Digital Commons Network^™

Provincial Disparities In Adolescent Fertility In Indonesia: An Ecological Analysis Of Child Marriage, Median Age At First Marriage, And Family Development Index, Andi Nisa Fathimiyah Afidah, Milla Herdayati

Kesmas

Adolescent fertility remains a public health concern in Indonesia, with substantial variations across provinces. However, the evidence explaining provincial disparities using population-level indicators remains limited. This study aimed to examine provincial disparities in adolescent fertility and assess the association of child marriage, median age at first marriage among women, and the Family Development Index called iBangga with adolescent fertility across Indonesia. This ecological, cross-sectional study used aggregated data from 34 Indonesian provinces. Descriptive statistics, spatial visualization, Pearson’s correlation, and multiple linear regression analyses were performed. The mean adolescent fertility rate was 25.0 births per 1,000 female adolescents aged 15–19 years, …

The Association Between Rapid Growth In Children Under The Age Of Five And Adolescent Obesity, Ratu Ayu Dewi Sartika, Fadila Wirawan, Iche Andriyani Liberty, Nurul Husna Mohd Shukri, Siti Arifah Pujonarti, Edy Purwanto, Munaya Fauziah

Kesmas

Early-life nutrition is a critical predictor of long-term health, yet the association between rapid early-childhood growth and adolescent obesity, particularly in relation to the “double burden of malnutrition,” remains under-researched in Indonesia. This study aimed to analyze the association between rapid growth and adolescent obesity. Data were obtained from the 1997, 2000, and 2014 waves of the Indonesian Family Life Survey (IFLS). This study included 641 children (aged 0–23 months at baseline) with complete anthropometric measurements across all three waves. Rapid growth was defined as an increase in z-scores of >0.67 in weight-for-age (WAZ), height-for-age (HAZ), or weight-for-height (WHZ) between …

Self-Management Interventions For Adults With Type 2 Diabetes Mellitus In Thai Primary Care And Community Settings: A Scoping Review, Sansanee Seetangkham, Supaluk Seetunya, Subhawan Yodprong

Kesmas

Diabetes mellitus is a leading cause of mortality and economic burden, with significant impacts on health outcomes and quality of life. Effective self-management is crucial for controlling Type 2 Diabetes Mellitus (T2DM). Thailand has implemented diverse self-management interventions for adults with T2DM in primary care and community settings, but the components, delivery, duration, and outcomes of these interventions have not been synthesized. Following the Arksey and O’Malley framework, Joanna Briggs Institute guidance, and PRISMA-ScR, five databases were searched from inception to June 2025. Eligible English-language intervention studies involved Thai adults with T2DM in primary care or community settings. Study characteristics …

Breaking The Cycle: From Victimization To Offending Through The Lens Of Human Services, Colette R. Penalosa

Master of Arts in Human Services

The victim-offender overlap challenges the common view that victims and offenders are separately labeled by recognizing that both groups have experienced significant childhood trauma, physical, emotional, and psychological abuse, neglect, and other adverse childhood experiences (ACEs). Current research implies these experiences can increase the risk of offending as they all influence cognitive and behavioral development while leaving criminal behavior undetermined. The purpose of this capstone is to analyze the relationship between childhood victimization and offending from a human service perspective; analyzing the pathways a victim takes on the road to offending. Research conducted will focus on exploring the victim-offender overlap, …

The Association Of Age, Race, And Gender And Novel Interventions In The Prevention Of Catheter-Associated Urinary Tract Infection, In Washington State, Lamin Darboe

Walden Dissertations and Doctoral Studies

Delayed removal of indwelling urinary catheters (IUCs) contributes to catheter-associated urinary tract infections, a leading healthcare-associated infection. A dot/smart-phrase communication tool, guided by the Health Belief Model construct of cues to action, to promote timely IUC removal interventions was evaluated in this quantitative, cross-sectional study. Secondary data from N = 372 adult patients with acute urinary retention in acute and critical care settings in Washington State were analyzed using SPSS Version 30. Binary logistic regression examined relationships among demographic variables, intervention-related factors (adherence within 48 hours, cosignature within 24 hours, and secure chat communication), and clinical outcomes (IUC removal and/or …

Countering Hpv Vaccine Misinformation On Social Media: Practical Strategies For Healthcare Providers, David Baldwin

Lynchburg Journal of Medical Science

Human papillomavirus (HPV) vaccination is a highly effective strategy for preventing cervical and other HPV-related cancers; however, vaccine hesitancy remains a significant barrier to optimal vaccination rates. Social media has become a major source of health information while simultaneously amplifying misinformation that influences parental attitudes toward HPV vaccination. This narrative literature review examined the relationship between social media misinformation and HPV vaccine hesitancy and identified evidence-based strategies healthcare providers can use to improve vaccine confidence.

A literature search of PubMed and Google Scholar identified 31 articles published between 2016 and 2025, of which 19 met inclusion criteria. The literature demonstrates …

Post-Pandemic Telebehavioral Health: Sustaining And Regulating Remote Mental Health Care As A Core Modality, Weiqiao Dong

Dartmouth College Master’s Theses

The United States continues to face a persistent mental health crisis after the COVID-19 pandemic, raising a policy question about the long-term role and regulation of telebehavioral health as a core modality of care. This thesis examines that question through a case study of New York State, an early center of the pandemic and a leader in telehealth policy reform.

Guided by the Health Policy Triangle framework, this thesis integrates longitudinal data from all 62 New York counties for 2010-2025 with a 2025 cross-sectional dataset covering 61 counties. Seventeen standardized indicators are organized into four dimensions: geographic, economic, demographic, and …

Defining Quality Of Life: The Lived Experience Of Adults With Pulmonary Hypertension And The Impact Of Activity-Induced Respiratory Distress, Bethany Jean Adams

Walden Dissertations and Doctoral Studies

Pulmonary hypertension (PH) is a progressive, life-limiting disease that significantly affects quality-of-life (QoL). Limited research has explored lived experiences of individuals with PH. Guided by Parse’s human becoming theory, this qualitative descriptive phenomenological study explored the lived experiences of individuals affected by PH and examined how activity-induced respiratory distress affected QoL. The research Question was: How do individuals with PH describe the impact of activity-induced respiratory distress on their QoL. I conducted interviews with nine participants, including eight adults diagnosed with PH and one caregiver of an individual with PH. Data were analyzed using Saldaña's comparative coding framework to identify …

Artificial Intelligence-Assisted Retinal Imaging For Chronic Disease Detection, Prediction, And Screening, Shivani Gandhi

Master's Projects and Capstones

A retinal image may reveal more than eye disease; it may also show early signs of chronic illness elsewhere in the body. Diabetes, hypertension, cardiovascular disease, and chronic kidney disease can develop before symptoms become noticeable, making earlier detection an important public health goal. Advances in artificial intelligence have created new possibilities for using retinal images to identify patterns linked to these conditions. This scoping review examined how Artificial Intelligence -assisted retinal imaging has been used for chronic disease detection, prediction, and screening, along with the practical and health-equity factors that may influence its use.

To map the current evidence, …

Predictors Of Academic Performance In First-Year Bsn Students: The Role Of Emotional Exhaustion, Alcohol Use, And Resilience, Jennifer Nerius

Doctoral Dissertations and Projects

The first year of nursing school can be academically demanding and emotionally challenging as students adjust to rigorous coursework, clinical expectations, and professional responsibilities. Understanding factors that influence student well-being and academic success is important for supporting students during this transition. The purpose of this quantitative longitudinal correlational study was to examine the relationships among emotional exhaustion, alcohol use, resilience, and academic performance in first-year Bachelor of Science in Nursing (BSN) students. Guided by Resilience Theory, the study explored whether resilience was associated with emotional exhaustion and alcohol use and whether emotional exhaustion, resilience, and alcohol use predicted academic performance. …

Software Tools And Simulation Exercises For Radiation Oncology Cyber-Attack Resiliency, Yevgeniy Vinogradskiy, James Lamb

Department of Radiation Oncology Faculty Papers

This review summarizes the rationale for radiation oncology cyberattack simulation exercises, recent results from multi-institutional resiliency drills, and the landscape of software tools developed to help clinics resume radiotherapy treatments rapidly and safely during a cyberattack or other major clinical software outage. Simulation exercises using record-and-verify (R&V) downtime and File Mode treatment delivery have identified failure modes not apparent in theoretical planning alone, including risks related to treatment documentation, repeated fractions, patient setup, and missed safety checks. Available software tools emphasize insulated backup of DICOM-format planning data and clinical notes, treatment-state dashboards, File Mode treatments, redundant R&V installations, and human-readable …

Relationship Between Sociodemographic Factors And Opioid Overdose Mortality In Milwaukee County, 2020-2021, Elizabeth David

Walden Dissertations and Doctoral Studies

Opioid overdose deaths increased significantly from 2020 to 2021, with Milwaukee County experiencing higher rates than the national and state averages. African American and Hispanic residents faced disproportionately high fatal overdose rates. The purpose of this quantitative retrospective cross-sectional study was to examine the associations among socioeconomic status, race, age, access to treatment (measured by emergency medical services [EMS] naloxone administration), and opioid overdose mortality among underserved minority populations in Milwaukee County. Guided by the social-ecological model, the study analyzed data from the Milwaukee Health Department and the Milwaukee County Medical Examiner's Office across 34 ZIP codes. Inclusion criteria for …

E-Health Literacy And Cyberchondria Severity Among Adolescent High School Students: A Cross-Sectional Study, Seyda Çavmak, Adem Bilgin

Makara Journal of Health Research

Background: Amid rapid digitalization and the growing use of artificial intelligence-based search engines, adolescents increasingly seek health information online. This study examined the relationship between high school students' e-health literacy and their cyberchondria tendencies.

Methods: This quantitative, cross-sectional study included 683 students from public high schools in Mersin, Türkiye. Data were collected using a Demographic Information Form, the e-Health Literacy Scale (eHEALS), and the Cyberchondria Severity Scale Short Form (CSS-12). Descriptive statistics, comparative tests, and Pearson correlation were applied (p < 0.05).

Results: Students' e-health literacy and cyberchondria severity were moderate. Significant positive correlations emerged between e-health literacy …

Preventive Interventions Targeting Social Determinants Of Health: Implications For Healthcare Utilization And Cost, Audrey Wrinkle

NEXUS: The Liberty Journal of Interdisciplinary Studies

Preventive interventions targeting social determinants of health could reduce avoidable healthcare utilization and positively impact long-term cost outcomes within healthcare systems. Evidence indicates that financial and social barriers to preventive care lead to delayed treatment and increased use of high-cost healthcare services in the long term. Preventive interventions focusing on upstream social factors, like home-based care and digital health programs, could improve patient outcomes and reduce avoidable service utilization. Also, incorporating social needs data into policy creation could promote better allocation of healthcare resources. This research highlights the role of prevention-focused strategies in promoting cost-effective, sustainable healthcare delivery.

Advancing Maternal Health Equity In Nebraska: Examining Prenatal Care Access Disparities, Policy Context, And Doula Integration As A Complementary Solution, Marlette Grace Dulcinee Mabiala-Maye

Theses & Dissertations

Maternal health inequities persist across the United States, with Black, Native American, and immigrant-origin women facing disproportionate barriers to timely prenatal care. This dissertation examined access to prenatal care in Nebraska, a mixed rural and urban state with extensive maternity care deserts, through three interrelated aims. Aim 1 analyzed PRAMS data using survey-weighted regression with race-by-socioeconomic-status interactions to characterize disparities in the timing and barriers to care. Aim 2 evaluated the state’s October 2020 Medicaid expansion across pre-pandemic, acute pandemic, and post-expansion periods. Aim 3 applied qualitative description and the Consolidated Framework for Implementation Research to interviews withtwenty-three maternity care …

Fall Risk In Community-Dwelling Adults: A Comparison Of English And Spanish-Speaking Individuals, Jesus D. Gomez

Dissertations, 2020-current

Falls are a leading cause of injury-related mortality among middle-aged and older adults. Although vestibular dysfunction, hearing loss, behavioral factors, and social determinants of health have been associated with increased fall risk, few studies have examined these relationships. Furthermore, limited research in audiology and vestibular science has investigated fall-risk vulnerability among Spanish-speaking individuals.

This study aimed to: (1) estimate the prevalence of fall risk among community-dwelling adults and compare prevalence between English-speaking and Spanish-speaking participants; (2) assess the prevalence of previously undiagnosed benign paroxysmal positional vertigo (BPPV) and compare prevalence between language groups; and (3) develop predictive models of fall …

Cultural Tailoring Of Digital Nutrition Interventions: A Scoping Review Of Adaptation Strategies, Evaluation Methods, And Evidence Gaps, Wendy Liang

Master's Projects and Capstones

Background: Nutrition-related chronic diseases disproportionately affect culturally diverse populations, highlighting the need for effective and equitable interventions. Digital nutrition interventions have expanded rapidly due to their accessibility; however, the extent to which they incorporate and evaluate cultural tailoring remains unclear.

Research aim: This scoping review maps the existing evidence on culturally tailored digital nutrition interventions, describes cultural adaptation strategies used, examines methods used to evaluate cultural appropriateness, and identifies gaps for future research and public health practice.

Methods: A scoping review was conducted following the PRISMA-ScR guidelines.

Findings: Culturally tailored digital nutrition interventions generally improved participant engagement, acceptability, and dietary …

“Now Serving… Not Quite Yet”: Improving Waiting Room Experience Through Consistent Communication In The Emergency Department, Juan Carlos Serrato

Master's Projects and Capstones

Context: The quality improvement project was implemented in the front-end microsystem of a 36-bed emergency department (ED) in a non-profit, Magnet-designated California hospital. Problem: Communication with non-roomed patients at Hospital X was inconsistent, contributing to dissatisfaction. In June 2026, Press Ganey reported that 61.4% of patients felt they were informed about delays. Baseline observation identified gaps in staff explanations of estimated wait times, next steps in care, and opportunities to ask questions. Intervention: A 30-day pilot provided staff education on the AIDET communication framework through formal in-service education and daily huddles. Patient-facing materials explained the ED process …

Staff Re-Entry Plan — Indian Trail, Flett, Woodridge, Travis Schulhauser

Spokane Wildfire Academic Consortium Repository

Following the downgrade of Level 3 Evacuation orders at Flett Middle School and Indian Trail and Woodridge elementary schools on Aug. 9, district staff worked with Fulcrum Environmental Consulting to conduct visual inspections and air-quality testing at these sites. More than 100 interior and exterior locations were tested, with indoor air quality within the Good-to-Moderate range under the EPA Air Quality Index. Inspectors also found no indication of unusual ash, soot or other settled particulates inside or outside the buildings.

Formative Work To Guide Implementation Of An Evidence-Based Breast And Cervical Cancer Prevention And Early Detection Behavioral Health Program In Clinics: Qualitative Study Guided By The Consolidated Framework For Implementation Research, Marlyn A Allicock, Crystal Costa, Ashley Hedrick Mckenzie, Preena Loomba, Roshanda S Chenier, Ross Shegog, Angelita Alaniz, Maria E Fernandez, Lara S Savas

Faculty, Staff and Student Publications

Background: Salud en Mis Manos (SEMM) is a community health worker-delivered evidence-based intervention shown to increase breast and cervical cancer screening in medically underserved Latinas. Despite SEMM's success in community-based settings, clinic-based implementation is limited.

Objective: This study aimed to identify factors influencing the implementation of SEMM in clinic settings using the Consolidated Framework for Implementation Research (CFIR) to inform and refine implementation strategy development.

Methods: We developed theory-informed (eg, CFIR, Social Cognitive Theory, and Readiness) interview guides to elicit barriers and facilitators of SEMM clinic implementation. We conducted 12 semistructured interviews with clinic leaders, outreach coordinators, and community health …

Examining The Association Between Socioeconomic Factors And Cervical Cancer Among Minority Women In The United States, Darla Fils

Walden Dissertations and Doctoral Studies

Cervical cancer remains a significant public health concern, with African American and Hispanic women experiencing disproportionately higher incidence and mortality rates in the United States. Socioeconomic factors, including income, education, employment status, and place of residence, may contribute to these disparities by affecting access to preventive services, timely diagnosis, and follow-up care. This quantitative cross-sectional study examined associations between these factors and cervical cancer incidence among African American and Hispanic women while controlling for age and health insurance status. Guided by the socio-ecological model, the study used 2022 Behavioral Risk Factor Surveillance System data from N = 33,886 African American …

Standardizing Gestational Diabetes Mellitus Education To Improve Patient Knowledge And Care Consistency In A Prenatal Clinic Setting, Wynn Zara

Master's Projects and Capstones

The gestational diabetes mellitus (GDM) group visit framework aims to improve consistency of GDM education by standardizing referral processes, educational materials, staff workflows, and patient communication. Although evidence-based GDM education supports patient self-management and improved maternal-fetal outcomes, variability in education delivery contributed to inconsistent care within the outpatient maternal-fetal medicine setting. This quality improvement project was conducted in an outpatient maternal-fetal medicine clinic in Santa Clara County serving pregnant patients diagnosed with GDM. To address this gap, a standardized GDM group visit framework was developed and implemented using structured educational resources, referral criteria, and communication workflows. The intervention was evaluated …

Evaluation And Continuation Of Oncology Nurse Mentorship Program, Gurpreet K. Kang

Master's Projects and Capstones

Problem: Newly hired nurses on a busy inpatient leukemia and lymphoma subspeciality unit experienced challenges after transitioning into specialty oncology practice. This resulted in decreased confidence, increased risk of medication errors, and a 40% unit-based annual turnover rate. The cost of replacing one staff nurse is $61,000.  Exit interviews determined root causes of turnover rates, nurse confidence.

Context: A quality improvement program was envisioned to optimize patient and organizational outcomes on a 25-bed inpatient unit to evaluate and sustain an oncology nurse mentorship program.

Interventions: Over one year, cohort 1 (n=8) and follow up 2^nd cohort (n=7) was implemented …

Psychosocial Experiences Of Secondary School Students Living With Sickle Cell Disease While In School In Lagos State, Nigeria, Toluwalope Yetunde Onuwe

Walden Dissertations and Doctoral Studies

Sickle cell disease (SCD) is a lifelong genetic condition significantly impacting the physical, emotional, and social health of those affected. Nigeria has one of the highest global burdens of SCD, yet there is limited research on the psychosocial experiences of secondary school students living with SCD in educational settings. This qualitative study explored these experiences among students in Lagos State, Nigeria. Using the social ecological model and interpreted through the social model of disability, the study examined how school environments, educational practices, and institutional support influenced students' psychosocial well-being and perceived health. Twenty secondary school students participated in 4 in-person …

Immigration Status And Lung Cancer Diagnosis In U.S. First-Generation Immigrants, Valeriya Lockwood

Walden Dissertations and Doctoral Studies

The healthy immigrant effect (HIE) is an observed phenomenon in which immigrants exhibit better health outcomes than native-born residents, though relatively few studies have examined its role in chronic diseases in the United States. The purpose of this quantitative cross-sectional study was to assess the associations between immigration status, age, sex, race/ethnicity, median household income, and geographic location and lung cancer diagnosis in first-generation immigrant adults aged 18 or older. The subsequent health trajectory model provided the theoretical framework for the study. Data were obtained from the SEER*Stat Database 1975-2022 (N = 1,993). Binomial regression analysis showed that immigrants were …

Implementing Routine Trauma Screening Using The Ace Questionnaire And Pcl-5, Esther Amune

Walden Dissertations and Doctoral Studies

This evaluation of a quality improvement initiative addressed inconsistent trauma screening and electronic documentation at an outpatient site. The baseline trauma-screening completion rate was 60%, below the organization's 80% target. The gap was relevant to nursing because nurses support screening, documentation, referral, coordination, and follow-up. The practice-focused question addressed whether the Adverse Childhood Experiences (ACE) Questionnaire and the Posttraumatic Stress Disorder Checklist for the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), or PCL-5, would improve documented screening completion and trauma-informed treatment planning over 10 weeks. The purpose was to incorporate both tools into care and …

Medical Tourism Patient Guidance: A Content Analysis Of Risk Reduction Guidelines Available To Global Health Seekers., Alicia Mason, Angela Ashmore

Faculty Submissions

This study examines medical tourism (MT) patient guidance messages intended to reduce procedural risks—those directly related to biomedical treatments—and process risks, which involve logistical, administrative, and interpersonal challenges of seeking healthcare abroad. The analysis focuses on print and digital publications authored by individuals independent of the MT industry, including policy researchers, travel health experts, lifestyle reporters, and consumer-focused medical travel writers. Using a two-phase digital and database search strategy, 27 publications from 2009 to 2024 were identified and analyzed using exploratory content analysis methods. Findings reveal important differences in the scope and depth of guidance aimed at reducing risks for …

Perilaku Merokok Dan Paparan Informasi Bahaya Merokok Di Media Pada Penduduk ≥15 Tahun: Analisis Potong Lintang Gats Indonesia 2021, Hana Aulia Putri, Izza Nayla Paramitha, Nuha Nazeeha, Rahma Amalia

Perilaku dan Promosi Kesehatan: Indonesian Journal of Health Promotion and Behavior

Background. Smoking remains a significant health problem in Indonesia. Although anti-smoking information is disseminated through various media, exposure levels and effectiveness among adults are not clearly documented.

Objective. To describe the proportion of anti-smoking information exposure among Indonesian adults by media type (television, radio, billboards, newspaper/magazines, internet, and others) and compare exposure between smokers and non-smokers using GATS 2021 data.

Methods. Cross-sectional study using Global Adult Tobacco Survey (GATS) Indonesia 2021 data. A total of 9,156 respondents aged ≥15 years were analyzed descriptively to determine exposure proportions by smoking status across multiple media channels.

Results. Television showed the highest exposure …

The Effectiveness Of "Little Doctor" Training On Health Knowledge And Behavior Of Karawang Primary Students (2025), Aurelia A. Erawan, Shahnaz F. Azzahra, Rubee P. Risdiyanto, Patricia Andini, Muhammad K. Ramadhan, Ailsa T. Kirana, Istingadah Desiana Md, Raden M. Rifada Md

Perilaku dan Promosi Kesehatan: Indonesian Journal of Health Promotion and Behavior

Background. Acute respiratory infection (ARI) remains a major public health problem in Indonesia, with West Java reporting the highest incidence. Poor Health-Related Behavior (HRB) practices are associated with increased ARI risk. The "Little Doctor" program is a government initiative that focuses on school health and aims to promote HRB among students. Along with this goal, this study aimed to determine the effectiveness of the program in improving knowledge of HRB and ARI among elementary school students in Pancawati Village, Karawang Regency.

Methods. This study employs a quasi-experimental one-group pretest-posttest design. Participants were selected based on inclusion criteria referring to the …

Hubungan Paparan Informasi Anemia Dan Tablet Tambah Darah (Ttd) Melalui Media Digital Dengan Kebiasaan Konsumsi Makanan Ibu Hamil Berdasarkan Food Frequency Questionnaire (Ffq), Muthiah Salsabilah, Bernadette Oktavia Jelita, Thariq Zafar Surapati, Alya Khairunnissa, Primasti Nuryandari Putri, Ratu Ayu Dewi Sartika

Perilaku dan Promosi Kesehatan: Indonesian Journal of Health Promotion and Behavior

Background: Proper nutrition is important for the mother and baby. The media is an important source of information for every pregnant woman, but the information might be inaccurate.

Aim: This study aims to examine the association between exposure to digital media information on anemia and iron-folic acid (IFA) supplementation and the food consumption habits of pregnant women as measured by the Food Frequency Questionnaire (FFQ) at Puskesmas Kecamatan Beji, Depok City in 2024.

Method: This study utilized a cross-sectional design involving secondary data analysis of the 2024 antenatal care (ANC) survey conducted at Beji Primary Health Center, Depok City. Purposive …