regression, and …

Opioid Overdose Bystander Assistance And Harm Reduction In Pennsylvania, Walkirya Peralta

Walden Dissertations and Doctoral Studies

Bystanders play a vital role in reducing opioid overdose deaths by administering naloxone, a medication that can reverse the effects of opioids when used promptly. With opioid-related fatalities considered a public health emergency in the United States, increasing public access to naloxone and education on overdose prevention has become a key strategy in harm reduction. Research shows that these efforts effectively lower overdose deaths in affected communities. As part of this public health approach, many states allow individuals to obtain naloxone without a prescription through standing orders at pharmacies and community programs. Additionally, legal protections such as Good Samaritan laws …

Earth Care Trusted Messengers Vaccine Access Project, Camille Velarde, Theresa H. Cruz

Reports & Documents

The Earth Care Trusted Messengers Vaccine Access Project was a two-month intervention implemented in Santa Fe, New Mexico in spring 2025 to address persistent barriers to COVID-19 and routine vaccine access among Spanish-speaking communities. Using a peer-to-peer “Trusted Messenger” model, respected community members received training in vaccine knowledge, communication strategies, and community organizing before hosting small house meetings to share accurate information, address concerns, and build trust.

A mixed-methods evaluation included pre/post/follow-up surveys, weekly house meeting questionnaires, and a final focus group. Quantitative results demonstrated substantial increases in participants’ confidence across all domains, including vaccine knowledge, communication skills, and ability …

The Association Between Malnutrition And Gingivitis Among Residents In St. Louis, Missouri, Alyssa Detrick

Walden Dissertations and Doctoral Studies

Malnutrition and gingivitis are common diagnoses in primary medical and dental care. The purpose of this quantitative study was to understand the association between malnutrition and gingivitis among residents in St. Louis, Missouri. The study was based on the social ecological model (SEM). The cross-sectional design involved secondary data (N = 2,553) from a Federally Qualified Health Center in St. Louis, Missouri that included de-identified patient demographic and diagnosis information of St. Louis City residents with a medical and dental visit in 2024. This study examined the relationship between malnutrition and gingivitis while controlling for ethnicity, preferred language, race, and …

Bridging Diagnostic Safety And Mental Health: A Systematic Review Highlighting Inequities In Autism Spectrum Disorder Diagnosis, Abirami Srivarathan, Andrea Bradford, Sara Shearkhani, Layla Heimlich, Sheryl Jefferson, Kristen E Miller, Kelly Smith, Helen Haskell, Traber D Giardina

Faculty, Staff and Students Publications

Introduction: There is increased recognition that diagnostic errors disproportionately affect marginalised and underserved patient populations in the USA. However, evidence on diagnostic inequities in mental disorders is sparse and not well integrated into the overall diagnostic safety literature.

Objective: We systematically reviewed and narratively synthesised evidence on inequities in diagnosis of mental disorders, guided by the Diagnostic Process Framework developed by The National Academies of Sciences, Engineering, and Medicine.

Methods: We conducted a systematic review and a narrative synthesis. Medline, Embase, PsycInfo and CINAHL were searched for studies published between 2015 and 2024. Studies were eligible if they reported on …

Family Healthy Weight Program: Smart Movestm Pilot Project Evaluation Report, Camille Velarde, Theresa H. Cruz Dr., Elena Martinez

Reports & Documents

The Smart Moves™ Family Healthy Weight Program is an evidence-based, family-centered intervention designed to address childhood overweight and obesity through nutrition education, physical activity, social-emotional learning, and caregiver engagement. In spring 2025, Presbyterian Community Health piloted Smart Moves™ in a South Valley community health clinic as part of the Healthy Here initiative, with evaluation conducted by the University of New Mexico Prevention Research Center.

The pilot, adapted from a 12-lesson curriculum to 8 core lessons plus orientation and celebration, included bilingual instruction, cooking in a teaching kitchen, and family-based incentives. Evaluation methods combined quantitative and qualitative data, including pre/post BMI …

Blenderized Tube Feeding Formulas: Attitudes, Barriers, And Clinical Benefits As Perceived By Registered Dietitians In Pediatric Care, Savannah Smiley Keeler

Master's Theses

Blenderized tube feeding formulas (BTFF) are increasingly recognized as a viable alternative to conventional commercial tube feeding formulas (CTFF) for pediatric patients requiring enteral nutrition. This cross-sectional, exploratory study aimed to assess the experiences, attitudes, and perceived clinical benefits of BTFF use among Registered Dietitian Nutritionists (RDNs) working with gastrostomy-tube-dependent pediatric populations in the United States. A total of 146 RDNs completed a 45-item online survey, which gathered quantitative and qualitative data on BTFF familiarity, feasibility, clinical outcomes, caregiver factors, and institutional barriers. Findings revealed that while BTFF use remains variable across clinical settings, 55.8% of RDNs reported increased utilization …

Lactation Management Training In Graduate Nutrition And Dietetics Programs: A Preliminary Report, Laura Ashton Gillin

Master's Theses

The American Academy of Pediatrics recommends exclusive breastfeeding (BF) for the first six months and continued breastfeeding for at least two years with complementary food. Despite this recommendation, only 24.9% of infants in the United States are exclusively breastfed at six months (Breastfeeding Report Card 2022). Breastfeeding support and lactation management are critical to promoting a successful breastfeeding experience. Specifically, qualified support from a Registered Dietitian Nutritionist (RDN) is recommended, yet graduate students in Nutrition and Dietetics do not receive adequate training regarding breastfeeding intervention. This study aimed to evaluate graduate Nutrition and Dietetic programs to determine the amount of …