Digital Commons Network^™

Knowledgable Births: Advancing Informed Consent In Maternal Healthcare, Ella A. Forrester

Senior Theses

Background:

Informed consent is both a legal requirement and an ethical cornerstone of healthcare, ensuring that patients understand and voluntarily agree to medical treatments. However, evidence suggests that the informed consent process is often inadequately implemented in maternal healthcare settings, particularly during childbirth. While giving birth, women retain full decision-making capacity but are not consistently provided with sufficient information or support to exercise this right. Contributing factors include ineffective patient–provider communication, limited health literacy, and insufficient access to culturally responsive educational resources.

Methods:

This study aimed to address gaps in accessible prenatal education by developing an online resource platform, Know …

Advancing The Understanding Of Palliative Care In Singapore: Knowledge, Attitudes, Receptiveness, And The Moderating Role Of Media Information-Seeking Preferences, Su Lin Yeo, Angel Lee, Raymond Han Lip Ng, May O. Lwin, Yumin Lin

Research Collection Lee Kong Chian School Of Business

Introduction: Despite the growing demand for palliative care, this specialized medical care remains severely underutilized, with almost 50% of countries worldwide lacking access. Given that misperceptions and stigma continue to hinder progress in healthcare policy, this study aims to examine the relationships between palliative care knowledge, attitudes, and receptiveness to better understand how public health communication can enhance awareness and understanding of the topic in Singapore. Applying the adapted knowledge-attitude-practice (KAP) model, it further extends theory by examining the moderating role of media information-seeking between knowledge and receptiveness.Methods: Mixed-mode surveys involving 1,226 participants (926 online and 300 in-person respondents), representing …

Length And Framing Of Anti-Junk Food Ads Impact Inclinations To Consume Junk Food Among Normal Weight, Overweight, And Adults With Obesity, Ross C. Hollett, Brennen Mills, Stephanie L. Godrich, Julia Butt, Gina S.A. Trapp

Research outputs 2022 to 2026

Background: Unrestricted junk food advertising increases the risk of short-term junk food consumption among viewers. We aimed to estimate the impact of junk food and anti-junk food advertisements differing in length and framing on junk food consumption inclinations. Methods: Adult participants (N = 505) were exposed to a randomly selected junk food advertisement or anti-junk food advertisement and reported their immediate craving and consumption intentions. These responses were separately analysed for two groups based on Body Mass Index (BMI): participants classified as within the normal range (18.5–25), and a combined group with BMI values indicating either overweight (25+) or obesity …

Setting Research Priorities For The Use Of Digital Technology In The Self-Management Of Heart Health: The Results Of The James Lind Priority Setting Partnership, Lis Neubeck, Simon Nichols, Nicola Straiton, Louise J. Dunford, Amitava Banerjee, Susan Dawkes, Donna Fitzsimons, Maria Hayes, Alistair Lawson, Abigail A. Lyons, Mary Mcauley, Jill Mclaggan, Richard Mindham, Nicholas L. Mills, Rakesh Modi, Alice Pearsons, Amanda Pitkethly, Fiona E. Strachan, Coral L. Hanson

Research outputs 2022 to 2026

Aims: There are wide inequalities in access to cardiovascular care, and risk factors such as obesity, high blood pressure, and physical inactivity are often not well managed. We aim to identify the most important questions about how digital technologies can help people and their carers prevent cardiovascular disease and improve access to care. Methods and results: A priority setting partnership that aimed to generate a top 10 list of research priorities for the use of digital technology in the prevention and management of heart disease and heart conditions in the UK and Ireland, with equal input by people with lived …

Using Social Network Analysis To Visualise Place-Based Partnerships For Systems Change In Regional Australia, Stephanie L. Godrich, Isabelle Chiera, Melissa Stoneham, Jess Doe, Amanda Devine, Emily Humphreys

Research outputs 2022 to 2026

Issue Addressed: Social network analysis (SNA) is a novel approach to investigating food security systems change in regional and remote communities. With short-term, siloed food security solutions often proving ineffective, this study used SNA to visualise how organisations across a vast area in Western Australia (WA) were working in partnership to support systems change and identify where these partnerships could be strengthened. Methods: One hundred and one food security initiative leaders, representing 148 initiatives, participated in semi-structured interviews. The number and type of regional partnerships were measured, and region-based partnership network typologies determined. Results: Most regions’ partnership networks were ‘Scattered …

Preoperative Health During A Pandemic: An Observational Study Assessing Lifestyle Changes In Patients Associated With Covid-19 In Western Australia, Nadine Radin, Dana Hince, Jim Codde, Paola Chivers, Dale W. Edgar

Research outputs 2022 to 2026

Background and Aim: Healthcare service disruptions resulting from the COVID-19 pandemic led to substantial changes in surgical pathways across public hospitals in Western Australia (WA). These disruptions, compounded by restrictions and containment measures, influenced the health and lifestyle behaviours of the WA community, including patients awaiting surgery. This study aimed to assess changes in self-reported modifiable lifestyle risk factors among patients during COVID-19. Methods: This observational study analysed hospital patient data across three seasonally matched calendar periods: Period 1 (January–March 2019 vs 2020), Period 2 (March–July 2019 vs 2020), and Period 3 (July–December 2019 vs 2020). Multivariable regression models were …

Confessions In Cases Of Child Physical Abuse-A Capnet Study, Margaret R Russell, Antoinette L Laskey, Henry T Puls, Suzanne P Starling, Joanne N Wood, Daniel M Lindberg, Nancy S Harper, Caitlin R Mcnamara, Angela N Bachim, Farah W Brink, Lori D Frasier, James D Anderst, Porcia Vaughn, Kristine A Campbell

Faculty, Staff and Students Publications

Objective: Prior research on confessions of physical abuse (PA) has explored mechanisms of injury. Little is known about conditions supporting a confession of abuse or how confessions may influence case outcomes.

Methods: This cross-sectional study of suspected PA in children aged < 10 years at 10 centers participating in CAPNET, a multicenter child PA research network, included children with in-person Child Abuse Pediatrics (CAP) consultations between February 2021 and December 2022 and excluded children without injury. Our focus was a confession of inflicted injury known to the CAP during clinical involvement. We compared child and clinical characteristics, out-of-home (OOH) placements, and arrests between cases with and without confessions. Multivariable models using generalized estimating equations (GEE) produced adjusted predicted probabilities (APP) clustering by CAPNET site.

Results: Confessions were known to CAPs in 115/4297 (2.7%) cases, with significant site variability. In a multivariable GEE model, confessions were more likely in cases with injuries with high specificity for abuse (APP 6.0% vs 1.6%, P < .001), near-fatality (APP 5.6% vs 2.3%, P < .001), and older children (APP 4.8% vs 2.5%, P = .025). OOH placements and arrests were more common in cases with confessions. CAP awareness of confessions, OOH placements, and arrests did not follow racial or ethnic patterns seen in the US child welfare system. Lower socioeconomic status was associated with OOH placements and arrests but not with CAP awareness of confessions.

Conclusions: Our findings highlight differences in case characteristics and outcomes where a confession is known to the CAP and raise questions about …

Yield Of Injury Testing For Contacts Of Children Evaluated For Physical Abuse, Lígia Batista, Joanne N Wood, Tagrid M Ruiz-Maldonado, M Katherine Henry, Jan Leonard, Angela Bachim, James D Anderst, Farah W Brink, Hannah B Sahud, Lori D Frasier, Nancy S Harper, Natalie Laub, Colleen J Bressler, Daniel M Lindberg

Faculty, Staff and Students Publications

Background: Siblings and household contacts of physically abused children are at increased risk for physical abuse and may have injuries that are not clinically apparent. However, injury testing recommendations for contact children remain debated.

Objective: Our objective was to describe testing practices and yield for contacts of physically abused children.

Participants and settings: This is a cross-sectional study of children < 10 years old evaluated for physical abuse at 10 US pediatric referral centers in the CAPNET research network.

Methods: We report the proportion of contact children who had a skeletal survey (SS) or neuroimaging and describe the proportion of tests that identified injuries.

Results: Among 6256 index evaluations, 4863 contacts were identified. Among 794 contacts with physical examinations, …

Lessons Learned From The Implementation Of A Pragmatic Trial Evaluating Non-Pharmacological Approaches To Dementia Care In Us Nursing Homes, Carin Wong, Catherine V. Piersol, Felicia Chew, Cara Lekovitch, Victoria Shier, Mike Morris, Jenny Martínez, Julie Britton, Natalie E. Leland

Department of Occupational Therapy Faculty Papers

RATIONALE: The consistent delivery of effective evidence into nursing home practice has been shown to enhance quality of care and residents' outcomes. Pragmatic trials enable the evaluation of efficacious interventions in a real-world context, including care of residents living with Alzheimer's Disease and Related Dementias (ADRD). Yet, there are limited pragmatic trials conducted in nursing homes and even less evidence on the strategies to successfully conduct such research in this setting.

OBJECTIVE: To identify the lessons learned from a pragmatic trial and provide recommendations for future successful studies in United States (US) nursing homes.

METHODS: Drawing on a case example …

Telemedicine Kiosks: Can Technology Solve Rural Mississippi's Healthcare Crisis?, Babu George, Martha Ravola

Journal of Public Health in the Deep South

Background: Mississippi’s rural counties face hospital gaps, clinician shortages, and limited broadband/device access that collectively delay care and constrain telehealth uptake.

Purpose: This paper assesses whether telemedicine kiosks can improve rural healthcare access in Mississippi while also supporting viable local entrepreneurship and community development.

Methods: A conceptual, policy-and-market analysis integrated narrative literature synthesis, secondary data and policy review, and 5-year financial modeling under two cost-allocation scenarios: an Operator Model (subscription fees covered by partners/grants) and a Network Model (subscription fees borne by the kiosk operator).

Results: Kiosks with embedded connectivity and diagnostic peripherals can deliver device-independent virtual care and directly …

Promoting A Culture Of Academic Integrity In The Context Of Artificial Intelligence: Lessons From One School Of Public Health In The Southeast, Gregory Pavela, Lindsay C. Aycock, Mercy Aula, Angela Sullivan, Matthew Fifolt

Journal of Public Health in the Deep South

No abstract provided.

Aircraft Wastewater Surveillance As A Tool For Monitoring Disease In The Pacific, Carla J. Eaton, Joanne R. Chapman, Brent J. Gilpin

Pacific Journal of Health

Wastewater surveillance is a powerful tool for monitoring infectious diseases within a population. However, as most wastewater surveillance relies on interconnected wastewater networks to provide samples representative of the population, many Pacific Islands have been excluded from benefiting from this tool due to their lack of reticulated sewerage systems. Many diseases of concern for the Pacific are detectable in wastewater even though individuals may be asymptomatic. We investigated whether analysis of wastewater from aircraft arriving in New Zealand from Pacific Island nations could be used as a proxy for in-country surveillance. Flights from the Pacific arrive in Auckland daily, with …

Determinants Of Stunting Among Under-Five Children (0–59 Months) In Central Sulawesi Province, Marchell Bamba, Mondastri Korib Sudaryo, Ratna Djuwita, Helwiah Umniyati

Jurnal Epidemiologi Kesehatan Indonesia

Stunting is caused by chronic malnutrition which can be caused by various factors including poverty, poor nutritional intake and maternal health, and inappropriate infant feeding. This study was conducted to determine what factors cause stunting in Central Sulawesi Province. This study was conducted using a cross-sectional observational analysis method using secondary data from the Survei Kesehatan Indonesia (SKI) 2023. The analysis was carried out using logistic regression. The sample used was 2179 respondents. The dependent variable is stunting while the independent variables are age, gender, area of residence, gestational age, provision of PMT, exclusive breastfeeding, maternal occupation, maternal education, and …

The Relationship Between Smartphone Screen Time Duration And Individual Chronotype: A Systematic Literature Review, Diego Sergio Giasia Lumbantobing, Thalia Altamilano Pramudya

Jurnal Epidemiologi Kesehatan Indonesia

The rapid increase in smartphone use over the past decade led to prolonged screen time across age groups, particularly during nighttime hours. Exposure to artificial light and pre-sleep digital activities was associated with circadian rhythm disruption and alterations in individual chronotype. This systematic literature review aimed to synthesize empirical evidence on the relationship between smartphone screen time duration and individual chronotype across all age groups and to identify key moderating factors influencing this association. The review was conducted in accordance with PRISMA 2020 guidelines. Literature searches were performed in PubMed, Scopus, and ScienceDirect for studies published between 2015 and 2025. …

Examining Predictors For Surgical Site Infection Following Abdominal Hysterectomy Among Women In New York, Nicole Henry

Walden Dissertations and Doctoral Studies

Surgical site infections (SSIs) remain one of the most frequent and preventable complications following abdominal hysterectomy. Existing literature has focused on clinical and procedural risk factors, while less is known about how social conditions shape surgical outcomes. This gap is especially concerning for women in New York State (NYS) where differences in income, marital status, primary payer, rurality, and county-level food insecurity may influence postoperative outcomes and subsequent care. The socioecological model provided the foundation for this retrospective cohort study by examining how social drivers of health (SDoH) are associated with SSI incidence following abdominal hysterectomy, and whether food insecurity …

U.S. Pharmacists’ Perceptions Of Getting The Covid-19 Vaccine And How That Affects Their Interactions With The Public, Megan Boals

Walden Dissertations and Doctoral Studies

Pharmacists play a pivotal role in public health, particularly in promoting vaccination. However, vaccine hesitancy among pharmacists significantly undermines their willingness to provide effective patient counseling and to advocate for vaccination, potentially eroding public trust in vaccines. This descriptive-phenomenological study sought to understand the factors contributing to pharmacists’ COVID-19 vaccine hesitancy and how this hesitancy affected their willingness to recommend vaccines to patients. Twenty practicing pharmacists were interviewed via Zoom between September 23 and October 14, 2025. The health belief model helped interpret the study findings. Thematic analysis, as described by Braun and Clarke, was conducted to identify and interpret …

The Blurred Boundaries Of Care: A Qualitative Analysis Of Nurse-Doula Role Conflict, Curisa Mae Tucker Phd, Rn, Maria Mcclam, Kelly Russin Dnp, Rnc-Ob, Chse, Nansi Boghossian, Rachel Gulczinski, Lauren Workman

Faculty Publications

Introduction:

Methods:

Patterns Of Multimorbidity Among Low-Income Adults Who Smoke With Implications For Tailored Interventions: A Cluster Analysis Using A Mixture Of Bernoulli Model, Monique T. Cano, Michael R. Lindstrom, Oscar F. Rojas Perez, Ricardo F. Muñoz

School of Mathematical & Statistical Sciences Faculty Publications

Introduction: Smoking cigarettes remains a leading modifiable risk factor for preventable health conditions. In the United States, the health burden of smoking disproportionately impacts low-income individuals. Multimorbidity is common in this group, complicating treatment and worsening outcomes. Identifying multimorbidity clusters can support targeted, individualized interventions. This study aimed to identify multimorbidity clusters among individuals who smoke and experience economic hardship and provide clinical recommendations to enhance health outcomes.

Method: Individuals who smoke and experience economic hardship (N = 60) were recruited from the San Francisco Health Network (SFHN) and were assessed for physical and mental conditions. Cluster analysis was …

Associations Between Caregiver-Provider Communication Quality And Unmet Care Needs Among Older Adults, Jiaming Liang, Rafael Samper-Ternent, Brian Downer, Zhigang Xie

Faculty, Staff and Student Publications

BACKGROUND: Unmet care needs (lack of assistance with daily activities) among older adults are common and linked to adverse health outcomes, greater healthcare utilization, and caregiver burden. While effective patient-provider communication is known to improve care quality, less is understood about the role of caregiver-provider communication, particularly across sociodemographic, health, and caregiving contexts. METHODS: We conducted a cross-sectional secondary analysis of pooled 2021–2023 National Health and Aging Trends Study (NHATS) and National Study of Caregiving (NSOC) data, restricted to community-dwelling older adults (65 + years) who received assistance from caregivers due to difficulty with daily activities, and had at least …

A Livelihood Intervention Improved Nutritional, Mental Health And Sexual Health Outcomes Among Hiv-Affected Adolescents In Western Kenya: Results From The Shamba Maisha Randomised Controlled Trial, Sheri D. Weiser, Lila Aziz Sheira, Pauline Wekesa, Jennifer Monroe Zakaras, Edward A. Frongillo Jr. Ph.D., Elly Weke, Jason M. Nagata, Amy A. Conroy, Marguerita Lightfoot, Torsten B. Neilands, Lisa M. Butler, Elizabeth A. Bukusi, Craig R. Cohen, Maricianah Atieno Onono

Faculty Publications

Introduction Interventions that address household-level factors, including food insecurity (FI) and poverty, may reduce HIV risk and improve sexual and reproductive health (SRH) among adolescent girls and young women (AGYW).

Methods This cluster randomised controlled trial in Kenya assessed AGYW living in households of adults enrolled in Shamba Maisha (SM). SM was a multisectoral agricultural livelihood intervention designed to improve HIV health. At the trial end, we used linear and logistic regressions to compare differences between the intervention and control arms in FI, and mental health among AGYW-caregiver pairs and SRH outcomes among the AGYW, accounting for clusters with robust …

Socioeconomic Disparities In Readmission Outcomes And Cardiac Procedures Among Atrial Fibrillation Hospitalizations, Muhammad U. Almani, Muhammad Yousuf, Noor Fatima, Muhammad Q. Ullah, Muhammed Arshad

Einstein Health Papers

Introduction: Atrial fibrillation (AF) remains one of the leading dysrhythmias incurring hospitalization. We set out to determine the impact of socioeconomic status (SES) on in-hospital cardiac procedures and the readmission outcomes in patients with AF. Methods: The National Readmission Database (NRD) was searched for adults with a primary diagnosis of AF between 2010 and 2019. We determined unplanned AF-specific readmission within 30 days. Median neighborhood household income was assessed by patient zip code as quartiles: low income (Q1), middle income (Q2), upper-middle income (Q3), and high income (Q4). Differences in in-hospital cardiac procedures during the index hospitalization and probability of …

Transformational Leadership In Higher Education, Dr. Jewel Hale, Jr., Kristi Apostel

Tapestry: Journal of Research in Education

A crisis can highlight the critical need for resilient leadership within higher educational settings. Educational leaders encounter extraordinary difficulties, ranging from different learning options to prioritizing the well-being of both staff and students, necessitating flexible and innovative methods. By exploring how school leaders apply transformational techniques in actual educational environments, this article addresses the impact of the four I’s of transformational leadership, idealized influence, inspirational motivation, intellectual stimulation, and individualized consideration, on building educator resiliency, sustaining school effectiveness, and promoting student achievement in higher education.

Fierce Leadership-Perspectives Of Black Women Educational Leaders: A Transcendental Phenomenological Study, Janice Taylor, Dianne Reed

Tapestry: Journal of Research in Education

The authors of this transcendental phenomenological study aimed to describe the lived experiences of Black women based on their perceptions, values, and beliefs about the complexities of leadership and the kind of leadership required to succeed in their respective roles, as educational leaders. This study was framed by the adaptive leadership theory. Adaptive leadership recognizes the need for leaders to stay flexible and resilient in fast-paced environments (Nelson & Squires, 2017). The three Black women leaders in this study were fierce adaptive leaders. The information acquired from this study is significant and highlights how Black women educational leaders developed the …

Engagement Patterns With #Naturalremedies On Tiktok: Formative Analysis, Apeksha Mewani, Corey H. Basch, Keanu Renne-Glover, Vincent Jones Ii, Cristiana Cordero, Adea Gutiqi

Publications and Research

This research letter provides formative evidence from a cross-sectional analysis of 118 TikTok videos under #NaturalRemedies, identifying content formats and expertise cues associated with higher engagement, while also demonstrating the feasibility of using engagement metrics and thematic coding to analyze health narratives on emerging platforms such as TikTok.

Bacteriophage Therapy For Antibiotic-Resistant Infections, Shiva Pariyar

Best Integrated Writing

Pariyar examines bacteriophage therapy as a promising alternative to antibiotics for treating multidrug-resistant infections, highlighting its targeted mechanism, ability to disrupt biofilms, and synergy with antibiotics. While challenges such as regulation, immune response, and limited clinical trials remain, the study argues that advances in biotechnology and global collaboration position phage therapy as a future cornerstone in combating antimicrobial resistance.

Food Insecurity’S Influence On Obesity, Hypertension, And Diabetes In Rural Vermont And Adirondack New York, Lindsay Morse

Walden Dissertations and Doctoral Studies

Food insecurity (FI) is a persistent public health challenge in the United States and disproportionately affects rural communities. Guided by syndemic theory, this quantitative cross-sectional study examined associations between FI and chronic disease outcomes among rural residents of Vermont and the Adirondack region of New York. Social determinants of health screenings and electronic medical records from 35 rural primary care sites were analyzed. Secondary data from n = 72,505 adults were used to evaluate these relationships. Binary logistic regression models assessed obesity, hypertension (HTN), and diabetes (DM), and a multinomial logistic regression model evaluated the combined presence of obesity and …

Development And Validation Of The Emergency Department Transitions Measure, Sara Beachy, Danielle M. Mccarthy, Julianna Lenoir, Alexzandra Gentsch, Richard W. Hass, Marissa Witmer, Paula Ostroff, Melissa Tupas, Lindsey Shughart, Hailey Shughart, Kristin L. Rising

Jefferson Center for Connected Care Faculty Papers

BACKGROUND: Transitions of care are high-risk periods for patient safety in the emergency department (ED), particularly for patients who are still in the diagnostic process and are discharged with diagnostic uncertainty. Care transitions must be improved for these patients, as one third of discharged ED patients have diagnostic uncertainty. Yet there are no validated measures that assess the quality of care transitions from the ED, limiting the ability to assess the impact of interventions. Thus, we developed and validated the ED Transitions (EDT) measure.

METHODS: This mixed methods study was conducted across a large healthcare system in three phases: item …

Sound, Speech, And Synapses: Rebuilding The Brain Through Neuroplasticity, Sireen Khader

The Cardinal Edge

No abstract provided.

Decision-Making At The Edges Of Capacity: Brain Science And Caregiving, Dr. Julie Yonker

University Faculty Publications and Creative Works

Keynote address at the Disabilities Resources Symposium at City Hope Church in Grand Rapids on 3/14/2026. Attached is her powerpoint.

• Describe why our brains don’t like decisions
• Understand the impact of different types of decisions
• Value suggestions for more sustained decision making
• Consider a faith perspective

Quality Of Prenatal Care, Provider Preference, And Preeclampsia Among African American Women In Georgia, Lyteasha Bass

Walden Dissertations and Doctoral Studies

African American women experience disproportionately high rates of preeclampsia in the United States; however, the contributions of prenatal care provider type, health care access, and quality of care to this disparity were insufficiently defined. Guided by the quality health outcomes model, this quantitative case-control study used primary data to examine associations between these factors and the occurrence of preeclampsia among African American women age 18–40 who had given birth within the previous 5 years in Georgia. Descriptive statistics and binary and multinomial logistic regression analyses were conducted. Prenatal care quality was measured using the Quality of Prenatal Care Questionnaire (QPCQ), …