Digital Commons Network^™

Burnout Assessment Tool Development And Validation For Healthcare Workers: A Psychometric Approach Using Rasch Modelling And Exploratory Factor Analysis, Rosnah Ismail, Suriya Kumareswaran Vallasamy

Kesmas

Burnout remains a significant occupational threat to healthcare workers (HCWs). Existing instruments, e.g., the Maslach Burnout Inventory, have limited applicability in healthcare-specific contexts. This study aimed to develop and validate the Burnout Scale for Assessing Stress in Healthcare Workers (BSAS-HCW), designed to measure cognitive and emotional exhaustion. A cross-sectional survey was conducted among 245 Malaysian HCWs representing diverse roles, including staff nurses (57.7%), house officers (14.3%), medical officers (13.5%), specialists (5.7%), pharmacists (4.5%), and other HCWs. Exploratory factor analysis revealed a two-factor structure with strong internal consistency (Cronbach's alpha: cognitive = 0.95; emotional = 0.97), and all items loaded above …

Improving Glycemic Control Among Indonesian Urban Adults: A Digital And Behavioral Extension Of The Information–Motivation–Behavioral Skills Model, Imelda Appulembang

Kesmas

Management of type 2 diabetes mellitus (T2DM) in Indonesia continues to face challenges due to behavioral, informational, and technological gaps among patients. This study analyzed the influence of self-regulatory competence and information, motivation, family support, and digital health literacy on glycemic control behavior. A cross-sectional survey was conducted from February to April 2025 among 587 adults aged >30 years with T2DM enrolled in the Chronic Disease Management Program at primary health care in six major cities: Jakarta, Surabaya, Yogyakarta, Medan, Makassar, and Banjarmasin. Data were collected through structured questionnaires and analyzed using partial least squares structural equation modeling. The findings …

Physician Peer Review: Just Culture And Practical Implementation In An Emergency Department, Christian Fromm, Monica Colicino, Merle A. Carter, Elizabeth M. Datner

Einstein Health Papers

BACKGROUND: Although regulatory agencies require hospitals to engage in peer review to maintain accreditation, quality assurance review processes are not standardized, and well-structured peer review of clinical cases involving medical errors and adverse events governed by Just Culture principles is not widespread. We implemented such an emergency department (ED) physician peer review process and performed an analysis of cases that underwent review.

METHODS: We formed an ED physician peer review committee at our institution guided by Just Culture principles, including promotion of a culture of safety to encourage open reporting of errors and near misses, and top-down leadership commitment to …

Developing Ehealth Interventions To Improve Diabetes Management In Emerging Adulthood: Qualitative Formative Study, Susan Eggly, Steven J Ondersma, Deborah A Ellis

Faculty, Staff and Student Publications

Background: Emerging adulthood is a high-risk period during which many with type 1 diabetes demonstrate suboptimal diabetes management and glycemic control. There is a need for effective, scalable interventions designed specifically for this population. Technology-based approaches are readily accessible to this age group. Furthermore, interventions consistent with self-determination theory-which posits that the fulfillment of psychological needs for autonomy, self-efficacy, and relatedness promotes intrinsic motivation for change-may resonate well with emerging adults' developmental needs for establishing independence and autonomy, and growing their social network.

Objective: This study aimed to enhance the potential relevance, sustainability, and efficacy of 3 self-determination theory-informed mobile …

Clinical Characteristics And Risk Factors Associated With Acute Kidney Injury Among Hospitalized Primary Covid-19 Infected Patients, Monchai Siribamrungwong, Kamontip Chaikomon

Chulalongkorn Medical Journal

Background: Coronavirus disease 19 (COVID-19) mainly affects to respiratory system from mild to severe symptoms. Additionally, acute kidney injury (AKI) is an important complication causing substantially high morbidity and mortality. During the pandemic of COVID-19, Public health care in Thailand experienced many cases and complications.

Objectives: This study demonstrated an incidence, clinical characteristic, independent risk factors of AKI and mortality in hospitalized COVID-19 patients with AKI and non-AKI patients.

Methods: A retrospective, observational study was performed in Lesdsin Hospital from August 2021 to August 2022. A total of 576 hospitalized patients with diagnosis of COVID-19 infection were analyzed. AKI was …

Cognitive Testing Of Candidate Items In A Wellbeing Measure Developed For Aboriginal And Torres Strait Islander Peoples, Alana Gall, Gail Garvey, Kate Anderson, Abbey Diaz, Kirsten Howard

Journal of the Australian Indigenous HealthInfoNet

Purpose Health and wellbeing for Aboriginal and Torres Strait Islander peoples is poorly understood, due to commonly used measures of quality of life and wellbeing not aligning with their collectivist worldviews. The need to develop a wellbeing measure, grounded in the aspects of life that Aboriginal and Torres Strait Islander people identify themselves as important, was therefore a priority. The current study aimed to cognitively assess the face and content validity of a new wellbeing measure under development for Aboriginal and Torres Strait Islander adults. Methods We employed a qualitative cross-sectional cohort design. Forty-nine unique draft wellbeing statements underwent cognitive …

Impact Of Community Factors On Naloxone Overdose Reduction In Ohio, Theophilus Oduro Frimpong

Walden Dissertations and Doctoral Studies

The opioid crisis in Ohio, driven by fentanyl, persists due to inequitable access to naloxone despite its proven effectiveness. This study examined how socioeconomic status (SES), race/ethnicity, population density, and hospital availability per capita predicted naloxone overdose reversals (dependent variable) in Ohio. Social-ecological theory guided this quantitative historical correlational analysis of Ohio’s Project DAWN index data (N = 5,280). Inclusion criteria included individuals ages 18 to 65 with naloxone-related overdose reversals (dependent), naloxone distribution (moderator), and community factors (independent). Multiple linear regression results showed that SES (p >.50), race/ethnicity (% White, p = .588; % Black, p = .495; % …

Analyzing The Global Happiness Index, Victoria Hernandez, Christy W. Wachira

SMU Data Science Review

This study explores the Global Happiness Index using data compiled from the OECD and Our World in Data to identify key factors contributing to societal well-being. Six primary predictors were analyzed: GDP per capita, social support, healthy life expectancy, freedom to make life choices, generosity, and perceptions of corruption. Regression and clustering techniques were employed to uncover patterns among countries. By expanding the analytical scope beyond conventional economic and social indicators, this study helps identify new pathways for improving well-being across diverse cultural and economic landscapes. Additional variables such as perceived safety, political engagement, and values related to family and …

Characterization Of Antiretroviral Therapy (Art) Adherence Phenotypes And Psychosocial Symptom Clusters Among Black/African American (Aa) And Hispanic/Latine Adolescents And Young Adults (Ayas) With Hiv In The Adherence Connection For Counseling, Education, And Support (Access-Ii) Trial, Ann-Margaret Navarra, Taehoon Ha, Eva Liang, Maurade Gormley, David R. Garcia, Jason Fletcher, Lloyd A. Goldsamt, Michael G. Rosenberg, Karin Hasegawa, Jie Yang

School of Nursing Faculty Publications

Antiretroviral therapy (ART) adherence behavior is heterogeneous among adolescents and young adults (AYAs) with HIV and influenced by individual and interpersonal psychosocial factors. The primary objective of this study is to characterize ART adherence phenotypes and psychosocial symptom clusters, as related to ART adherence and HIV viral load suppression. This analysis included 60 AYAs with HIV enrolled in an ART adherence support clinical trial. Self-reported ART adherence at baseline, 12-weeks, and 24-weeks was used to define four ART adherence phenotypes: consistently high adherence (YY), early-only adherence (YN), late-only adherence (NY), and consistently low adherence (NN). Symptom clusters were empirically derived …

Design And Refinement Of Cybercelltm, A Virtual Reality Health Education Program For Adolescents And Young Adults With Sickle Cell Disease, Aimee Hildenbrand, Melanie Pitone, Benjamin Bear, Corinna L. Schultz, Sherman Finch, Danielle Morley, Stephanie Hubbard, Alyssa Decino, Melissa A. Alderfer, Lori E. Crosby, Fredric Freeman

Department of Pediatrics Faculty Papers

For people living with sickle cell disease (SCD), the risk for disease complications and premature death rises sharply in adolescence and young adulthood, when chronic organ damage is compounded by reduced preventive care. To make informed health care decisions, adolescents and young adults (AYAs) require effective education about their health condition and treatment options. We aimed to systematically design and develop a user-centered, evidence-based virtual reality (VR) health education program to optimize the use of SCD therapies among AYAs with SCD. We engaged a diverse team including AYAs with SCD and their caregivers, multidisciplinary SCD clinicians and researchers, patient education …

An Essay On Trailblazing With Service Animals Langer, Pilot, Bowie, And Izzie: Preserving Non-Partisan Public Health And The Law, Gary C. Norman

Journal of Law and Health

A direct correlation exists among humans, their animals, and human health and wellness. This article will focus concisely on law students with disabilities and lawyers with disabilities and how they can be empowered to be trailblazers while remaining healthy and well. Salutogenic Model should be optimized by lawyers with disabilities working at the intersection of animal law, disability law, and public health law. Service animals have positive and salubrious impacts upon their handlers in several ways, including psychosocial health and wellbeing. The Grand Architect (or in my Cherokee tradition, "great spirit") continuously partners me with complicated but magnificent dog partners …

From Potholes To Perceived Social Support: Community Influences On Individuals With Mobility Disabilities And Their Care Teams In New Orleans, Kelsey Witmeier, Gabrielle Gonzalez, Michael Norman, Mary Delahoussaye, Phil Wilson, Tung-Sung Tseng

Journal of the Louisiana Public Health Association

Background: Little is known about the role of community in influencing the experiences, needs, and well-being among individuals with mobility impairments and disabilities (IMIDs), caregivers, and service providers in New Orleans. Methods: We conducted semi-structured interviews with 10 individuals who identified as IMIDs, caregivers, and service providers, who were recruited using convenience sampling. Transcripts were transcribed verbatim, and thematic analysis was conducted to identify key themes. Results: Three themes were found: 1) community barriers and facilitators, 2) the community’s role in perceived belongingness, and 3) the unique influences of the community on caregivers. Conclusion: Community influences the experiences of IMIDs …

Understanding The U.S. Maternal Healthcare System At The Intersection Of Asian American Birth Outcomes And The Model Minority Stereotype: A Literature Review, Sophia Hevel

University Honors Theses

This thesis aims to explore the maternal healthcare system in the United States as it pertains to Asian American birthing people, the ways in which their racial, ethnic, and cultural identities are interacted with within the U.S. Healthcare system, and subsequently the detrimental effects of the medical system's devaluation of culturally specific birthing and postpartum practices have on Asian American birthing experiences. This will be accomplished through an exploration of the United States' maternal healthcare system, or rather, its crisis; how Asian Americans navigate a system that has not been structured to support their specific needs; and lastly, a discussion …

Risk Factors For Unexpected Death In Patients Identified By A Communication And Resolution Program, Peter Lodato, Neal D. Goldstein, Alexandra M, Mapp, Adebayo Gbadebo, David A. Paul

Department of Pediatrics Faculty Papers

Many patients experience unexpected harm while receiving healthcare, with a lasting impact on patients, families, and caregivers. Communication and Resolution Programs are being adopted with increased frequency, as a more systematic, transparent, and equitable approach to these unexpected outcomes. The aim of this study was to identify whether demographic factors played a role in identifying patients with unexpected death, as managed in our CRP. This nested case-controlled compared 236 patients who experienced an unanticipated death with 2,360 controls who died expectedly over a 10-year period. Patients with unexpected death were more likely to be Black (AOR 2.18 95% CI 1.01-4.68), …

The Time-Dependent Association Between Irritable Bowel Syndrome And All-Cause And Cause-Specific Mortality In The Nih-Aarp Cohort Study, Shreela V Sharma, Qing Lan, Maki Inoue-Choi, Baharak Moshiree, Paul Albert, Rashmi Sinha, Emily Vogtmann

Faculty, Staff and Student Publications

Introduction: Evidence on the association between irritable bowel syndrome (IBS) and mortality is conflicting. In this study, we estimated the association between IBS and all-cause and cause-specific mortality in the NIH-AARP Diet and Health Study.

Methods: IBS diagnoses between 1994 and 2008 were identified from Medicare claims data, and mortality outcomes through 2019 were obtained through linkage to the National Death Index. Using multivariable Cox proportional hazards regression models, we estimated hazard ratios (HRs) and 95% confidence intervals (CIs) for all-cause and cause-specific mortality within partitioned follow-up time categories (>2-5, >5-8, >8-11, >11-14, >14-17, and >17 years) with adjustment …

Volume 5 November '25 Full Issue, Donna Williams

Journal of the Louisiana Public Health Association

No abstract provided.

Third Grade Reading Proficiency In Deaf/Hard Of Hearing Children Who Received Early Intervention, Jareen Meinzen-Derr, Cassandra Conrad, Mekibib Altaye, Elodie Betances, Jayna Schumacher, Susan Wiley

Journal of Early Hearing Detection and Intervention

Background

Early enrollment in Part C Early Intervention (EI) by age 6 months is linked to improved language and kindergarten readiness in deaf or hard of hearing (DHH) children, but its effect on later academic outcomes is unclear. This study examines whether earlier (<6 months) or later (>6 months) enrollment influences third-grade reading proficiency.

Method

This study used data linked from three Ohio state agencies for infants identified with permanent hearing loss born 2008-2014 who received EI; 412 had third grade standardized reading tests. Reading levels were categorized from limited to advanced. Logistic regression assessed the association between enrollment timing and reading proficiency, …

Developing A Research Agenda In Partnership With Parents Of Deaf/Hard-Of-Hearing Children, Carrie A. Davenport, Ursula M. Findlen, Ann Schenk Mcalearney, Lisa Vaughn

Journal of Early Hearing Detection and Intervention

Background: Community-based participatory research (CBPR) is an excellent fit for understanding and addressing the unique and diverse needs of deaf or hard-of-hearing (DHH) children and their families.

Objectives: We describe lessons learned from a capacity building project initiating an academic-community partnership between a multidisciplinary research team and a small group of parents of DHH children. Trainings and focus group style discussions created a research agenda reflective of families’ priorities.

Methods: Processes are described related to the development and composition of a Family Advisory Council, training topics and methods, the process for generating and prioritizing topics, and evaluation procedures.

Lessons learned: …

The Follow-Up Gap: Racial Disproportionality And Social Determinants Of Health In New Jersey’S Hearing Detection And Intervention Program, Maryrose Mcinerney, Wendy Zeitlin

Journal of Early Hearing Detection and Intervention

Objectives. To assess how race/ethnicity and social determinants of health are related to loss to follow-up (LTF) from NJ’s Early Hearing Detection and Intervention (EHDI) program.

Methods. All infants born in NJ between June 2015 and June 2017 referring for additional hearing healthcare after hospital discharge were considered for inclusion in this study. The sample consisted of 4,141 babies, 10.7% of which received no follow-up care. Step-wise multi-level logistic regression was used to determine how race/ethnicity, family-level, and community-level social determinants of health (SDOH) were predictive of LTF.

Results. In each model, the odds of being LTF were significantly higher …

Band-Aids And Backroads: Surviving Rural Healthcare In South-Central Mississippi, Cambry L. Craft

Honors Theses

Health is more than the absence of disease—it is the product of opportunity, trust, and access. Yet for millions living in rural areas of the United States, equitable healthcare remains out of reach. This thesis seeks to amplify the voices of rural residents in Mississippi and uncover how their experiences, beliefs, and cultural values shape their perception of their local hospital and the care that is provided there. This qualitative research study examines the experiences and opinions of a rural community in south-central Mississippi regarding their local hospital, as well as their perceptions of the most effective approach to prevent …

Exploring The Acceptability Of The Kimberley Mum’S Mood Scale For Perinatal Mental Health Screening In Gove District Hospital, North-East Arnhem Land, Tom P. Atkinson, Erica P. Spry, David Atkinson, Julia V. Marley, Emma Carlin

Journal of the Australian Indigenous HealthInfoNet

Objective: Across Australia perinatal mental health challenges disproportionately impact Aboriginal women. Identifying Aboriginal women at risk of adverse mental health outcomes in the perinatal period is an important step in supporting their overall health and wellness. Current screening tools have significant limitations when used with Aboriginal women.

The Kimberley Mums Mood Scale (KMMS) is a culturally secure approach to screening for perinatal mental health disorders in Aboriginal women. It has been validated in the Kimberley region of Western Australia and may be able to improve mental health screening in other regions. In this study the KMMS was trialled at a …

Parentcoach: Designing An Mhealth Parenting App To Enhance Parental Involvement In Adhd Support, Franceli L. Cibrian, Nancy Herrera, Jesus A. Beltran, Lucas M. Silva, Mikaela Pulse, Kayla Anderson, Cassie Zeiler, Luc Rieffel, Daniel I. Lee, Sabrina E. B. Schuck, Kimberley D. Lakes

Engineering Faculty Articles and Research

Introduction: Parents play a vital role in supporting self-regulation and managing behaviors in children with Attention-Deficit/Hyperactivity Disorder (ADHD). However, many face barriers to accessing consistent, evidence-based support. Mobile health (mHealth) technologies offer a promising way to deliver flexible, low-burden guidance for parents on best practices and strategies to support their children's self-regulation. However, designing them is non-trivial.

Objective: This paper introduces ParentCoach, a mobile application designed to support parents of children with ADHD through brief daily lessons, reflection prompts, and skill-building activities.

Methods: ParentCoach was developed in two phases: (1) secondary analysis of qualitative data from over 30 families …

State Of Ohio Adversity And Resilience (Soar) Study Protocol: A Comprehensive, Multimodal, Family-Based, Longitudinal Observational Investigation Of Risk And Resilience In Mental Health And Substance Use Disorders, Chris Flask, Martha Sajatovic

Faculty Scholarship

Introduction Deaths related to drug overdose and suicide in the USA have increased 500% and 35%, respectively, over the last two decades. The human and economic costs to society associated with these - €- deaths of despair' are immense. Great efforts and substantial investments have been made in treatment and prevention, yet these efforts have not abated these increasing trajectories of deaths over time. The COVID-19 pandemic has exacerbated and highlighted these problems. Notably, some geographical areas (eg, Appalachia, farmland) and some communities (eg, low-income persons, - €- essential workers', minoritised populations) have been disproportionately affected. Risk factors have been …

Agitation In Alzheimer’S Disease: From Assessment To Therapeutics, Natalia P Rocha

Faculty, Staff and Student Publications

Agitation is a neuropsychiatric syndrome characterized by excessive motor and/or verbal behaviors, with or without aggressive behaviors. The prevalence of agitation in Alzheimer’s disease varies from 5% to over 50%. Multiple factors have been implicated in its pathophysiology, including disease stage, comorbidity with other symptoms (e.g., psychosis, anxiety/depression), and psychosocial factors. Ruling out delirium and identifying environmental triggers are fundamental steps in the management of agitation in Alzheimer’s disease. For establishing an effective therapeutic plan, it is important to define duration, severity, and potential for harm. While non-pharmacological approaches are considered the first line of intervention, pharmacological agents …

What Covid-19 Taught Extension: Experiences Of Extension County Engagement Specialists Promoting Vaccinations In Meat Processing Plants In Rural Missouri., Wilson Majee, Ifeolu David, Lynelle Phillips, Rachel Buenemann, Kassandra Maturino

Journal of Extension

Extension played a significant role, in collaboration with other key community organizations, by disseminating information that debunked COVID-19 myths, and promoting vaccinations at the community level. In this article we present insights from the experiences of Extension faculty at the University of Missouri who were engaged in promoting COVID-19 vaccinations for meat processing plant workers. Findings from this quality improvement project highlight opportunities for leveraging Extension field faculty, and challenges to consider in future public health promotion efforts.

Editorial: Healthcare Technologies And Space: Therapeutic Built Environment As A Health Technology And Technologies For Improved Healthcare Settings, Evangelia Chrysikou, Fernando Loizides, Marianna Obrist, James Barlow, Paul Barach

College of Population Health Faculty Papers

No abstract provided.

Vitamin D Deficiency And Cardiovascular Health Disparities In High-Melanin Populations: A Scoping Review, Jalen K. Luter, Silver R. Kaylor, Michael S. Boyer

Doctoral Projects

Cardiovascular disease (CVD) remains a leading cause of mortality and disproportionately affect individuals with darker skin tones, partly due to vitamin D deficiency (Sabzmakan et al., 2014). This Doctor of Nursing Practice (DNP) project uses a scoping review methodology to examine the relationship between vitamin D deficiency and cardiovascular outcomes, with an emphasis on high-melanin populations. Guided by the Joanna Briggs Institute Framework, the review synthesizes existing evidence, identifies gaps in representation and biomarker use, and highlights social and biological contributors to disparity. Databases including PubMed, CINAHL, EMBASE, and Scopus were searched, and studies were screened using standardized inclusion criteria: …

Survey On Preparedness And Readiness For Technological Advancements In Ai Sparta Ai, Jegason Phosphorus Diviant

Population Health Research and Scholarship

Generative AI is rapidly entering academic workflows, yet readiness to use these tools in graduate training and the workplace remains unclear. The SPARTA AI was administered online to faculty and graduate students in the University of New Mexico’s Psychology Department and COPH (Feb–Sep 2025). The analytic sample included N=37 respondents. Descriptives, role-stratified academic AI usage, one-sample tests of perceived preparedness vs a 3.0 midpoint, and correlations between AI interest and academic usage were computed; Wilson CIs were used for proportions. The sample comprised 20 faculty and 17 graduate students, primarily from COPH and Psychology. AI usage was generally infrequent across …

What Are The Barriers And Facilitators To The Acceptance Of Information And Communication Technology-Based Interventions For Improving Resilience And Mental Health Of Healthcare Workers: A Scoping Review Protocol, Elisabete Alves, Ricardo Rodrigues, César Fonseca, Manuel Lopes, Inês Faria, Nina Dalkner, Paul Barach, Frans Folkvord, Jim Ingebretsen Carlson, Eva Reininghaus, Michele Wessa, Yvonne Prinzellner, Vanessa Leung, Eva Turk, Lara Guedes De Pinho

College of Population Health Faculty Papers

INTRODUCTION: Healthcare workers (HCWs) report overwhelming demands and experience crisis levels of burnout and unique challenges that further impair their mental health. Promotion of mental health among HCWs using information and communication technology (ICT) has received little empirical research attention and interventions for improving mental health resilience in HCWs are not well established.

DESIGN: Scoping review to map existing evidence and identify gaps for future research regarding the main barriers and facilitators of the acceptance of ICT-based interventions for improving resilience and mental health among HCWs working in all healthcare settings.

METHODS AND ANALYSIS: This protocol was developed in accordance …

Co-Designing A Patient-Facing Version Of A Mental Healthcare Pathway For People Receiving Dialysis, Alexandra Albers, Charlotte Berendonk, Julie Robison, Richard Sawatzky, Loretta Lee, Monika Bolin, Jeff Costley, Sandy Johnstone, Kevin Kemp, Justin Leroux, May Tourangeau, Sabiha Zaman, Kara Schick-Makaroff

Patient Experience Journal

A Community Advisory Committee comprised of nine members with lived experience of kidney failure, identified the need for a patient-facing version of a mental healthcare pathway for people receiving dialysis in Alberta, Canada. Recognizing that healthcare tools to support person-centred care practices should be available in lay language, our team (comprised of Community Advisors and healthcare clinicians and researchers) co-designed a patient-facing pathway: “Your Journey: Coping with and Adjusting to Dialysis.” The Provincial Pathways Unit provided a template for the pathway, and the content was adapted through multiple online and in-person meetings with the Community Advisors. Adaptations were informed by …