Digital Commons Network^™

Improving Identification And Referral Of Xylazine‑Associated Wounds In Homeless Healthcare, Ramon A. Gambino

Doctor of Nursing Practice Scholarly Projects

Background: Xylazine-adulterated fentanyl is linked to distinctive necrotic wounds and complex care needs in unsheltered populations. This quality improvement (QI) project implemented a brief survey and referral log at Albuquerque Health Care for the Homeless (AHCH) to track suspected xylazine-associated wounds and referrals to advanced care. Methods: Final data were exported from Qualtrics, cleaned to retain finished responses, standardized categories, and de-identified. The analytic sample included 18 encounters. Results: Results showed that 55.6% (n = 10) documented suspected xylazine-associated wounds; 5.6% (n = 1) reported no suspicion; 38.9% (n = 7) were uncertain. Referrals were rarely documented overall at AHCH …

Self-Efficacy And Health Promotion: The Roles Of Family Health And Health Literacy, Müjdat Yeşildal, Yunus Emre Öztürk

Makara Journal of Health Research

Background: Chronic noncommunicable diseases are the leading causes of death globally and in Türkiye, emphasizing the need to explore how individual, familial, and informational factors shape health-promoting behaviors. This study examined whether family health and health literacy sequentially mediate the relationship between general self-efficacy and health-promoting behaviors among adults in Türkiye.

Methods: A cross-sectional correlational study was conducted with 1,240 adults in Konya Province, Türkiye, between November and December 2022. Participants completed the Turkish versions of the General Self-Efficacy, Family Health, Health Literacy, and Health-Promoting and Protective Behaviors Scales. Data were analyzed using descriptive statistics, Pearson correlation, and …

Examining The Psychometric Properties Of The Big Three Perfectionism Scale–Short Form (Btps-Sf) Among Malaysian Chinese Students At A Private University, Kam-Fong Lee, Ashraf Sadat Ahadzadeh, Shin Ling Wu

Makara Journal of Health Research

Background: Perfectionism is increasingly prevalent among young adults and is a significant predictor of pathological and behavioral outcomes. Despite its relevance, validated and reliable measures of perfectionism tailored to university students, particularly within the Malaysian cultural and academic context, are lacking. This study addresses this gap by examining the psychometric properties of the BTPS-SF among Chinese students at a private university in Malaysia.

Methods: Data were collected using a cross-sectional design with convenience and snowball sampling from 380 students aged 18–25 years, predominantly from a Chinese student population.

Results: The results of the exploratory factor analysis, conducted …

Identifying Delays Impacting Maternal And Perinatal Deaths Using A Facility-Based Death Audit Review System Integrated With Community Engagement: A Mixed Methods Study, Zahid Memon, Wardah Ahmed, Shah Muhammad, Sajid Soofi, Shanti Chouhan, Arjumad Rizvi, Paul Barach, Zulfiqar A. Bhutta

College of Population Health Faculty Papers

BACKGROUND: Pakistan's persistently high maternal (178 per 100 000 livebirths) and neonatal (41 per 1000 livebirths) mortality ratios are compounded by lack of reliable data on the root causes and preventable risk factors, which hinders their effective use in improving care and progress toward safe, high-quality services. We sought to identify system delays impacting maternal and perinatal deaths using a facility-based death audit review system integrated with community engagement for implementing actionable solutions.

METHODS: We used a mixed methods, concurrent parallel study design at three secondary level healthcare facilities in District Matiari, Sindh, Pakistan. We reviewed 319 cases that included …

Beyond The Numbers: Supporting Young Adults With Diabetes In The Transition To Adulthood, Alexis Salkovick

Honors Projects

This project focuses on the transition to adulthood for young people with diabetes, a chronic medical condition. Both Type 1 and Type 2 diabetes are included. The main research focus is two-part: first examining this transition including barriers to health care, changes in lifestyle, and mental health, and then creating a new, innovative tool to support young adults with diabetes. An independent literature review was conducted to investigate diabetes management, barriers to health care, how transitioning to adulthood impacts diabetes care, and the importance of patient support systems. Then, a board game was developed with the dual purpose of educating …

An Ot Educational Program For Individuals With Upper And Lower Limb Amputations, Laurie R. Spinks Mrs, Cassandra Nelson

Spring 2026 OTD Capstone Symposium

An OT approach to reducing prosthetic abandonment with an accessible guide to promote self sufficiency and community connections for individuals with amputations.

Occupational Therapy For Maternal Pelvic Floor And Mental Health: A Holistic Approach To Recovery, Diana S. Theodore

Student Capstone Papers

Maternal pelvic floor dysfunction (PFD) is highly prevalent yet often underrecognized in occupational therapy practice, despite its significant impact on mental health, daily function, and quality of life. Many postpartum women experience symptoms such as urinary incontinence, pain with intimacy, and pelvic organ prolapse, which are frequently normalized or left untreated. Occupational therapy practitioners often have limited training in addressing the complex relationship between pelvic floor function and maternal mental health, contributing to gaps in care. The purpose of this capstone project was to develop a comprehensive handbook for occupational therapy students and practitioners integrating pelvic floor function and maternal …

Community-Based Program To Support The Occupational Needs Of Middle Eastern Refugee Women Transitioning Into Western Society, Zuha A. Mohammad, Cassandra Nelson

Spring 2026 OTD Capstone Symposium

Middle Eastern refugee women resettling in Western societies often experience barriers that disrupt participation in meaningful occupations, including language barriers, unfamiliar systems, financial challenges, and social isolation. These challenges can limit independence and community participation during the resettlement process. Occupational therapy is well-positioned to address these barriers through culturally responsive, occupation-based interventions.

This capstone project developed and implemented a community-based program designed to support Middle Eastern refugee women during early resettlement. The program focused on key areas including system navigation, financial literacy, home safety, stress management, self-advocacy, and community engagement. Educational sessions and practical activities were used to promote skill …

From Data To Action: Enhancing Public Health Communication & Information Dissemination, Ryan Hayden, Devon Donovan

Health Sciences Student Scholarship

No abstract provided.

Using Geospatial Environmental And Income Variables As Predictors Of Diabetes In Appalachia, John Kunicki Huth

Walden Dissertations and Doctoral Studies

Diabetes remains disproportionately prevalent in Appalachia, and macroenvironmental contributors remain poorly understood. Guided by spatial epidemiology, this quantitative, cross-sectional ecological study examined whether county-level environmental factors including distance to mine, distance to landfill, distance to water, mean annual precipitation, mean annual temperature, forest classification, distance to impervious surface, and median income were independently and collectively associated with diabetes cases per capita in West Virginia, used as a surrogate for Appalachia. Research questions addressed environmental predictors of diabetes cases per capita with and without controlling for median income. Publicly available county-level data from 53 West Virginia counties representing adults aged 20 …

Cervical Cancer Screening Among Women Across The United States, Srivathsan Vijaya Raghavan

Walden Dissertations and Doctoral Studies

While cervical cancer is not among the most frequently diagnosed cancers in the United States, it remains a significant concern due to its preventability through regular Pap smears and Human Papillomavirus (HPV) vaccination. However, incidence rates are rising as screening participation among U.S. women declines. This quantitative study (N = 15714) explored cervical cancer screening behaviors by analyzing levels of community involvement and social functioning, guided by the socioecological model (SEM). The dependent variable was cervical cancer screening, while the independent variables were community involvement and social functioning. The study controlled for health insurance status, age, race, ethnicity, employment, education, …

Evaluating An Lgbtq+ Adolescent Sexual Health Toolkit: Boosting Confidence And Provider Knowledge, Joslyn Lypka

Doctoral Dissertations & Projects

When leveraged correctly, sexual health education empowers youth to build resilience, deepen self-understanding, and confidently navigate gender and sexual identities. However, many school-based programs emphasize cisgender and heterosexual norms, leaving LGBTQ+ adolescents with limited access to inclusive and affirming sexual health information. This project aimed to develop and evaluate an online sexual health education toolkit designed to increase knowledge and support self-advocacy among LGBTQ+ adolescents, parents/caregivers, and healthcare providers. In collaboration with a Midwest nonprofit organization serving sexual and gender-diverse individuals, an online toolkit was developed and evaluated using two sequential Plan–Do–Study–Act (PDSA) cycles. During the first cycle, subject matter …

From Tradition To Transition: Evaluating Culinary Medicine As A Tool For Metabolic Health Among Nigerian Immigrants In The United States And The United Kingdom, Simi Oduwole M.S.

Department of Nutrition Student Projects

This scoping review examines existing publications to evaluate whether Culinary Medicine can be used as a tool for metabolic health among Nigerian immigrants in the United States and the United Kingdom. Nigeria is one of the fastest-growing populations globally, with increasing migration to high-income countries such as the United States and the United Kingdom. Evidence suggests that Nigerian immigrants experience a rise in diet-related chronic diseases, including obesity, diabetes, and cardiovascular disease, as duration of residence increases. This phenomenon is often attributed to dietary acculturation and shifts toward Westernized eating patterns. This scoping review evaluates whether culinary medicine can mitigate …

Rural Community Perspectives On Hurricane Helene In Western North Carolina, Jennifer A. Horney, Lilly Moreau, Search Wnc

Journal of Appalachian Health

Introduction: After making landfall on the Florida Gulf Coast in September 2024, Hurricane Helene impacted Western North Carolina (WNC) with historic flooding, landslides, and hurricane-force winds. More than 100 deaths in the region were attributed to the storm’s direct impacts.

Purpose: The purpose of this study was to assess community perspectives of long-term recovery in Mitchell and Yancey Counties, two rural WNC counties severely impacted by Hurricane Helene.

Methods: A 14-question interview guide was developed based on prior disaster research and the community engagement work of Sustaining Essential and Rural Community Healthcare (SEARCH). Questions covered post-Helene experiences related to access …

Exploring Systemic Challenges In The Western North Carolina Dental Safety Net: A Qualitative Analysis, Blaire Mirmow, Bill Milner, Nadia Laniado

Journal of Appalachian Health

Introduction: Despite statewide growth, rural communities in Western North Carolina (WNC) face persistent barriers to oral health care driven by chronic dental workforce shortages and systemic geographic disparities. Within this Appalachian region, the dental safety net serves as a vital yet strained support system, struggling with limited financial resources and a lack of provider participation that leaves many underserved populations without essential oral health services.

Purpose: This study aims to explore the experiences of individuals working within the WNC dental safety net to identify barriers and strategies required to strengthen the delivery of oral health care in high-need rural settings. …

The Effects Of Hurricane Helene On Mental Health And Physical Activity, Hunter Smathers, Robyn York, Jarrett Walbolt

Journal of Appalachian Health

Introduction: Hurricane Helene brought widespread damage to Southern Appalachia, disrupting utilities, health care, and recreation. While natural disasters are linked to declines in mental and physical health, few studies have examined their effects on distinct types of physical activity (PA).

Purpose: This study evaluated the effects of Hurricane Helene on perceived stress, depressive symptoms, post-traumatic stress disorder (PTSD) symptomology, and intentional (exercise for health benefits) and incidental (physical labor or transportation) PA. Evacuation status influence was also explored.

Methods: Twenty participants completed assessments four weeks before (BASE), immediately after (0POST), and four weeks after landfall (4POST). Measures included the Perceived …

Assessing The Aesthetic Responsiveness Among Patients In A Free Clinic Setting, Jack E. Pitts

Student Scholar Showcase

Art therapy has increasingly been recognized as a complementary intervention in healthcare settings, with demonstrated benefits for stress reduction and overall biopsychosocial well-being. However, limited research has explored aesthetic engagement within medically underserved and economically disadvantaged populations. This study examines aesthetic responsiveness among patients receiving care at the Free Clinic of Central Virginia using a standardized Aesthetic Responsiveness Assessment. The assessment consists of 14 Likert-scale questions assessing individuals’ cumulative aptitude across three domains: aesthetic appreciation, intense aesthetic experience, and creative behavior. Responses and data were collected voluntarily and anonymously, and they were analyzed to better understand how patients in an …

Experiences Of Maternal Care In The Gypsy, Roma, And Traveller Population In The United Kingdom: A Cultural Care Model, Sarah Englebert Crowson

Walden Dissertations and Doctoral Studies

Gypsy, Roma, and Traveller women (GRT) in the United Kingdom face persistent maternal health disparities and show poor engagement with healthcare services. Exclusion, discrimination, and a lack of cultural competence from healthcare professionals contribute to poor health outcomes including preterm births; and GRT women have more babies born with congenital anomalies than non-GRT women in the United Kingdom. The purpose of this focused ethnographic qualitative study was to explore how self-identified GRT women living in the United Kingdom experienced maternal care and how cultural identity and social structures influenced their interactions with healthcare providers based on Madeleine Leininger’s cultural care …

A Scoping Review Of The Objective Structured Assessment Of Technical Surgical Skills (Osats), David J. O'Regan, Christopher Caddy, Retnagowri Rajandram, Paul Barach

College of Population Health Faculty Papers

BACKGROUND: Objective structured assessment of technical skills (OSATS) offers an objective tool for assessing bowel anastomosis on a benchtop. It was developed in 1997 to set appropriate standards and expectations for the surgical trainee. OSATS have become the gold standard of assessment across many disciplines. A global Likert rating scale, including respect for tissues, instrument handling, economy of movement, and flow of the operation predominates the literature. This has led to many questioning OSATS objectivity, claiming the process to be time-consuming, subjective, demanding human resources, and requiring extensive training of the trainer. We believe OSATS scoring has omitted the 22-point …

Views, Knowledge, And Implications Of Abortion Law In Texas Obgyn Residencies, Jessica Harper, Sharon Barazani, Kate Mowry, Melissa Mendez

Central & West Texas and San Antonio GME Research Day 2026

No abstract provided.

Coverage, Traits, And Geographic Distribution Of Online Surgeon Reviews: Large-Scale Cross-Sectional Analysis, Michael Geng, Carlos Riveros, Yash B. Shah, Sanjana Ranganathan, Kai Fok, Renil Sinu Titus, Vatsala Mundra, Eusebio Luna Velasquez, Dharam Kaushik, Allan S. Detsky, Angela Jerath, Benjamin N. Breyer, Yusuke Tsugawa, Christopher J. D. Wallis, Raj Satkunasivam

Student Papers, Posters & Projects

BACKGROUND: The use of online physician rating platforms has significantly increased and has been shown to influence physician selection. There are limited data on the use of these platforms for rating surgeons.

OBJECTIVE: In this study, we sought to assess the geographic distribution of and patterns in rating scores of surgeons in the United States. Additionally, we examined rating volumes across different surgical specialties and the association between peer-nominated and patient-initiated ratings on online rating platforms in the United States.

METHODS: We conducted a cross-sectional study by identifying 201,154 surgeons in the United States via the National Plan and Provider …

Assessing Current Telehealth Mobile Applications In The United States: Accessibility, Privacy, And Care Delivery, Rosemary K. Frugé

Honors Theses

Telehealth has improved patient access by reducing barriers to convenient, cost-effective, and quality health care. Telehealth mobile applications allow individuals to remotely access services through smartphone-based platforms. The purpose of this study was to evaluate leading telehealth applications available in the United States, analyzing key factors that influence platform selection, including cost, prescribing and diagnostic capabilities, user feedback, and data privacy practices. Applications were identified through keyword-based searches of major app stores using the term “telehealth,” and each app was systematically evaluated using predefined criteria. Findings highlight variability across platforms in pricing transparency, service offerings, and privacy disclosures, despite generally …

Health Data And Policy Related To Methamphetamine-Use Suicide In Mississippi, Mary C. Drane

Honors Theses

The purpose of this research is to investigate how methamphetamine use in Mississippi, especially in its rural areas, intersects with public health, policy, and suicide outcomes in the state. Mississippi's methamphetamine crisis has evolved significantly, shifting from locally produced drugs to cartel-supplied crystal methamphetamine, while state and federal policies have struggled to keep pace with the scale and complexity of the problem. Using a convergent parallel mixed-methods design, this research analyzed CDC Wonder multiple causes of death data and SAMHSA Treatment Episode Data Set Admissions (TEDS-A) data from 2018 to 2024 alongside four qualitative key informant interviews with stakeholders across …

Digital Touchpoints: Investigating Contact Page Accessibility And Visual Authenticity Within Medical Tourism Health Websites, Alicia Mason, Elizabeth Spencer, Kristen Livingston, Treyton Meyers, Sakshi Bhati, Himika Akram

Faculty Submissions

This study examines two critical digital touchpoints on medical tourism provider (MTP) websites: (1) the accessibility of contact pages which often function as entry points for inquiries, scheduling, and pre-travel coordination, and (2) the authenticity of visual imagery used to shape expectations about care environments, personnel, and technological capacity. A sample of 105 MTPs across all six World Health Organization regions were analyzed using quantitative web accessibility testing and qualitative visual analysis. Results indicate pervasive accessibility errors on contact-page touchpoints and extensive reliance on inauthentic imagery to depict patients, providers, and medical technologies. Together, these practices may distort user expectations …

Health Insurance Literacy Among College Students At The University Of South Carolina, Emma J. Smith, Lorie Donelle Phd, Rn, Fcan, Robin Dawson

Caroliniana Undergraduate Research Journal

Purpose: This study aims to investigate the health insurance literacy skills of graduate college students and undergraduate college students.

Methods: A cross-sectional research design incorporated a 20-item questionnaire to examine college students’ knowledge of common health insurance terms and definitions, as well as their perceived understanding of health insurance. Descriptive analyses were conducted of participant demographics, health insurance literacy scores were summarized, and common health insurance policies were tested through a readability checker.

Results: The majority of students were between the ages of 18-25 and undergraduate students. More than half of the participants were female, and more …

Bio-Cybersecurity: Securing The Healthcare Industry, Amanda D. Coleman

Cybersecurity Undergraduate Research Showcase

Bio-cybersecurity refers to the aspect of cybersecurity that applies to the biological sciences and the protection of digital biomedical information. Today’s healthcare industry has evolved with the enhancement of internet and biomedical technology. While hospitals and private medical providers remain compliant with the Health Information Portability and Accountability Act (HIPAA) through traditional means of securing documented patient information, the emergence of beneficial internet-based healthcare services like virtual appointments and digital patient records requires new policies and healthcare cybersecurity frameworks to protect sensitive information from unauthorized access. This paper examines the role of cybersecurity in healthcare, the vulnerabilities that exist and …

Maladaptive Influences Of Direct-To-Consumer Pharmaceutical Advertising: The Moderating Influence Of Age And Consumer Loneliness, Sanjay Puligadda

Atlantic Marketing Association Proceedings

No abstract provided.

Connectivity, Classroom, And Contagion: An Ecological Analysis Of Testing Availability, Sex Education, And Sti Rates In The Upper Midwest, Macey M. Boerhave

Honors Thesis

Rural and frontier communities in the Upper Midwest face unique challenges that shape how young people access sexual health information and testing. While sexually transmitted infection (STI) rates continue to rise nationally, less is known about how sexual health education, digital access, and geographic distance influence these trends at a county level. This study examines the relationship between broadband internet access rates, poverty rates, proximity to free or low-cost STI testing sites, and county-level STI rates among individuals aged 15-24 in selected counties across South Dakota, North Dakota, Minnesota, Iowa, and Nebraska. Using an ecological, cross-sectional design, county-level STI surveillance …

The Role Of Intravascular Ultrasound Imaging In 30-Day Readmissions Among Acute St-Elevation Myocardial Infarction Patients, Britta Watson

MUSC Theses and Dissertations

Cardiovascular disease (CVD) remains one of the leading causes of death in the United States. Coronary artery disease (CAD) is the largest contributor to deaths that result from cardiovascular disease. When CAD is left untreated, it can result in an acute ST elevation myocardial infarction (STEMI). To treat coronary blockages caused by CAD, a percutaneous coronary intervention (PCI) is performed. A PCI is a non-invasive procedure that uses coronary balloons and stents to open a narrowed or blocked coronary artery and restore blood flow.

An acute ST elevation myocardial infarction (STEMI) is a major cause of early hospital readmissions. Technological …

Association Between Childhood Exposure To Family Substance Abuse, Mental Health Issues, And Cervical Screening Among Women Ages 18-65 In South Carolina, Ashley Laine Hamm

Walden Dissertations and Doctoral Studies

Adverse childhood experiences (ACEs) have been associated with adverse health outcomes in adulthood; however, less is known about their relationship with preventive health behaviors such as cervical cancer screening. The purpose of this quantitative, correlational study was to examine associations between selected ACEs and cervical cancer screening among women aged 18–65 in South Carolina. Data were drawn from the 2020 South Carolina Behavioral Risk Factor Surveillance System (BRFSS) and included 1,323 women. Binary logistic regression analyses were used to examine unadjusted and adjusted associations between ACE exposures and being up to date with Pap testing, controlling for age, race/ethnicity, income, …