Digital Commons Network^™

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 …

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 …

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 …

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 …

``But What About Me?'': A Structural Redesign For Cascading Trust Into An Integrated Culture Of Care, Hazelin Hei Laam Ngan

Patient Experience Journal

In healthcare, patient experience (PX) and employee experience (EX) are often managed as separate priorities despite their interdependence. This article presents a case study from NYC Health + Hospitals/Community Care, a 250-person safety-net division providing home-based services across New York City. In response to frontline staff repeatedly asking, ``But what about me?'' when offered PX best practice suggestions, the organization integrated patient experience, staff engagement, and wellness into a unified Care Experience portfolio led by the Chief Experience Officer. From this structural redesign emerged a practical framework for trust-building organized around three pillars: Purpose, Presence, and Partnership. Purpose aligns staff …

Plan Of Day | Plan Of Stay: How Inter-Disciplinary Communication Improved Patient Experience And Hospital Throughput, Theresa Jean Dionne, Felicia Hurst, Danna Qunibi, Lauren Lazar, Sydney Mccurdy, Ashlyn Coenraad, Brittney Ward, Whitney Black, Ashley Nelson, Judd Salem, Luisa Restrepo

Patient Experience Journal

Background: Effective communication among healthcare team members is critical for delivering high-quality, patient- and family-centered care while optimizing hospital operations. This case study examines the implementation of a structured ``Plan of Day | Plan of Stay'' model, leveraging bedside whiteboards to enhance inter-disciplinary communication in a pediatric hospital setting. By providing a clear, visual summary of daily care plans, care team members, and discharge goals, whiteboards foster transparency, empower patients and families, and facilitate coordinated clinical decision-making. Purpose: This quality improvement initiative evaluated the implementation of a standardized Plan of Day | Plan of Stay communication model on a pediatric …

Patient Psychological Safety: A Qualitative Study Of Patient Experiences, Derick R. Simmons, Cheryl Rathert, Ryan Valayil, Maria Joseph, Ibraheem Jawadi

Patient Experience Journal

There is growing interest in understanding patients' experiences with psychological safety during healthcare encounters. Recent studies reveal that patients describe needing patient psychological safety (PPS) to form connections with their care providers, which are associated with better health outcomes. Therefore, it is critical to examine indicators of PPS. Using a phenomenological interpretive approach, this study utilized a patient narrative survey methodology to qualitatively explore how and why patients experience a lack of PPS during their healthcare encounters. We surveyed patients from across the U.S. and analyzed responses among a sub-sample of respondents to an open-ended question whose responses indicated they …

Self-Medication Experience And Healthcare Trust Among Youth: A Regionally Concentrated Digital Survey In Indonesia, Wahyudi Wahyudi, Azra Muzaiyana Nasution, Arini Dwi Rahmadani, Alysa Rahmadani Hasibuan

Patient Experience Journal

Self-medication has become a central experience for youth transitioning toward independent medical decision-making. In the digital era, young people must navigate a complex landscape of health information while seeking independent health solutions. This study investigates self-medication experiences and healthcare trust among youth, utilizing a regionally concentrated digital survey approach in Indonesia. Data were collected via a cross-sectional approach using digital platforms (Instagram, TikTok, and Twitter/X), facilitated by 76 trained enumerators. While respondents from all 38 provinces participated, the sample (N = 2,790) exhibits a major geographical concentration in the Sumatra region. The study employed a validated 16-item instrument to evaluate …

Trust Earned Through Relational Care: How Adverse Childhood Experiences Shape Patient Trust In Their Inpatient Physicians—A Convergent Mixed-Methods Study, Marlise Jeanne Pierre-Wright, Ibrahim Badreldin Mokhtar, Uma Thachapuzha, Yashoswini Chakraborty, Revika Singh, Rachel O'Conor, Jing Song, Julia Lee, Maria E. Theodorou, Christine Schaeffer, Kimberly Collins, Muriel Jean-Jacques

Patient Experience Journal

Background: Adverse childhood experiences (ACEs) are common, with approximately 60% of the population reporting at least one exposure. Despite well-established links between ACEs and adverse health outcomes, little is known about how ACE exposure shapes hospitalized patients' trust in inpatient physicians. Objective: To examine the association between ACEs and hospitalized patients' trust in inpatient physicians and to explore how trust is formed among patients with high ACE exposure. Methods: In this convergent mixed-methods study, 86 patients admitted to a general internal medicine teaching service at a large urban academic medical center were surveyed across six data-collection sessions (January–July 2024). Participants …

From Hospital To Home After Lower-Extremity Open Reduction And Internal Fixation: Patients' Experiences Of Pain Self-Management And Trust-Building Discharge And Follow-Up Support, Sahrudi Sahrudi, Achmad Fauzi Kamal, Masfuri Masfuri, Kasiyah Junus

Patient Experience Journal

After lower-extremity open reduction and internal fixation (ORIF), patients often return home while pain, wound care, mobility restrictions, medication routines, and follow-up needs are still evolving. During this transition, trust in discharge information may shape how patients interpret symptoms, use analgesics, mobilise, involve family members, and decide when to seek help. This qualitative descriptive study explored patients' experiences of pain self-management after lower-extremity ORIF in an Indonesian public hospital context, with attention to trust-building needs across discharge and early follow-up. Eighteen adults participated in individual face-to-face semi-structured interviews at an orthopaedic outpatient clinic. Interviews were audio-recorded, transcribed verbatim, and analysed …

Centering Community Voices To Address Healthcare Inequities In Underserved Utah Populations, Karishma Shah, Jazmine Abril, May Shaaban, Silvia Soule, Sonia Sehgal, Rawad Farhat, Jeannette Villalta, Oreta Tupola, Valentine Mukundente, Cathy Wolfsfeld, Ivana Holiday, Walter Watchman, Carrie Olvera, Lauren Gleave, Kamaile Tripp, Alexander Sperber, Rita Osborn

Patient Experience Journal

Persistent disparities in health outcomes across the United States are often driven by systemic inequities and social determinants of health. In Utah, these inequities are particularly pronounced among racially, ethnically, and geographically underserved populations. Community healthcare workers (CHWs) who share lived experiences with these communities are uniquely positioned to bridge the gap between patients and a fragmented healthcare system. This study aimed to explore how underserved communities in Utah perceive and interact with the healthcare system, centering their lived experiences to inform more equitable care models. We conducted eight focus groups with 73 participants from six medically underserved communities: African …

Caring But Still Hurting: Uninsured Patients' Illness And Healthcare Experiences At A U.S. Free Clinic, Danaya Amornnimit, Eda G. Christensen, Adelaida Salmeron, Kian Robison, Sofia Ampudia Arroyo, Jessica Benelli, Brenda Spearman, Akiko Kamimura

Patient Experience Journal

While free clinics provide essential healthcare to socioeconomically disadvantaged populations, patients' lived experiences in these settings remain underexplored. This qualitative study examined how uninsured patients at a U.S.-based free clinic perceive their illness experiences and interactions with healthcare providers. From October to December 2024, semi-structured interviews were conducted with 21 adult patients (ages 18–72; M = 49.14), most of whom were non–U.S.-born and primarily Spanish-speaking. Participants described illness as entangled with emotional distress, social isolation, stigma, and disruptions to identity and family roles—revealing a psychological burden that extends beyond physical symptoms. These findings highlight the need to integrate psychosocial and …

From Drifting To Anchored: How Online Health Communities Can Transform Care For Complex Chronic Illness, Mads Eggerding

Patient Experience Journal

This personal narrative recounts a 25-year diagnostic odyssey with Ehlers-Danlos syndrome, defined by medical fragmentation, dismissed symptoms, and profound isolation. It illustrates how Online Health Communities (OHCs) bridged the chasm between lived experience and a clinical system ill-equipped for complex chronic illness. For patients like me, these digital forums provide the peer validation, practical knowledge, and self-advocacy tools necessary to navigate a disjointed healthcare landscape. For providers, this story underscores a critical opportunity: proactive, non-judgmental engagement with OHCs is not a threat to expertise but a foundational strategy for patient-centered care. By acknowledging and constructively partnering with these patient-led spaces, …

Secondary Infertility: A Personal Story Of Loss And Grief, Ben Hughes

Patient Experience Journal

An increasing number of people worldwide are experiencing fertility and this trend is reflected in the data from the United Kingdom. However, most research focuses on the experiences of women and so the male perspective is largely missing from the literature. This narrative is an account of my personal journey of secondary infertility. Presenting a male perspective of infertility provides a point of view which is rarely explored and is about a topic which feels largely a societal taboo. I chart how infertility has changed me, what it has meant to me through my years of trying to come to …

When Hope Meets Harm: A Story Of Trust, Pain, And Consent In Intimate Care, Sharon I. Choe, Erin Foster

Patient Experience Journal

Transparent communication is key to building and maintaining strong patient-provider relationships. In this article, I interviewed a patient who shared her experience undergoing treatment for a chronic vulvar condition and the consequences that followed. She described a painful procedure for which she felt unprepared and later realized she had not been educated about the need for ongoing care. Years later, this gap in understanding contributed to irreversible disease progression. After re-establishing care with a dermatologist she felt comfortable confiding in, the patient expressed a desire for her story to be shared. This narrative presents her experience as she shared it …

Ai As A Physician Companion In Enhancing Trust In Healthcare, Saria Gouher

Patient Experience Journal

Trust remains a fundamental pillar of the physician–patient relationship, ensuring care that is safe, evidence-based, and grounded in shared decision-making; however, the increasing use of artificial intelligence tools such as ChatGPT has introduced a new dynamic in how patients interpret symptoms and seek medical advice. This narrative describes a clinical encounter involving an elderly patient with multiple myeloma whose caregiver used ChatGPT to evaluate new-onset slurred speech suggestive of stroke, resulting in an urgent recommendation driven by incomplete clinical information. Through comprehensive history-taking, physical examination, and careful review of the Artificial Intelligence (AI)-generated response, the physician reassured the caregiver, contextualized …

Rebuilding Trust After Bondi Beach: Healing Patients, Protecting Caregivers, And The Sacred Work Of Care, Anne Marie Hadley

Patient Experience Journal

The Bondi Beach tragedy of December 14, 2025 profoundly disrupted Australia's collective sense of safety, belonging, and trust. Beyond the immediate loss of life and injury, such events exert lasting impacts on healthcare systems and the people who work within them. This article explores how trust can be rebuilt not only for patients and communities, but also for caregivers themselves. Drawing on trauma-informed care, psychological safety, and human experience design, it examines the often-overlooked dimensions of staff safety, the essential role of pastoral care and chaplaincy, and the particular vulnerabilities experienced by faith-based caregivers during periods of social fracture and …

Co-Designing Trust: Patient Experience, Relationships, And The Design Of Care, Toni Land

Patient Experience Journal

Trust can have a positive or negative impact on patients, families, and community healthcare experience. Although important, it is often treated as something soft and intangible rather than something intentionally measured and designed. Currently, healthcare organizations collect and report patient experience data related to communication, courtesy, respect, and responsiveness. But these measures do not capture the specific behaviors that influence whether trust builds or whether it stalls. This commentary explores trust as a foundational behavioral and environmental element in healthcare and challenges that improving trust requires more than good intentions; it requires bringing voices to the table through co-design. Starting …

Healing The Social Covenant: Rebuilding Trust And Re-Humanizing Healthcare, Cynda Hylton Rushton

Patient Experience Journal

Violence against healthcare workers continues to escalate despite substantial investments in security measures, workplace violence prevention programs, and legislative protections. Although these interventions are necessary, they have not produced sustained improvements in workforce safety or retention, suggesting that workplace violence is more than a behavioral or security problem. This commentary argues that it also reflects a deeper erosion of trust within healthcare. Drawing on evidence linking workplace violence to burnout, moral injury, psychological distress, and turnover intention among nurses, we propose that repairing trust is essential to sustaining the workforce and healthcare.Building on our earlier work, Rebuilding a Foundation of …

Integrating Matrescence Into Birth Worker Practice: A Practice Improvement Project, Kelsey B. Green

Doctor of Nursing Practice (DNP) Projects

Background: Perinatal mood and anxiety disorders (PMADs) affect 20–25% of mothers worldwide and are a leading cause of maternal complications. Stigma, fragmented care, and limited provider training leave families vulnerable, while birth workers offer trusted, continuous support.

Problem: Birth workers' maternal mental health (MMH) training is minimal and often excludes matrescence, the developmental transition to motherhood, limiting their ability to distinguish normal adjustment from clinical PMADs and delaying intervention.

Methods: A single-group, pre-/post-test design evaluated a matrescence-informed workshop at Roots Community Health's 2nd Annual Symposium. Anonymous surveys measured knowledge, attitudes, and confidence, analyzed with Mann–Whitney U, Wilcoxon signed-rank tests, and …

An Online Epilepsy Self-Management Tool For Patients With Epilepsy: A Formative Usability Study, Katarzyna Czerniak, Ross Shegog, Refugio Sepulveda, Robert Addy, Youngran Kim, Sahiti Myneni, Alejandra Garcia-Quintana, Kimberly Martin, David M Labiner

Faculty, Staff and Student Publications

Background: Epilepsy is a serious chronic neurological condition with no permanent cure. Continual self-management is important to mitigate seizure frequency and optimize quality of life in people with epilepsy who have greater disparities in accessing epilepsy care. The Management Information & Decision Support Epilepsy Tool (MINDSET [UTHealth, University of Arizona, and Radiant Digital]) was developed to enhance accessibility to epilepsy self-management (ESM) assessment and treatment. The purpose of this formative usability pilot study was to assess the user experience and functionality of MINDSET 2.0, an enhanced cross-platform online version of MINDSET, among a sample of patients with epilepsy prior to …

The 2025 Measles Outbreak In Texas, Tamer Oraby, Martial L. Ndeffo-Mbah

School of Mathematical & Statistical Sciences Faculty Publications

Background: In 2025, Texas experienced its largest measles outbreak in decades, reporting 762 cases by mid-August. Measles is a highly contagious but vaccine-preventable infection transmitted mainly among unvaccinated individuals and capable of causing severe outcomes.

Methods: We investigate counterfactual measles control scenarios based on daycare and school closures and reactive vaccination of infants and children, including mixed interventions. We analyze the 2025 Texas outbreak using an age-structured multi-stage SEIR model formulated as a system of ordinary differential equations. The model is fit to case data using Bayesian inference to estimate the effective reproduction number and generate posterior predictive trajectories under …

Same-Day Cancellation Reduction In An Ambulatory Surgery Unit, Anthone Dalit Vengersammy

Master's Projects and Capstones

Problem: Same-day surgical cancellations in the outpatient surgery setting remain a significant operational and patient care challenge. Preventable cancellations negatively affect patient experience, operating room efficiency, staff productivity, and healthcare costs. 

Context: A microsystem and organizational culture assessment identified several factors contributing to same-day cancellations, including unclear preoperative instructions, incomplete medical clearance, inconsistent patient education, lack of standardized workflows, unclear staff responsibilities, and communication gaps among interdisciplinary teams. SWOT and gap analyses were used to identify opportunities for improvement and guide intervention planning.

Interventions: Quality improvement interventions were implemented through iterative Plan-Do-Study-Act (PDSA) cycles. Strategies included revising preoperative patient instructions, …

Addressing Obesity In Rural Health Clinics, Morgan P. Trusley

Student Scholarly Projects

Practice Problem: According to the Centers for Disease Control and Prevention (CDC), more than 2 in 5 adults in the United States are obese (CDC, 2024a). In a rural primary care clinic in South Carolina, approximately 70% of patients are obese and there is no current intervention in place to help educate and guide these patients in weight loss strategies.

PICOT: In obese adults over the age of 18 at a rural health clinic with a Body Mass Index (BMI) greater than or equal to 30, does implementing weekly virtual and in person multicomponent behavioral intervention educational sessions compared to …

Public Perceptions Regarding Surveillance Of Lyme Disease In Tennessee, Shaheena Yasmin Asad

Walden Dissertations and Doctoral Studies

Lyme disease (LD), a tick-borne illness, has been a growing concern in the state of Tennessee. Studies have established environmental concerns regarding a growing tick population and identified a gap between reported cases and disease burden in Tennessee. Despite this information, it remains classified as a low-incidence reporting state, raising concerns about underreporting that indicate an ineffective current surveillance system. Because the public perception regarding surveillance of LD is unknown, the purpose of this qualitative study was to explore how adults in Tennessee perceived LD as a credible public health threat within the context of the current surveillance system. Guided …

Conceptual Framework And Key Considerations For Field-Based Infrastructure In Food Is Medicine Research, Shreela V Sharma, Colleen Tewksbury, Christopher R Long, Colleen Spees, Ronit A Ridberg, Reshma Gupta, Erin P Ferranti, Naomi Tice, Eric Peterson, Brian Levine

Faculty, Staff and Student Publications

In 2023, the American Heart Association launched the Healthcare by Food (HCXF) initiative to establish a rigorous evidence base for Food Is Medicine (FIM) programs, so that patients with acute or chronic disease could access FIM programs as a covered benefit under their health insurance. The HCXF initiative is engaging in research, advocacy, and education to support the development and testing of interventions that improve health outcomes. The HCXF initiative launched 9 task forces aligned with research progress, including the Field-Based Infrastructure task force designed to examine broader questions to help support either earlier or later stages of the HCXF …

Hope Kit Program, Monica Reuber

Capstone Experience: Master of Public Health

Suicide is a leading cause of death in adolescents and young adults, with a disproportionate burden of those deaths in rural areas such as Kansas. High rates of depressive symptoms, suicidal thoughts, and suicidal attempts, combined with a shortage of mental health providers, emphasize the need for community-based intervention.

This capstone is designed to develop a plan for Hope Kits, a proposed suicide prevention program, among youth in grades 7-12 in Sheridan County, Kansas to improve coping skills, promote help-seeking behavior, and reduce suicide risks.

A logic model guides the program development, which aligns with available literature and Social Cognitive …

Rural/Urban Disparities In Utilization Of Diabetes Self-Management Training (Dsmt) To The Fee-For-Service Medicare Population, 2017–2024, Wanying Zhu, Aleksandr Taraskin, Jeffrerey Talbert

Rural & Underserved Health Research Center Publications

Key Report Highlights

• A significant rural DSMT access gap exists. Rural beneficiaries accounted for 20.1% of Medicare beneficiaries with diabetes but only 7.8% of DSMT participants.

• Geographic availability remains limited. Only 16.8% of counties with DSMT utilization were rural.

• Access, not demand, appears to be the primary challenge. Rural counties offering DSMT achieved utilization rates more than twice those observed in urban counties (6.0% vs. 2.5%).

• Expanding rural DSMT capacity may represent a high-impact opportunity to improve diabetes self-management support among underserved Medicare beneficiaries.

Addressing Food Pantry Capacity To Offer Medically Tailored Groceries For Food Insecure Individuals With Chronic Disease In Rural South Carolina, Anna G. Taylor

All Theses

This study examines the feasibility of implementing medically tailored grocery (MTG) programs within rural food pantries in South Carolina to better serve food-insecure individuals living with chronic diseases. Using a mixed-methods design, the study aimed to assess current pantry capacity, identify barriers and facilitators to MTG implementation, and evaluate strategies to strengthen MTG delivery.

The intervention was guided by three implementation science frameworks: the Six-Step Knowledge Sharing Model, the Consolidated Framework for Implementation Research (CFIR), and the RE-AIM evaluation framework. Data collection occurred in two phases. In Phase 1, statewide focus groups, capacity surveys, and inventory assessments were conducted to …

Cost-Effectiveness Evaluation Of Artificial Intelligence-Assisted Chest Radiograph Interpretation For Tuberculosis Screening In Rural Health Units In The Philippines, Harold Henrison C. Chiu, Bryan Christopher C. Lao, Gloanne C. Adolor

Graduate School of Business Publications

Background: Tuberculosis remains a major public health burden in the Philippines, where diagnostic delays are amplified by limited radiology capacity in rural health units (RHUs) and geographically isolated and disadvantaged areas (GIDAs). Computer-aided diagnosis (CAD) using artificial intelligence (AI)-assisted chest radiograph interpretation may shorten the screening pathway and reduce reliance on scarce specialist readers. However, its economic value for RHUbased tuberculosis screening has not been fully evaluated.
Methods: We developed a decision-tree cost-effectiveness model in Microsoft Excel 365 to compare AI-assisted chest radiograph interpretation with conventional manual radiologist or teleradiology interpretation among a theoretical annual cohort of 1,000 presumptive tuberculosis …