Digital Commons Network^™

Group Antenatal Care Positively Transforms The Care Experience: Results Of An Effectiveness Trial In Malawi, Crystal L. Patil, Kathleen F. Noor, Esnath Kapito, Li C. Liu, Xiaohan Mei, Elizabeth Chodzaza, Genesis Chorwe-Sungani, Ursula Kafuulafula, Elizabeth T. Abrams, Allissa Desloge, Ashley Gresh, Rohan D. Jeremiah, Dhruvi R. Patel, Anne Batchelder, Heidy Wang, Jocelyn Faydenko, Sharon S. Rising, Ellen Chirwa

Department of Medicine Faculty Publications

Background

We developed and tested a Centering-based group antenatal (ANC) model in Malawi, integrating health promotion for HIV prevention and mental health. We present effectiveness data and examine congruence with only the Group ANC theory of change model, which identifies key processes as supportive relationships, empowered partners in learning and care, and meaningful services, leading to better ANC experiences and outcomes.

Methods

We conducted a hybrid effectiveness-implementation trial at seven clinics in Blantyre District, Malawi, comparing outcomes for 1887 pregnant women randomly assigned to Group ANC or Individual ANC. Group effects on outcomes were summarized and evaluated using t-tests, Mann-Whitney, …

Delayed Hypertension Diagnosis And Its Association With Cardiovascular Treatment And Outcomes, Yuan Lu, John E. Brush Jr, Chungsoo Kim, Yuntian Liu, Xin Xin, Chenxi Huang, Mitsuaki Sawano, Patrick Young, Jacob Mcpadden, Mark Anderson, John S. Burrows, Jordan R. Asher, Harlan M. Krumholz

Department of Medicine Faculty Publications

Importance Hypertension is a major risk factor for cardiovascular disease, yet delays in diagnosis may limit timely treatment initiation and increase cardiovascular risk.

Objectives To examine the timing of clinical hypertension diagnosis, its association with antihypertensive medication prescribing, and its association with long-term cardiovascular outcomes.

Design, Setting, and Participants This retrospective cohort study analyzed electronic health record (EHR) data from an integrated health care system. Adults aged 18 to 85 years with at least 2 outpatient blood pressure (BP) readings of 140/90 mm Hg or more recorded at least 30 days apart from January 1, 2010, to December 31, 2021, …

The Reliability Gap: How Traditional Search Engines Outperform Artificial Intelligence (Ai) Chatbots In Rosacea Public Health Information Quality, Houston C. Nelson, Morgan T. Beauchamp, April A. Pace

Department of Medicine Faculty Publications

Background: The internet has become a primary source of health information for the public, with important implications for patient decision-making and public health outcomes. However, the quality and readability of this content vary widely. With the rise of generative artificial intelligence (AI) tools such as ChatGPT and Gemini, new challenges and opportunities have emerged in how patients access and interpret medical information.

Objective: To evaluate and compare the quality, credibility, and readability of consumer health information provided by traditional search engines (Google, Bing) and generative AI platforms (ChatGPT, Gemini) using three validated instruments: DISCERN, JAMA Benchmark Criteria, and Flesch-Kincaid Readability …

Consumption Of The Food Groups With The Revised Benefits In The New Wic Food Package: A Scoping Review, Qi Zhang, Priyanka T. Patel, Bidusha Neupane, Caitlin M. Lowery, Futun Alkhalifah, Faezeh Mahdavi, Esther May Sarino

Epidemiology, Biostatistics, & Environmental Health Faculty Publications

Background: On 18 April 2024, the United States Department of Agriculture (USDA) published the first food package changes to the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) in over a decade, which reduced some food benefits (juice, milk, canned fish, and infant fruits and vegetables) and offered substitutes (cash-value vouchers (CVVs) or cash-value benefits (CVBs) to redeem for fruits and vegetables, cheese, soymilk, or other dairy products). Methods: To assess the impact of the changes on the consumption and redemption of these food groups, a systematic search was conducted, identifying 23 peer-reviewed publications between 2010 and 2024. …

Politics In Public Health: Growing Partisan Divides In Covid-19 Vaccine Attitudes And Uptake Post-2021 Presidential Inauguration, Hongbin Fan, Zhongliang Zhou, Guanping Liu, Chi Shen, Qi Zhang

Epidemiology, Biostatistics, & Environmental Health Faculty Publications

Objectives: To investigate whether the 2021 U.S. presidential inauguration contributed to a widening of partisan divides in COVID-19 vaccine attitudes and uptake. Methods: We leverage the presidential inauguration as a natural experiment and analyze data from the Household Pulse Survey and CDC vaccination records. Using a difference-in-differences framework with continuous treatment, we examine how the transition differentially affected state-level vaccine refusal rates and county-level vaccination rates, based on varying levels of partisanship as measured by the Trump-Biden vote gap. Results: Following Biden's inauguration, vaccine refusal declined more in pro-Biden states. Distrust in government and vaccines accounted for approximately 80% of …

Providing Healthcare Access For The African Population Using An International Care Coordination System: A Case Study Of Nigeria And Ghana, Aminat B. Nwaonumah

College of Graduate Studies: Theses & Dissertations

Introduction: Healthcare access is a major population health challenge among underserved populations in many parts of the world, and the situation in Africa is no exception. Foreign aid, a significant component of healthcare financing in Africa, has played a crucial role in mitigating communicable diseases. However, there is a lacuna in care for non-communicable diseases, such as chronic illnesses, especially among the elderly. This study explored an innovative approach to expanding healthcare access in Nigeria and Ghana through care coordination sponsored by migrant family members residing in the United States. Beyond foreign aid, this research elucidates how the International Care …

Exploring The Impact Of Covid-19 And The Role Of The Church On African Americans’ Mental Well-Being In South Georgia, Adrian D. Lewis

College of Graduate Studies: Theses & Dissertations

The emergence of COVID-19 in 2020 disrupted the social dynamics of communities in the United States. Furthermore, public health mandates led to closures that changed how populations access faith. Historically, African Americans have utilized the church to cope with societal stressors. This study will explore the history of church utilization in the African American community, assess how COVID-19 public health mandates led to church closures for the first time in recent history and impacted this marginalized population, and provide a qualitative perspective on the quality of life during the closures and what changed after the closures for African Americans in …

Harmonizing Healing: Integrating Traditional/Cultural Remedies And Western Medicine For Chronic Pain Management In Immigrant Populations, Doreen Ugwu, Samuel T. Opoku

Eagles Talking About the Public’s Health

No abstract provided.

Enhancing Malaria Prevention: Barriers To Expanding Vaccine Access In Sub-Saharan Africa, Nenrot Gopep, Patra Chisom Ezeamii, Ho-Jui Tung

Eagles Talking About the Public’s Health

No abstract provided.

Bullying As A Public Health Crisis: Linking Aces To Long-Term Health Consequences, Doreen Ugwu, Dziyana Nazaruk

Eagles Talking About the Public’s Health

No abstract provided.

Buyer Be Aware: An Underutilized Tool In The Public Health Protection Toolkit, Padde Musa, Jacob Gakpo, Samuel T. Opoku, Bettye A. Apenteng

Eagles Talking About the Public’s Health

No abstract provided.

Leveling The Playing Field: The Critical Role Of Ada Compliance In Graduate Education, Victoria Davis, Katie M. Mercer, Amber J. Culpepper

Eagles Talking About the Public’s Health

No abstract provided.

Association Of Non-Communicable Diseases With Severe Covid-19 Among People Living With And Without Diagnosed Hiv/Aids In New York State, Ravi Kumar Balu

Electronic Theses & Dissertations (2024 - present)

Background: People living with diagnosed HIV (PLWDH) have a higher chance of co-infections and co-morbidities than the general population. When SARS-CoV-2 was first reported in China in December 2019 and later declared a pandemic, it was speculated that PLWDH might be more prone to SARS-CoV-2 infection and severe disease outcomes given their increased vulnerability to other respiratory infections like influenza, pneumococcal pneumonia and tuberculosis. However, several facets of COVID-19 disease in PLWDH are incompletely understood, including whether non-communicable diseases (NCDs) are strong risk factors for severe disease outcomes and death as they are in the general population.

Methods: The data …

Applying The Ecological Model Of Medical Encounters To Understand Patient-Centered Communication For Older Korean Migrants In The U.S., Seulgi Park

Electronic Theses & Dissertations (2024 - present)

Patient-Centered Communication (PCC) is defined as an approach that places patients at the center of communication with healthcare providers. PCC has been recognized as a strategy to address disparities experienced by minority populations. However, despite its associations with positive health outcomes and ethical significance, there has been a paucity of research on PCC in minority populations such as older Korean migrants in the U.S. Understanding PCC within this group may contribute to improving healthcare communication tailored to their needs. This dissertation aimed to (1) explore the expectations of PCC in primary care settings among older Korean migrants in the U.S., …

Non-Profit Hospital Spending On Community Health Improvement: Catalysts, Impediments, And Opportunities In New York State, Isaac H. Michaels

Electronic Theses & Dissertations (2024 - present)

This dissertation assesses the distribution and determinants of spending by non-profit hospitals in New York State on community health improvement services and community benefit operations. Utilizing the Social Ecological Model of Health, this study considers multiple levels of influence on this spending, including organizational and community characteristics. Using quantitative analysis, it examines cross-sectional, spatial, and longitudinal patterns in spending and identifies organizational and community-level factors influencing it. Qualitative analysis investigates operational factors affecting spending, including individual and interpersonal influences. The results of this mixed-methods study can inform hospital administrators, public health officials, policymakers, and communities in optimizing policies and decision-making …

Investigating The Interplay Of Thermal, Lighting, And Acoustics In Intensive Care For Enhanced Patient Well-Being And Clinical Outcomes, Emil E. Jonescu, Edward Litton, Benjamin Farrell

Research outputs 2022 to 2026

This research explores the interplay among noise levels, thermal conditions, and lighting intensity in an intensive care unit (ICU), focusing on preserving circadian rhythm and promoting nighttime sleep to advance patient-centric care. This investigation assesses lighting levels (Lux), natural versus artificial light ratios, ICU room temperature, and correlations with acoustic data during a field research period and examines the collective impact of patient exposure to sleep linked to delirium and health outcomes, addressing critical gaps in understanding. Findings reveal that noise levels between 60 and 90 dB(A) during patient occupancy exceed sleep disruption thresholds, with daytime averages of 53.6 dB(A) …

The Association Between Obstetric Violence And Postpartum Depression Among Latina Women In The United States: An Integrative Review, Natalia Alameda

Scripps Senior Theses

Obstetric violence, a structural form of gender-based violence, involves abuse, mistreatment, or neglect by healthcare providers during obstetric care. It is often associated with childbirth trauma and may result in physical and psychological harm to mothers and children, including postpartum depression. Postpartum depression is a major depressive episode occurring during pregnancy or within four weeks following delivery. While these concepts are often studied independently, few studies examine their intersection, particularly among Latina women in the United States. To address this gap, an integrative literature review was conducted to explore the association between obstetric violence and postpartum depression among Latina women. …

Impact Of Volume-Based Procurement Policy On Coronary Stent Use In Tianjin: Interrupted Time Series Analysis, Zhao Yang, Liangyu Ni, Wei Zhao, Yuxi Li, Yongyi Wu, Qiyun Zhu, Linlin Da, Weijia Liu, Qi Zhang, Jianping Li, Bin Jiang

Health Behavior, Policy & Management Faculty Publications

Objectives

This study aimed to analyze the impact of China’s centralized volume-based procurement policy on the procurement and utilization of coronary stents in Tianjin from 2019 to 2021.

Methods

An interrupted time-series design was used to assess monthly procurement data of coronary stents and balloons in Tianjin from January 2019 to December 2021.

Results

The volume-based procurement policy significantly reduced coronary stents prices, with an average price reduction of 92.67% for ten selected stents, and the lowest price dropped to 469 CNY. Following policy implementation, annual procurement in Tianjin increased by 59.55%, and tertiary hospitals demonstrated a significant monthly level …

Exploring Lgbtq+ Competency In Healthcare, Jordan Whiteman

Honors College Theses

Marginalized groups such as the LGBTQ+ community are known to face healthcare disparities that negatively affect their process of navigating healthcare systems. This project explores the perceived lack of representation and understanding of the LGBTQ+ community within healthcare settings, exposing the deficits in knowledge for unique challenges and inequalities these patients may face. By viewing the literature, a myriad of complications faced by LGBTQ+ people in clinical settings can be identified. They possess a generalized feeling of mistrust towards the healthcare system. Healthcare staff overall describe low confidence with caring for this demographic. Heteronormativity’s presence in the field of healthcare …

Focus On Frailty: Co-Designing Digital Frailty Education With Healthcare Students, Kristiana Ludlow, Sarah Martin, Benignus Logan, Ruth E. Hubbard, Nicola Warren, Olivia Gallagher, Bonnie K. Kwok, Rosemary Saunders

Research outputs 2022 to 2026

Introduction: Frailty is prevalent in hospitals and is associated with adverse events and poor health outcomes. In Australia, there is a need for co-designed, multidisciplinary, and contextually relevant frailty education to improve healthcare students’ understanding and knowledge of frailty within the hospital setting. Objective: This study aimed to i) explore healthcare students’ understanding of frailty and their experiences with patients who are frail, and ii) seek healthcare students’ design ideas for the content of a new digital frailty education course.

Methods: Participants were university students enrolled in a health-related degree. Online focus groups and interviews were conducted between August and …

A Scoping Review Of Randomised Controlled Trials Of Vaccines That Recruited Care Home Residents: Lessons For Future Trials, Selvarani Selvarani Subbarayan, Imogen Smith-Dodd, Gabriel Nicolson, Jennifer Kirsty Burton, Janet T. Scott, Seshadri S. Vasan, Susan D. Shenkin, Roy L. Soiza

Research outputs 2022 to 2026

Introduction: Older care home (CH) residents are particularly vulnerable to infections and often experience adverse outcomes. Despite this group being frequently prioritised for vaccinations, trials of vaccines rarely recruit CH residents. Given that the social and biological characteristics of CH residents may influence vaccine effectiveness, it is crucial to test vaccines in this population.

Methods: The Widening Access to Trials in Care Homes project was established to develop best practice guidance on designing and conducting vaccine trials in the CH population. As part of this project, a scoping review following Joanna Briggs Institute methodology was conducted to identify vaccine trials …

Navigating Ethical Complexities In Health Education: Exploring Challenges In Teaching Food And Health, E. Oljans, M. Quennerstedt, D. Barker, A. Caldeborg, V. Varea

Research outputs 2022 to 2026

Teaching food and health may be challenging, especially in classrooms where young people from different cultures, ethnicities, and religions meet. This article explores teachers’ navigation of ethical complexities when teaching food and health in classrooms with immigrant students. Five didactical strategies were identified: (1) The educare strategy, (2) The tiptoeing strategy, (3) The collegial support strategy, (4) The intercultural strategy, and (5) The pluralistic strategy. These didactical strategies are embedded in various educational settings. Our results demonstrate that a further focus on ethical and intercultural competence should be carefully supported and implemented in teacher education and continual professional development programmes …

Investigating Falls Risk Awareness In Hospitals Using The Self-Awareness Of Falls Risk Measure (Safrm): Empirical Research Quantitative, Elissa Dabkowski, Simon J. Cooper, Jhodie Duncan, Karen Missen

Research outputs 2022 to 2026

Aim: The overarching aim of this study was to explore patients' falls risk awareness in hospitals using section A of the validated Self Awareness of Falls Risk Measure (SAFRM). Design: Descriptive cross-sectional study design. Setting: Three rural/regional hospitals in the State of Victoria, Australia. Methods: Using a purposive sampling strategy, patients were eligible to participate if aged ≥ 40 years, English-speaking, and have ambulatory capacity prior to hospital admission. Participants were excluded from the study if they returned a Standardised Mini-Mental State Examination (SMMSE) score < 18. Falls risk awareness data was collected from both patient and health professionals using section A of the SAFRM. Patient demographic data was collected from patient medical records. Results: A total of 77 patients (72.9 years ±11.2) and 58 health professionals were recruited. Patients had a significant difference in falls risk awareness when compared to their clinician (z = −2.08, p = 0.038). Regression analyses showed that patients were more likely to overestimate their falls risk if they used anticoagulant medication and if their highest education level was less than or equal year 11. An exploratory factor analysis (EFA) revealed a three-factor solution from section A of the SAFRM, which were labelled Physical Activity Awareness, Cognitive Awareness and Balance Awareness. Conclusions: There was a significant difference in patients' falls risk awareness compared to a health professional. The independent associations of variables with falls risk awareness, such as age, education level and medication use, further our understanding of the differences in falls risk awareness. The findings also establish that the 15-item section A SAFRM is a reliable and feasible falls risk perception measure for use in hospitals, with future research recommended to evaluate the proposed three-factor model with the addition of tailored hospital falls education. Implications for the Profession and/or Patient Care: The findings from this study establish a significant difference in patients' falls risk awareness compared to their health professional. Section A of the SAFRM is a reliable tool for nurses and other health professionals to establish the presence of a falls risk disparity. The ability to empirically measure this disparity and to determine an under- or overestimation of falls risk is a useful addition to clinical practice. The SAFRM facilitates a person-centred approach to falls prevention by providing opportunities for the clinician to collaborate with the patient and tailor fall prevention strategies. Impact: Problem: Inpatient falls in hospital settings. Main Findings: There was a significant difference in patients' falls risk awareness compared to a health professional. Section A of the Self-Awareness of Falls Risk measure is a reliable and feasible tool to identify under- or overestimation of falls risk perception in hospitals. Patients were more likely to overestimate their falls risk if they used anticoagulant medication and if their highest education level was less than year 11. The findings for a three factor-model Physical Activity Awareness, Cognitive Awareness and Balance Awareness could inform future hospital falls education. Impact: Registered nurses, health professionals, inpatients. Reporting Method: STROBE checklist for cross-sectional studies. Patient or Public Contribution: This study involved the collection of data from patient participants and registered nurses.

Multifactorial Fall Interventions For People Over 65 Years In The Acute Hospital Setting: Pre–Post-Test Design, Allison Wallis, Christina Aggar, Deb Massey

Research outputs 2022 to 2026

Background: Falls are the most reported patient safety incident for patients >65 years in acute hospital settings worldwide. While multifactorial fall interventions reduce the number of falls in subacute and rehabilitation settings, fall interventions in acute hospital settings are unknown. Aim: To evaluate the effectiveness of multifactorial fall interventions on the number of falls using codesigned education targeting staff and the patient and review the environment in acute hospital settings in NSW, Australia for patients over 65 years of age. Method: A pre–post-test design with a non-equivalent group was conducted. All acute hospital inpatient falls occurring both pre- and post-intervention …

The Changes In Health-Related Quality Of Life After Attending Cardiac Rehabilitation: A Qualitative Systematic Review Of The Perspective Of Patients Living With Heart Disease, Amineh Rashidi, Lisa Whitehead, Helena Halton, Lisa Munro, Ian Jones, Lisa Newson

Research outputs 2022 to 2026

Background Although the benefits of engaging in cardiac rehabilitation are well established, patient perceptions of the changes in their health-related quality of life are poorly documented. This systematic review synthesized qualitative studies on patients’ perspectives of change in their health-related quality of life after attending cardiac rehabilitation. Objective To identify and synthesize the best available evidence on the perspective of patients living with heart disease about the changes in their health-related quality of life after attending cardiac rehabilitation. Methods Eight databases were used to identify relevant papers published in English and peer-reviewed, and no date restrictions were considered for the …

Undergraduates’ Lifestyle And Suboptimal Health Status (Shs): A Cross-Sectional Study In The Ha’Il Region Of Saudi Arabia, Bandar Alsaif, Collins Otieno Asweto, Sehar Un Nisa Hassan, Mohamed Ali Alzain, Mohammed Elshiekh Saeed, Ahmed Kassar, Kamal Elbssir Mohammed Ali, Mouna Ghorbel, Rafat Zrieq, Wei Wang

Research outputs 2022 to 2026

Background University students in Saudi Arabia are embracing some of the negative traits of the fast-paced modern lifestyle, typified by unhealthy eating, low physical activity, and poor sleep habits that may increase their risk for poor health. Health and holistic well-being at the population level are among the priorities of the 2030 vision of a vibrant society in the Kingdom of Saudi Arabia. The current study thus aims at determining the prevalence and predictive factors of Suboptimal Health Status (SHS) among university students. Methods A cross-sectional study was conducted among 9,026 undergraduate students between 31st May and 15th June 2023. …

Facilitators, Barriers, And Strategies For Supporting Shared Decision-Making With People With Intellectual Disability: A West Australian Primary Healthcare Professional Perspective, Kathryn Teale, Abigail Lewis, Rachel Skoss

Research outputs 2022 to 2026

Background: Shared decision-making between patients and primary healthcare professionals positively impacts health outcomes. However, people with intellectual disability face additional barriers and require supported shared decision-making (SSDM) to participate. Little is known about how healthcare professionals use SSDM with this population. This paper explores the facilitators and barriers experienced, and strategies/resources employed by healthcare professionals working with people with intellectual disability. Method: Ten purposively sampled primary healthcare professionals participated in semi-structured interviews. This descriptive qualitative study used content analysis. Findings were compared with a proposed model of factors influencing triadic (the person with intellectual disability, their caregiver and the healthcare …

The Impacts Of Covid-19 Restrictions On Care-Givers Of People With Cognitive Impairment And Their Support Needs: A Mixed-Methods Systematic Review, Loretta Baldassar, Thi N. M. Nguyen, Bronte Jones, Catriona Stevens, Lukasz Krzyzowski, Silvia Lozeva, Simone Marino, Maria G. C. Du Plooy, Johanne Eldridge, Osvaldo P. Almeida, Manonita Ghosh

Research outputs 2022 to 2026

The COVID-19 pandemic and ensuing restrictions/lockdowns have caused significant physical and psychological consequences for people with cognitive impairment who are heavily dependent on their care-givers. However, little is known about the impact on care-givers, the factors that exacerbate their situation and what supports they need. The aims of this paper are threefold: (a) to examine the impact of COVID-19 physical restrictions on both formal and informal care-givers of people with cognitive impairment; (b) to identify attributing factors influencing this impact; and (c) to recognise their support needs. Further, this paper informs future research, policy and practice. Guided by the Joanna …

Support For Older People Living With Chronic Life-Limiting Illnesses In Rural Ghana, Barbara Adonteng-Kissi, Obed Adonteng-Kissi

Research outputs 2022 to 2026

Summary: This research aims to address formal support needs of informal caregivers (ICs) in the context of long-term care of older people (OP) living with chronic life-limiting illnesses and examine the relationships of ICs of OP with formal support in rural Ghana. We undertook ethnographic interviews with 15 OP; 15 ICs; and 10 healthcare professionals (HPs) after participatory observations during 6 months of fieldwork. This was supported with daily field notes used to collect the needed data and purposively sampled across Gomoa West District in Ghana. The average age of participants was 76 years. Interviews were recorded and transcribed, using …

Assessment Of The Psychometric Properties Of The Mask Usability Scale: A Measure Of The Perceived Usability Of N95 Respirators Among Healthcare Students And Staff, Lorna Kwai Ping Suen, Wai Hang Kwok, Ignatius Tak Sun Yu, Sony Nai Yeung So, Kin Cheung, Paul Hong Lee, Lily Yuen Wah Ho, Ka Yan Ko, Sukki Ho, Simon Ching Lam

Research outputs 2022 to 2026

Aim: To test the reliability and construct validity of the Mask Usability Scale in healthcare students and staff. Design: A methodological study involving repeated measures. Methods: The study included two batches of participants: (1) 283 university nursing students and (2) 1753 participants composed of students (61%) and clinical staff (39%). All participants underwent N95 respirator fit tests and user seal checks. They also responded to the Mask Usability Scale, which comprises 11 items evaluated using Likert scales. The internal consistency was assessed using Cronbach's alpha and item–total correlation test. Test–retest reliability was evaluated by the intraclass correlation coefficient (ICC). The …