Digital Commons Network^™

Telehealth Evaluation In The United States: Protocol For A Scoping Review, Yunxi Zhang, Yueh-Yun Lin, Lincy S Lal, Jennifer C Reneker, Elizabeth G Hinton, Saurabh Chandra, J Michael Swint

Faculty, Staff and Student Publications

BACKGROUND: The rapid expansion of telehealth services, driven by the COVID-19 pandemic, necessitates systematic evaluation to guarantee the quality, effectiveness, and cost-effectiveness of telehealth services and programs in the United States. While numerous evaluation frameworks have emerged, crafted by various stakeholders, their comprehensiveness is limited, and the overall state of telehealth evaluation remains unclear.

OBJECTIVE: The overarching goal of this scoping review is to create a comprehensive overview of telehealth evaluation, incorporating perspectives from multiple stakeholder categories. Specifically, we aim to (1) map the existing landscape of telehealth evaluation, (2) identify key concepts for evaluation, (3) synthesize existing evaluation frameworks, …

School Teachers' Perceptions Of Adolescent Human Papillomavirus (Hpv) Vaccination: A Systematic Review, Jihye Choi, Efrat K Gabay, Paula M Cuccaro

Faculty, Staff and Student Publications

School nurses are uniquely positioned to educate students about immunizations, including human papillomavirus (HPV) vaccination, but schools are often without a nurse for different reasons. In lieu of nurses, teachers who closely interact with students and are traditionally well-trusted by parents may be able to communicate about HPV vaccination, alleviating parental vaccine hesitancy. This systematic review explores school teachers' perspectives on adolescent HPV vaccination and factors influencing their willingness to make vaccine recommendations. We searched three databases with appropriate medical subject headings and keywords to identify relevant studies. We reviewed fifteen studies and provided an extensive summary and a comparison …

Hesitation Towards The Covid-19 Vaccine In The United States: A Digital Ethnographic Study [Vacilación Ante La Vacuna Contra El Covid-19 En Estados Unidos De América: Un Estudio Etnográfico Digital], Rosalynn A. Vega

Anthropology Faculty Publications

Following the authorization of the use of COVID-19 vaccines in babies age 6 months through children 4 years old in the United States, some individuals (parents, pediatricians, and communicators) framed COVID-19 vac-cination as an issue of access, while many others expressed hesitancy, and some resisted recommendations from the US Centers for Disease Control and Prevention. In this context, this study aimed to explore: 1) divergent reactions to the authorization of COVID-19 vaccine use in children aged 6 months to 4 years; and 2) opposing logics underlying attitudes towards pro-vaccination, anti-vaccination, and vaccine hesitancy regarding COVID-19 vaccines. To achieve this, a …

Evaluating Drowning Prevention Campaigns - The Challenge Of Getting The Right Information To The Right People At The Right Time: A Response To Calverley, Petrass, And Blitvich, Gemma Crawford, Meg Abercromby, Malena Della Bona, Justine E. Leavy Ph.D.

International Journal of Aquatic Research and Education

Evidence-informed decision making requires timely and readily available research and evaluation for policy and practice. In the context of drowning prevention, evaluation of interventions in the grey and peer reviewed literature is relatively scarce. Lack of evidence and associated barriers to access limits the scope of knowledge translation efforts and the application of research outcomes to initiatives designed to prevent drowning. The paper, Alcohol Focused Drowning Prevention Campaigns: What Do We Know and What Should We Do Now? highlights a lack of specific evaluation for alcohol-focused drowning prevention campaigns. We offer insights as evaluators of a youth water safety program …

Impacts Of Opioids On Health And Ways To Overcome The Addiction, Kennedy Chidi Alajemba

Doctoral Dissertations and Projects

Background: The opioid crisis in the United States has affected millions of individuals, causing high levels of opioid addiction among the population. With the onset of synthetic opioids, deaths from opioid-related causes have increased drastically. This study aims to understand the effect of opioid addiction and methods of controlling the problem for adult African Americans and Latinos at Pathways to Recovery Counseling and Education Services, Hazleton, Pennsylvania. Methods: The theories guiding this study are the Intersectionality Model and the Bay Area Regional Health Inequalities Initiative (BARHII) model. These theories reveal that factors such as age, ethnicity, and gender have a …

Physical Activity Barriers And Facilitators In African American Women: A Social Ecological Models Perspective, Leah Ann Carter

LSU Doctoral Dissertations

African American (AA) women experience poor health outcomes that can be addressed by increasing PA engagement. Understanding how PA barriers and facilitators occur at multiple levels of influence may help tailor PA interventions for AA women. Although prior work has established barriers to PA that are unique to African American women, few studies identify the sociocultural norms associated with these impediments. Little is known about the cultural implications of barriers such as haircare maintenance, and public policy.

The primary aim of this dissertation was to capture AA women’s voice about PA barriers and facilitators using the social ecological model framework. …

Nurse-Led Brief Intervention For Enhancing Safe Sex Practice Among Emerging Adults In Hong Kong Using Instant Messaging: Feasibility Study, Sharon Hoi Lam Pak, Man Ping Wang, Anne M. Teitelman, Janet Yuen Ha Wong, Daniel Yee Tak Fong, Edmond Pui Hang Choi

College of Nursing Faculty Papers & Presentations

BACKGROUND: The incidence of sexually transmitted infections has been increasing throughout the world. Additionally, substantial changes in emerging adults' attitudes toward sex and the popularization of premarital sex could further affect the diagnosis and treatment of sexually transmitted infections. With the high acceptability and effectiveness of instant messaging (IM) interventions for health promotion, there is potential for such interventions to improve condom use knowledge and promote safer sex practice.

OBJECTIVE: The study evaluates the feasibility of a nurse-led IM intervention to promote safer sex practices in emerging adults.

METHODS: A 30-minute adaptive IM intervention and a 5-day booster dose of …

What Do Cervical Cancer Patients Know, How Do They Learn, And Who Do They Tell? A Pilot Study, Sharon Larson, Brian Mcanany, Ilene Ladd, Radhika Gogoi

College of Population Health Faculty Papers

BACKGROUND: This study explored what patients identified with cervical cancer know about the link between human papillomavirus (HPV) and cervical cancer and where they learned this information. Patients share a great deal of information with family, friends and colleagues and we were interested in the accuracy and sources of information they are sharing.

METHODS: Patients identified through the EHR of a health system who had a history of cervical cancer were invited to participate in a brief survey of their experience. The sample represents an opportunity sample of patients who responded.

RESULTS: Generally, these patients, drawn from the Geisinger Health …

Exploration Of Latina/Hispanic Women's Experiences Living With Non-Alcoholic Fatty Liver Disease: A Qualitative Study With Patients In Houston, Natalia I Heredia, Erika Mendoza Duque, Sylvia Ayieko, Amelia Averyt, Lorna H Mcneill, Jessica P Hwang, Maria E Fernandez

Faculty, Staff and Student Publications

OBJECTIVES: A deeper understanding of the lived experiences of Hispanic patients with non-alcoholic fatty liver disease (NAFLD) can help guide the development of behavioral programs that facilitate NAFLD management. This paper explores Hispanic women's experiences living with NAFLD.

DESIGN, SETTING, PARTICIPANTS: We collected brief sociodemographic questionnaires and conducted in-depth interviews with 12 low-income (all had household income ≤USD$55 000 per year) Hispanic women with NAFLD from the Houston area. Transcripts were audio-recorded and transcribed. We developed a coding scheme and used thematic analysis to identify emergent themes, supported by Atlas.ti.

RESULTS: Participants identified physicians as their main information source on …

Dining Patterns At Campus Food Venues: University Employees’ Perspectives, Kritika Gupta, Jangwoo Jo, Laurel Lambert, Georgianna Mann, Selby Rebecca Entrekin

Journal of Public Health in the Deep South

Background: Few studies exist concerning university employees’ on-campus dining patterns patronage with regard to healthy eating principles. Purpose: To understand the importance that faculty/staff (F/S) place on healthy eating principles and the influence it may have on satisfaction and dining patterns at campus food venues. Methods: A validated online survey was used to collect data on F/S’s perspectives. The survey was distributed through a survey panel group, offered through the University’s Office of Research. Results: Responses on the importance of healthy eating principles showed a severe skewness towards high importance. Younger F/S placed higher importance on …

Ways To Improve Uptake Of Tier 2 Weight Management Programmes In Bame Communities In Medway: A Qualitative Study, Jennifer A. Teke, Johnson Mbabazi, Emma Giles, Scott Elliot, Louisa Ells, Lawrence Achilles Nnyanzi

International Journal of Physical Activity and Health

Overweight and obesity is usually determined by Body Mass Index (BMI). Twelve BAME adults participated in the interviews: six were female, ten were first-generation migrants, three were retirees, none lived with a disability, and all were concerned about their excess weight. There were four themes from the data and eight subthemes obtained. To improve the uptake of the weight management service provided in Medway, the participants recommended the use of strategies such as indigenous food labelling, BAME-led clinics, the use of translated leaflets, the recruitment of local weight management champions, better coordination of services, appropriate communication strategies, and further research. …

External Relationships As Implementation Determinants In Community-Engaged, Equity-Focused Covid-19 Vaccination Events, Ramey Moore, Jennifer Callaghan-Koru, Jennifer L. Vincenzo, Susan K. Patton, Marissa J. Spear, Sheldon Riklon, Eldon Alik, Alan Padilla Ramos, Stephanie Takamaru, Pearl A. Mcelfish, Geoffrey M. Curran

The Eleanor Mann School of Nursing Faculty Publications and Presentations

Background:

While relationships and connectedness among organizations have been included in implementation theories, models, and frameworks, the increased attention to health equity in implementation science raises the urgency of understanding the role of relationships external to the implementing organization. This paper addresses this gap through an exploration of the role of external relationships in community-based, equity-focused interventions.

Methods:

This study focuses on an equity-focused, community-based COVID-19 vaccination intervention in Arkansas, drawing upon long-term community-engaged relationships among University of Arkansas for Medical Sciences and the Hispanic and Marshallese Islander communities. We used an exploratory qualitative descriptive design to examine barriers and …

Experiences Of Women In Sierra Leone Relating To Accessing Breast Cancer Treatment, Anne Neville, Magdeline Aagard Dr.

Journal of Sustainable Social Impact

The lack of consistent access to breast cancer care and treatment remains a significant problem for women diagnosed with breast cancer in Sierra Leone. The instability of the political structure has created an environment with a high level of illiteracy and financial hardship among the female population, resulting in a significant deficiency in information relating to symptoms and the detection of breast cancer. To study the lived experience of women living in Sierra Leone who were diagnosed with breast cancer, I [the first author] used a descriptive phenomenological approach. I conducted semi-structured interviews based on Andersen and Newman’s healthcare utilization …

Liax Is A Surrogate Marker For Cell Envelope Stress And Daptomycin Non-Susceptibility In Enterococcus Faecium, Dierdre B Axell-House, Shelby R Simar, Diana Panesso, Sandra Rincon, William R Miller, Ayesha Khan, Orville A Pemberton, Lizbet Valdez, April H Nguyen, Kara S Hood, Kirsten Rydell, Andrea M Detranaltes, Mary N Jones, Rachel Atterstrom, Jinnethe Reyes, Pranoti V Sahasrabhojane, Geehan Suleyman, Marcus Zervos, Samuel A Shelburne, Kavindra V Singh, Yousif Shamoo, Blake M Hanson, Truc T Tran, Cesar A Arias

Faculty, Staff and Student Publications

Daptomycin (DAP) is often used as a first-line therapy to treat vancomycin-resistant

Immuno-Molecular Targeted Therapy Use And Survival Benefit In Patients With Stage Ivb Cervical Carcinoma In Commission On Cancer, Collin A Sitler, Chunqiao Tian, Chad A Hamilton, Michael T Richardson, John K Chan, Daniel S Kapp, Charles A Leath, Yovanni Casablanca, Christina Washington, Nicole P Chappell, Ann H Klopp, Craig D Shriver, Christopher M Tarney, Nicholas W Bateman, Thomas P Conrads, George Larry Maxwell, Neil T Phippen, Kathleen M Darcy

Faculty, Staff and Student Publications

PURPOSE: To investigate IMT use and survival in real-world stage IVB cervical cancer patients outside randomized clinical trials.

METHODS: Patients diagnosed with stage IVB cervical cancer during 2013-2019 in the National Cancer Database and treated with chemotherapy (CT) ± external beam radiation (EBRT) ± intracavitary brachytherapy (ICBT) ± IMT were studied. The adjusted hazard ratio (AHR) and 95% confidence interval (CI) for risk of death were estimated in patients treated with vs. without IMT after applying propensity score analysis to balance the clinical covariates.

RESULTS: There were 3164 evaluable patients, including 969 (31%) who were treated with IMT. The use …

Vaccine Hesitancy Among Youth Living With Hiv In Detroit, Madeline B. Simone

Medical Student Research Symposium

Vaccine hesitancy among youth with human immunodeficiency virus (HIV) was evaluated to determine if the pandemic affected vaccine acceptance. A retrospective chart review was conducted to analyze vaccine rates over a five-year (pre-post COVID) in one university-based clinic. Results indicated a variation in acceptance rates between vaccines, with the MenACWY, MenB, tetanus, and HPV having the highest acceptance rates and COVID-19 and annual flu vaccine having the lowest acceptance rates. Vaccine hesitancy did not correlate with HIV treatment hesitancy nor with aversion to needles. Negative messaging around vaccines from a variety of sources appeared to be the primary factor in …

Altered Mitochondrial Respiration In Peripheral Blood Mononuclear Cells Of Post-Acute Sequelae Of Sars-Cov-2 Infection, Sahera Dirajlal-Fargo, Jared C. Durieux, Grace A. Mccomsey

Faculty Scholarship

Peripheral blood mononuclear cells (PBMC) mitochondrial respiration was measured ex vivo from participants without a history of COVID (n = 19), with a history of COVID and full recovery (n = 20), and with PASC (n = 20). Mean mitochondrial basal respiration, ATP-linked respiration, maximal respiration, spare respiration capacity, ATP-linked respiration, and non-mitochondrial respiration were highest in COVID + PASC+ (p ≤ 0.04). Every unit increase in non-mitochondrial respiration, ATP-linked respiration, basal respiration, spare respiration capacity, and maximal respiration increased the predicted odds of PASC between 1 % and 6 %. Mitochondrial dysfunction in PBMCs may be contributing to the …

“No Matter How Hot It Is, You Just Have To Do The Work”: Examining Farmworkers’ Experiences With Heat And Climate Change In Idaho, Carly Hyland, Delmy Flores, Grace Augusto, Irene Ruiz, Marielena Vega, Rulon Wood

Public and Population Health Faculty Publications and Presentations

Introduction: Farmworkers are one of the populations most vulnerable to climate change. In addition to disproportionate exposure to climate-intensified hazards such as extreme heat and wildfire smoke, many farmworkers face situational and psychosocial stressors that also impact their health.

Methods: We conducted open-ended interviews with 16 farmworkers in Southcentral Idaho during June-August 2023 as part of a digital storytelling project in partnership with the Idaho Organization of Resource Councils (IORC). Interviews assessed participants’ experiences with climate change, perceived impacts on their health, and strategies and barriers to protecting themselves. Bilingual (English/Spanish) study staff translated and transcribed all video recordings verbatim, …

The Great Resignation: Narratives Of Mid-Career Teacher Burnout And Attrition, Nicole Burton

Dissertations and Doctoral Documents, University of Nebraska-Lincoln, 2023–

The COVID-19 pandemic has increased the issues of teacher attrition. According to the U.S. Bureau of Labor and Statistics, from January to November 2021, there was a 40% increase in the quit levels of teachers within the state and local education agencies (John, 2022). While prior research has examined early-career teachers leaving the profession, mid-career teachers have largely been left out of the conversation. This narrative inquiry investigates the reasons that mid-career teachers are leaving the profession. Semi-structured interviews were conducted with four mid-career teachers hailing from the Midwest region. Interviews focused on understanding how teachers have experienced stress and …

Utilization Of The System Engineering Design Process To Design And Test A Low-Cost Infectious Aerosol Control Mechanism For Patient Aeromedical Evacuation, Sara Shaghaghi

Theses and Dissertations

The aeromedical evacuation of military patients is a critical component of care for Armed Forces members. The Air Force’s ability to transport patients relies on the technology and systems available. A vital transport responsibility is keeping the patient and medical personnel safe during transport. The historical and legacy systems provide reliable transport mechanisms for the Armed Forces’ patients infected with high-level biological agents, but drawbacks must be considered. This dissertation will discuss the development, conceptual design, and initial evaluation of a new low-cost, litter-mounted patient transport system, Biological-Mitigation in Patient Transport (B-MIPT), using the “V” model of the system engineering …

What Adolescents Say In Text Messages To Motivate Peer Networks To Access Health Care And Sexually Transmitted Infection Testing: Qualitative Thematic Analysis, Marguerita Lightfoot, Chadwick Campbell, Allysha C. Maragh-Bass, Joi Jackson-Morgan, Kelly Taylor

OHSU-PSU School of Public Health Faculty Publications and Presentations

Background:While rates of HIV and sexually transmitted infections (STIs) are extremely high among adolescents and young adults in the United States, rates of HIV and STI testing remain low. Given the ubiquity of mobile phones and the saliency of peers for youths, text messaging strategies may successfully promote HIV or STI testing among youths.

Objective:This study aimed to understand the types of messages youths believe were motivating and persuasive when asked to text friends to encourage them to seek HIV or STI testing services at a neighborhood clinic.

Methods:We implemented an adolescent peer-based text messaging intervention to encourage clinic attendance …

Voices From Grenada: An Impact Evaluation Of A Community-Academic Partnership., Sade Richardson

Doctor of Social Work Capstone Projects

The purpose of this study was to evaluate the impact of the community-academic partnership between the University of Michigan School of Public Health Office of Public Health Practice and the Grenadian community. Five key informant interviews were conducted to analyze the partnership from the perspectives of the community partners in Grenada to understand the strengths, challenges, and existing opportunities, specifically within the context of a global collaboration.

The findings highlighted the benefits of community-based collaboration, considerations for partnership design, and opportunities for education, practice, policy, research, and leadership. The organizations spoke highly of the partnership, underscoring their desire for expanded …

Recognize & Resist: An Online Health Intervention To Promote Writing About Sexual Consent And Egalitarian Gender Roles Among One Direction Fanfiction Writers, Ashley Hedrick Mckenzie, Barbara G Friedman, Francesca R Dillman Carpentier, Allison J Lazard, Laura F Salazar, Ross Shegog

Faculty, Staff and Student Publications

This paper focuses on the development and feasibility of a digitally-based educational intervention, titled Recognize & Resist (R&R), for writers of One Direction (1D) fanfiction on Wattpad.com. The goal of R&R is to reduce the prevalence of social norms that are supportive of sexual violence within 1D fanfiction. 1D fanfictions, or fictional romance stories written by fans of this British boy band, have hundreds of millions of views on Wattpad.com. Formative research has found that social norms supportive of sexual violence are prevalent in 1D fanfictions and that some authors have internalized these norms. R&R aims to …

Evaluation Of A Collaborative Model Between Managed Care And Affordable Housing On Acute Care Costs, Jack Tsai, Suja Rajan, Chau Truong, Vanessa Schick, Cecilia Ganduglia Cazaban

Faculty, Staff and Student Publications

Objectives: This study evaluated a collaborative service model between the largest Medicaid managed care organization (MCO) in Texas, Superior HealthPlan, and the affordable housing provider Prospera Housing Community Services.

Study design: Using a quasi-experimental 2-groups research design, we compared health care outcomes and costs between a sample of 104 participants served by the Prospera+Superior collaborative model and a group of 104 participants who had health care coverage through the Superior HealthPlan Medicaid MCO but did not live at Prospera properties (ie, Superior-only group).

Methods: Data from medical claims were analyzed to examine change in outcomes 12 months before and after …

Market Realities For Rural And Small-Town Practices, W. E. Rupprecht Dds

The Journal of the Michigan Dental Association

This article explores the challenges rural dental practitioners face in Michigan, highlighting the struggle to find successors for practice continuity and the impact on patient care. Examining sales data and demographic trends reveals disparities in successful practice transitions, emphasizing the difficulty in attracting buyers to rural areas. The reluctance of potential buyers, influenced by family and professional considerations, underscores the need for strategic solutions. Initiatives by the Michigan Dental Association and innovative approaches such as mentorship and financial incentives aim to address these challenges. The article concludes by urging practitioners to act as stewards and plan for successful transitions in …

Diras3 Induces Autophagy And Enhances Sensitivity To Anti-Autophagic Therapy In Kras-Driven Pancreatic And Ovarian Carcinomas, Gamze Bildik, Joshua P Gray, Weiqun Mao, Hailing Yang, Rumeysa Ozyurt, Vivian R Orellana, Olivier De Wever, Mark S Carey, Robert C Bast, Zhen Lu

Faculty, Staff and Student Publications

Pancreatic ductal adenocarcinoma (PDAC) and low-grade ovarian cancer (LGSOC) are characterized by the prevalence of KRAS oncogene mutations. DIRAS3 is the first endogenous non-RAS protein that heterodimerizes with RAS, disrupts RAS clustering, blocks RAS signaling, and inhibits cancer cell growth. Here, we found that DIRAS3-mediated KRAS inhibition induces ROS-mediated apoptosis in PDAC and LGSOC cells with KRAS mutations, but not in cells with wild-type KRAS, by downregulating NFE2L2/Nrf2 transcription, reducing antioxidants, and inducing oxidative stress. DIRAS3 also induces cytoprotective macroautophagy/autophagy that may protect mutant KRAS cancer cells from oxidative stress, by inhibiting mutant KRAS, activating the STK11/LKB1-PRKAA/AMPK pathway, increasing lysosomal …

Measuring The Comparative Performance Of Usaf Behavioral Health Clinic Operations: Emphasis On Capacity, Daniel L. Straw

Theses and Dissertations

This research examines the operations of behavioral health clinics in Air Force Continental United States facilities, with a focus on operational efficiency and capacity through Data Envelopment Analysis. Most facilities operate near capacity, demonstrating efficient resource usage, but concerns arise with the potential of increased demand. Days-to-care and leakage are identified as major sources of inefficiency, suggesting that addressing these issues can enhance operations and reduce costs. The study also explores the impact of COVID-19 on care delivery.

Daily Income Targets And Passenger Pressure On Safety Risky Riding Behavior Among Online Motorcycle Taxi Riders In Jakarta, Indonesia, Zulkifli Djunaidi, Agra Mohamad Khaliwa, Azka Hafia, Nadya Putri

Kesmas

Online motorcycle taxi riders, a vulnerable group on the road, are more susceptible to serious injury than non-motorcycle riders. This study analyzed a correlation between daily income targets, passenger pressure, risk perception, safety attitudes, and risky riding behavior. This cross-sectional study used a semi-quantitative approach by collecting online-based questionnaires from 500 online motorcycle taxi riders in Jakarta, and 50 of them were obtained through offline interviews. The findings revealed a significant relationship between daily income targets, passenger pressure, risk perception (danger level, stochastic evaluation, and safety priority), safety attitudes (pragmatic attitude to rule violations and dissatisfaction with traffic rules), and …

Metabolomic Profiles Of Sleep-Disordered Breathing Are Associated With Hypertension And Diabetes Mellitus Development, Ying Zhang, Bing Yu, Qibin Qi, Ali Azarbarzin, Han Chen, Neomi A Shah, Alberto R Ramos, Phyllis C Zee, Jianwen Cai, Martha L Daviglus, Eric Boerwinkle, Robert Kaplan, Peter Y Liu, Susan Redline, Tamar Sofer

Faculty, Staff and Student Publications

Sleep-disordered breathing (SDB) is a prevalent disorder characterized by recurrent episodic upper airway obstruction. Using data from the Hispanic Community Health Study/Study of Latinos (HCHS/SOL), we apply principal component analysis (PCA) to seven SDB-related measures. We estimate the associations of the top two SDB PCs with serum levels of 617 metabolites, in both single-metabolite analysis, and a joint penalized regression analysis. The discovery analysis includes 3299 individuals, with validation in a separate dataset of 1522 individuals. Five metabolite associations with SDB PCs are discovered and replicated. SDB PC1, characterized by frequent respiratory events common in older and male adults, is …

The Influence Of Motivation And Knowledge On The Completeness Of Medical Records With Attitude As An Intervening Factor, Junaedi Junaedi, Supriyantoro Supriyantoro, Intan Silviana Mustikawati, Ericko Ongko Joyo

Jurnal ARSI : Administrasi Rumah Sakit Indonesia

Incomplete medical record filling by doctors is still a widespread problem encountered in various hospitals. Incomplete medical record documentation is very detrimental to the hospital. This research aims to determine the correlation between motivation and workload on doctors' completeness of medical record filling through attitude mediation. This study was conducted with a cross-sectional design, which included 40 doctors who worked at the inpatient ward of Annisa Citeureup Hospital as the respondents. Motivation, knowledge, and attitudes were assessed using a questionnaire with a Likert scale, while the medical records completeness data was obtained by directly evaluating the medical records. Partial least …