Digital Commons Network^™

Identifying Delays Impacting Maternal And Perinatal Deaths Using A Facility-Based Death Audit Review System Integrated With Community Engagement: A Mixed Methods Study, Zahid Memon, Wardah Ahmed, Shah Muhammad, Sajid Soofi, Shanti Chouhan, Arjumad Rizvi, Paul Barach, Zulfiqar A. Bhutta

College of Population Health Faculty Papers

BACKGROUND: Pakistan's persistently high maternal (178 per 100 000 livebirths) and neonatal (41 per 1000 livebirths) mortality ratios are compounded by lack of reliable data on the root causes and preventable risk factors, which hinders their effective use in improving care and progress toward safe, high-quality services. We sought to identify system delays impacting maternal and perinatal deaths using a facility-based death audit review system integrated with community engagement for implementing actionable solutions.

METHODS: We used a mixed methods, concurrent parallel study design at three secondary level healthcare facilities in District Matiari, Sindh, Pakistan. We reviewed 319 cases that included …

How Pollinator Populations Can Impact Chronic Disease Risk, Kylee Cubbison

Honors Projects

This project investigates how pollinator populations can impact chronic disease risk. Pollinator populations are declining, which can have serious implications for human health. Declining pollinator populations can limit healthy food production and affordability. Poor nutrition is a major risk factor for most chronic diseases. Less healthy food available for people to consume can negatively impact diets and increase the risk of developing chronic diseases. This project aims to address a potential gap in research existing on this specific topic regarding pollinator populations and human chronic disease risk. A brochure targeted towards educating the general public on this topic was created …

Beyond The Numbers: Supporting Young Adults With Diabetes In The Transition To Adulthood, Alexis Salkovick

Honors Projects

This project focuses on the transition to adulthood for young people with diabetes, a chronic medical condition. Both Type 1 and Type 2 diabetes are included. The main research focus is two-part: first examining this transition including barriers to health care, changes in lifestyle, and mental health, and then creating a new, innovative tool to support young adults with diabetes. An independent literature review was conducted to investigate diabetes management, barriers to health care, how transitioning to adulthood impacts diabetes care, and the importance of patient support systems. Then, a board game was developed with the dual purpose of educating …

An Ot Educational Program For Individuals With Upper And Lower Limb Amputations, Laurie R. Spinks Mrs, Cassandra Nelson

Spring 2026 OTD Capstone Symposium

An OT approach to reducing prosthetic abandonment with an accessible guide to promote self sufficiency and community connections for individuals with amputations.

Occupational Therapy For Maternal Pelvic Floor And Mental Health: A Holistic Approach To Recovery, Diana S. Theodore

Student Capstone Papers

Maternal pelvic floor dysfunction (PFD) is highly prevalent yet often underrecognized in occupational therapy practice, despite its significant impact on mental health, daily function, and quality of life. Many postpartum women experience symptoms such as urinary incontinence, pain with intimacy, and pelvic organ prolapse, which are frequently normalized or left untreated. Occupational therapy practitioners often have limited training in addressing the complex relationship between pelvic floor function and maternal mental health, contributing to gaps in care. The purpose of this capstone project was to develop a comprehensive handbook for occupational therapy students and practitioners integrating pelvic floor function and maternal …

Community-Based Program To Support The Occupational Needs Of Middle Eastern Refugee Women Transitioning Into Western Society, Zuha A. Mohammad, Cassandra Nelson

Spring 2026 OTD Capstone Symposium

Middle Eastern refugee women resettling in Western societies often experience barriers that disrupt participation in meaningful occupations, including language barriers, unfamiliar systems, financial challenges, and social isolation. These challenges can limit independence and community participation during the resettlement process. Occupational therapy is well-positioned to address these barriers through culturally responsive, occupation-based interventions.

This capstone project developed and implemented a community-based program designed to support Middle Eastern refugee women during early resettlement. The program focused on key areas including system navigation, financial literacy, home safety, stress management, self-advocacy, and community engagement. Educational sessions and practical activities were used to promote skill …

Rhode Island Right To Life: Veritas Grant Funded Internship Summer 2025, Ekaterina Rau

Biology Student Scholarship

No abstract provided.

From Data To Action: Enhancing Public Health Communication & Information Dissemination, Ryan Hayden, Devon Donovan

Health Sciences Student Scholarship

No abstract provided.

Decreasing Catheter Associated Urinary Tract Infection Through Reinforcement Of Hand Hygiene Compliance In A Rehabilitation Unit, Gloria Ihenwe

Doctor of Nursing Practice Final Project Abstract

Purpose

The purpose of this project is to decrease the CAUTI rate among adult rehabilitation patients with indwelling catheters from 40% to 1% through improved staff hand hygiene (HH) compliance and to increase hand hygiene compliance from 45.24% to 60.47% within 3 months. The secondary aim is that staff will report self-improvement in hand hygiene knowledge and technique.

Background

Catheter-associated urinary tract infections (CAUTIs) are common preventable healthcare-associated infections. Inconsistent HH compliance among direct care staff remains a common challenge and can contribute to infection risks and transmission of microorganisms

Methodology

The Plan-Do-Study-Act (PDSA) quality improvement model guided the implementation …

Using Geospatial Environmental And Income Variables As Predictors Of Diabetes In Appalachia, John Kunicki Huth

Walden Dissertations and Doctoral Studies

Diabetes remains disproportionately prevalent in Appalachia, and macroenvironmental contributors remain poorly understood. Guided by spatial epidemiology, this quantitative, cross-sectional ecological study examined whether county-level environmental factors including distance to mine, distance to landfill, distance to water, mean annual precipitation, mean annual temperature, forest classification, distance to impervious surface, and median income were independently and collectively associated with diabetes cases per capita in West Virginia, used as a surrogate for Appalachia. Research questions addressed environmental predictors of diabetes cases per capita with and without controlling for median income. Publicly available county-level data from 53 West Virginia counties representing adults aged 20 …

Perceived Inadequate Neighborhood Food Shopping And Cardiovascular Disease Risk: The Multi-Ethnic Study Of Atherosclerosis, Amier Haidar, Ghadi Ghanem, Rishi Rikhi, Karol E Watson, Shreela V Sharma, Michael D Shapiro

Faculty, Staff and Student Publications

Background: Individuals with access to healthy food have healthier diets, improved cardiometabolic risk profiles, and decreased cardiovascular disease (CVD). However, previous studies have focused on the neighborhood food environment as distance to and density of food retailers. Our study examines the association between an individual's perceived adequacy of neighborhood food shopping and incident CVD.

Methods: We analyzed data from 6814 participants in the MESA (Multi-Ethnic Study of Atherosclerosis), a prospective cohort study of individuals aged 45 to 84 who were enrolled in the study between 2000 and 2002 and followed longitudinally. Cox proportional hazards models estimated hazard ratios (HRs) for …

The Burden Of Neglect: Examining Environmental And Health Risks At Kiteezi Landfill, Uganda, Rebecca Martha Nantale, Nfn Dangpa Wandji Nana, Bright Agbotui, Maame Yaa Okrah, Emmanuel N. Clottey

Montview Journal of Research & Scholarship

The Kiteezi Landfill, located near Kampala, Uganda, exemplifies the severe environmental and health challenges arising from inadequate urban waste management. Established in 1996, the landfill was designed to handle the city's waste but has been operating beyond its capacity for years. By 2024, it had received between 1,500 and 2,000 tons of solid waste daily, far exceeding its intended limits by more than 200%. This study investigates the environmental and public health impacts of the Kiteezi Landfill in Uganda. The primary research question is: How has inadequate waste management at Kiteezi Landfill contributed to environmental degradation and public health crises? …

Cervical Cancer Screening Among Women Across The United States, Srivathsan Vijaya Raghavan

Walden Dissertations and Doctoral Studies

While cervical cancer is not among the most frequently diagnosed cancers in the United States, it remains a significant concern due to its preventability through regular Pap smears and Human Papillomavirus (HPV) vaccination. However, incidence rates are rising as screening participation among U.S. women declines. This quantitative study (N = 15714) explored cervical cancer screening behaviors by analyzing levels of community involvement and social functioning, guided by the socioecological model (SEM). The dependent variable was cervical cancer screening, while the independent variables were community involvement and social functioning. The study controlled for health insurance status, age, race, ethnicity, employment, education, …

Changes In Activity Levels Observed In Elementary Grade Levels., Kelsie R. Harvey

2026 Honors Symposium

Background: Physical activity is important for children, recess is a great opportunity for physical activity, however, little is known how physical activity during recess changes throughout a school year, which is important for identifying key potential intervention points.  Purpose: To determine how physical activity of elementary students changes throughout the school year. Methodology: This is a research-based, longitudinal, observational study design. Through local observations at a nearby elementary school, we can analyze the activity levels of elementary students. Trained research assistants conducted systematic research observation using SOPLAY (System for Observing Play and Leisure Activity in Youth) method. SOPLAY measures the …

Evaluating An Lgbtq+ Adolescent Sexual Health Toolkit: Boosting Confidence And Provider Knowledge, Joslyn Lypka

Doctoral Dissertations & Projects

When leveraged correctly, sexual health education empowers youth to build resilience, deepen self-understanding, and confidently navigate gender and sexual identities. However, many school-based programs emphasize cisgender and heterosexual norms, leaving LGBTQ+ adolescents with limited access to inclusive and affirming sexual health information. This project aimed to develop and evaluate an online sexual health education toolkit designed to increase knowledge and support self-advocacy among LGBTQ+ adolescents, parents/caregivers, and healthcare providers. In collaboration with a Midwest nonprofit organization serving sexual and gender-diverse individuals, an online toolkit was developed and evaluated using two sequential Plan–Do–Study–Act (PDSA) cycles. During the first cycle, subject matter …

Long Work Hours, Suboptimal Diabetes Management, And Differences By Sex And Race/Ethnicity, Nhanes (2011-2018), Tailisha Gonzalez, Margrethe Horlyck-Romanovsky, Terry T.-K. Huang, Sandra E. Echeverria

Publications and Research

In the United States (US), occupational segregation by sex and race/ethnicity can contribute to health disparities. Although work schedule characteristics have been previously linked to elevated cardiovascular risk, little is known about the effects on chronic disease management in women and minoritized workers. We examined the association between work hours and diabetes management among US workers, testing for differences by sex and race/ethnicity. We utilized 2011–2018 National Health and Nutrition Examination Survey (NHANES) data on working adults (age ≥20 years) with diagnosed diabetes (n = 1041). Suboptimal diabetes management was defined as HbA1c ≥7%. Work hours were categorized per WHO …

From Tradition To Transition: Evaluating Culinary Medicine As A Tool For Metabolic Health Among Nigerian Immigrants In The United States And The United Kingdom, Simi Oduwole M.S.

Department of Nutrition Student Projects

This scoping review examines existing publications to evaluate whether Culinary Medicine can be used as a tool for metabolic health among Nigerian immigrants in the United States and the United Kingdom. Nigeria is one of the fastest-growing populations globally, with increasing migration to high-income countries such as the United States and the United Kingdom. Evidence suggests that Nigerian immigrants experience a rise in diet-related chronic diseases, including obesity, diabetes, and cardiovascular disease, as duration of residence increases. This phenomenon is often attributed to dietary acculturation and shifts toward Westernized eating patterns. This scoping review evaluates whether culinary medicine can mitigate …

First Covid-19 Vaccination Rates Among Pregnant Tennessee Women By Month Of Conception And Urbanization Level: March 2021 – November 2021, Claudia Valenzuela, Anne K. Driscoll, Elizabeth Harvey, Heather Wingate

Journal of Appalachian Health

Introduction: Throughout the pandemic, COVID-19 vaccination coverage was lower for the general population living in rural counties than in urban counties. In Tennessee (TN), COVID-19 vaccinations became available to pregnant women in March 2021. Little is known about rates of COVID-19 vaccination in pregnancy during the pandemic, or whether these rates changed or differed by urbanization level.

Purpose: The purpose of this study is to describe COVID-19 vaccination rates among pregnant women in TN by month of conception and urbanization level.

Methods: COVID-19 vaccination data from the TN Immunization Information System and the TN Surveillance for Emerging Threats to Mothers …

Evaluating The Feasibility And Preliminary Effectiveness Of A Tailored Diabetes Education Program For Rural Residents, Brittany L. Smalls, Oluwatosin Leshi, Suraksha Khanal, Grejika E. Abram-Erby

Journal of Appalachian Health

Introduction: Diabetes is a top ten Rural Healthy People 2030 priority for health improvement among rural Americans. Socioeconomic, environmental, geographic and political barriers contribute to the type 2 diabetes (T2D) prevalence and its disparate impact in rural communities. However, promoting proper self-care behaviors via self-management education can help people with diabetes better manage their condition.

Purpose: To account for the social environmental factors that affect rural residents, a tailored diabetes education program was developed, and the program’s effectiveness in improving diabetes knowledge and T2D-related health outcomes was assessed.

Methods: Using data collected from Appalachian Kentucky residents enrolled in a six-week, …

Rural Community Perspectives On Hurricane Helene In Western North Carolina, Jennifer A. Horney, Lilly Moreau, Search Wnc

Journal of Appalachian Health

Introduction: After making landfall on the Florida Gulf Coast in September 2024, Hurricane Helene impacted Western North Carolina (WNC) with historic flooding, landslides, and hurricane-force winds. More than 100 deaths in the region were attributed to the storm’s direct impacts.

Purpose: The purpose of this study was to assess community perspectives of long-term recovery in Mitchell and Yancey Counties, two rural WNC counties severely impacted by Hurricane Helene.

Methods: A 14-question interview guide was developed based on prior disaster research and the community engagement work of Sustaining Essential and Rural Community Healthcare (SEARCH). Questions covered post-Helene experiences related to access …

Exploring Systemic Challenges In The Western North Carolina Dental Safety Net: A Qualitative Analysis, Blaire Mirmow, Bill Milner, Nadia Laniado

Journal of Appalachian Health

Introduction: Despite statewide growth, rural communities in Western North Carolina (WNC) face persistent barriers to oral health care driven by chronic dental workforce shortages and systemic geographic disparities. Within this Appalachian region, the dental safety net serves as a vital yet strained support system, struggling with limited financial resources and a lack of provider participation that leaves many underserved populations without essential oral health services.

Purpose: This study aims to explore the experiences of individuals working within the WNC dental safety net to identify barriers and strategies required to strengthen the delivery of oral health care in high-need rural settings. …

Infective Endocarditis Hospitalizations In Kentucky, 2008-2018: Spatial And Temporal Trends, Meera Marji, Steve Browning, W. Jay Christian, Richard Charnigo, Steve W. Leung, Anna Kucharska-Newton

Journal of Appalachian Health

Introduction: Infective endocarditis (IE) hospitalization rates have increased significantly in the last decade, primarily due to the opioid epidemic. In 2016, Kentucky (KY) ranked among the top ten states for opioid-related overdose deaths, but limited data exist on IE trends in KY.

Purpose: This study seeks to examine county-level spatial and temporal trends in IE hospitalization rates in KY.

Methods: Hospital inpatient discharge data from 2008–2018 for KY residents aged 18 and older were analyzed. IE admissions and drug use status were identified using ICD-9 & 10 diagnosis codes. U.S. Census data calculated yearly IE hospitalization rates per 100,000 residents. …

The Effects Of Hurricane Helene On Mental Health And Physical Activity, Hunter Smathers, Robyn York, Jarrett Walbolt

Journal of Appalachian Health

Introduction: Hurricane Helene brought widespread damage to Southern Appalachia, disrupting utilities, health care, and recreation. While natural disasters are linked to declines in mental and physical health, few studies have examined their effects on distinct types of physical activity (PA).

Purpose: This study evaluated the effects of Hurricane Helene on perceived stress, depressive symptoms, post-traumatic stress disorder (PTSD) symptomology, and intentional (exercise for health benefits) and incidental (physical labor or transportation) PA. Evacuation status influence was also explored.

Methods: Twenty participants completed assessments four weeks before (BASE), immediately after (0POST), and four weeks after landfall (4POST). Measures included the Perceived …

Starting With Story, Not Symptom: Narrative Collapse And Cultural Repair In Appalachia, Wayne Coombs Ph.D.

Journal of Appalachian Health

Appalachia’s opioid crisis reflects uneven burdens, especially in distressed coalfield counties, and it cannot be solved by symptom tracking alone. This commentary argues for a narrative shift, starting with story and cultural repair alongside clinical care. Narrative collapse is defined here as the loss of shared, dependable public meaning across groups, not the absence of storytelling in families, churches, and recovery circles. Trauma science suggests that chronic threat reshapes nervous systems across generations, making safety a prerequisite for renewed trust. Drawing on narrative identity research, the piece proposes peer story work as infrastructure that can reduce shame, support treatment engagement, …

The Effect Of A Low-Glycemic Index Diet On Polycystic Ovary Syndrome Symptoms Among University-Aged Women, Angelika A. Gonzalez, Annalise M. Sankar, Noelle D. Nguyen

Department of Nutrition Student Projects

Polycystic Ovary Syndrome is an endocrine disorder among women of reproductive age and is associated with insulin resistance, menstrual irregularities, hyperandrogenism, and metabolic dysfunction. Dietary modifications targeting glycemic response have emerged as a nonpharmacologic approach for PCOS management. However, long-term randomized controlled trials targeting young adult populations remain limited.

The purpose of this study is to evaluate long-term effects of adherence to a low-glycemic index diet on the frequency and severity of PCOS symptoms among female college students ages 18-22. This 12-month randomized controlled trial will recruit participants meeting the Rotterdam criteria from university health clinics. Participants will be randomly …

Mplus Data For Campus Mental Health Study 2026 - Flourishing Paper, Alice Ann Crandall, Carl L. Hanson

ScholarsArchive Data

MPlus Data file, input file, and output file.

Assessment Of Clinical And Neuroimaging Efficacy Of Treatment Targeting Tau Pathology In Mild Cognitive Impairment And Mild To Moderate Alzheimer’S Disease With Hydromethylthionine Mesylate Using External Control Data, Bjoern O. Schelter, Helen Shiells, Serena Lo, Nafeesa Nazlee, Emily Evans, Peter Bentham, Serge Gauthier, Henrik Zetterberg, Gordon K. Wilcock, Lutz Froelich, Alistair Burns, Emer Macsweeney, Clive Ballard, Jin-Tai Yu, Tay Siew Choon, Vahe Asvatourian, Natalia Muehlemann, Jan Priel, Karin Kook, Tenecia Sullivan, Diane Downie, Sonya Miller, Carol Pringle, John M. D. Storey, Tom Baddeley, Charles R. Harrington, Roger Staff, Anca-Larisa Sandu, Claire Hull, Richard G. Stefanacci, Claude M. Wischik

College of Population Health Faculty Papers

BACKGROUND: Hydromethylthionine mesylate (HMTM) targets tau pathology and also has tau-independent symptomatic activity. A traditional randomised placebo-controlled trial (RCT) was precluded by loss of blinding due to urinary colouration and therapeutic activity at the minimum dose required to maintain blinding.

OBJECTIVE: To evaluate the efficacy of HMTM in participants with mild cognitive impairment (MCI) and mild to moderate dementia due to Alzheimer's disease (AD).

METHODS: Because a traditional RCT was not feasible without loss of blinding, we compared HMTM 16 mg/day in TRx-237-039 with propensity score matched true placebo controls from the FDA-sponsored Critical Path for AD (CPAD) database with …

Assessing The Aesthetic Responsiveness Among Patients In A Free Clinic Setting, Jack E. Pitts

Student Scholar Showcase

Art therapy has increasingly been recognized as a complementary intervention in healthcare settings, with demonstrated benefits for stress reduction and overall biopsychosocial well-being. However, limited research has explored aesthetic engagement within medically underserved and economically disadvantaged populations. This study examines aesthetic responsiveness among patients receiving care at the Free Clinic of Central Virginia using a standardized Aesthetic Responsiveness Assessment. The assessment consists of 14 Likert-scale questions assessing individuals’ cumulative aptitude across three domains: aesthetic appreciation, intense aesthetic experience, and creative behavior. Responses and data were collected voluntarily and anonymously, and they were analyzed to better understand how patients in an …

Perceived Stigmatization Of Mental Health Problems And Utilization Of Academic Accommodations Among College Students, Sabrina Williams, Robert E. Davis Ph.D., Kristin Bogda Ph.D.

2026 Honors Symposium

Background: Higher education is seeing an increase in students utilizing mental health services. Studies on students with disabilities suggest students often have reservations about accessing these accommodations due to anticipated social stigmatization. Purpose: This study aimed to assess relationships among stigmatization and indicators of psychological distress among a sample of students who qualify for accommodations. Methods: This was a cross-sectional survey of students at a large university in the central United States. Data collection measures included previously validated screening instruments for depression, anxiety, suicidal ideation, and adapted versions of the validated scales to assess specific aspects of stigma related to …

Experiences Of Maternal Care In The Gypsy, Roma, And Traveller Population In The United Kingdom: A Cultural Care Model, Sarah Englebert Crowson

Walden Dissertations and Doctoral Studies

Gypsy, Roma, and Traveller women (GRT) in the United Kingdom face persistent maternal health disparities and show poor engagement with healthcare services. Exclusion, discrimination, and a lack of cultural competence from healthcare professionals contribute to poor health outcomes including preterm births; and GRT women have more babies born with congenital anomalies than non-GRT women in the United Kingdom. The purpose of this focused ethnographic qualitative study was to explore how self-identified GRT women living in the United Kingdom experienced maternal care and how cultural identity and social structures influenced their interactions with healthcare providers based on Madeleine Leininger’s cultural care …