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 …

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 …

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 …

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 …

Nurses' Perceptions Of Medical Services In Acute Care Hospitals In The Post-Covid-19 Era, Yoko Nakano, Tomoya Yokotani, Rika Nakajima, Hidemi Yoshii

Patient Experience Journal

Purpose: This study aimed to clarify nurses' perceptions of healthcare services in acute care hospitals. Methods: A cross-sectional, anonymous, web-based questionnaire was conducted using SurveyMonkey. Participants were selected using convenience sampling. The survey included questions about the participants' basic attributes and the 22-item M-SERVQUAL scale (a modified multiple-item scale for measuring consumer perceptions of medical service quality). Data analysis involved age-based comparisons using the Kruskal–Wallis test, followed by multiple comparisons using the Bonferroni method. The significance level was set at p < 0.01. Results: The survey was distributed to 1,542 participants, yielding 566 valid responses, with an effective response rate of 36.7%. …

Pathways To Patient-Provider Conflict In Nigeria: A Structural Equation Model Of Expectations, Communication, Trust, And Organizational Constraints, Akaninyene O. Unaam, Christie Divine Akwaowo, Edidiong A. Unaam

Patient Experience Journal

Objective: This study empirically investigated the drivers of patient-provider conflict and tested a conceptual model linking treatment expectations, communication, trust, and organizational constraints to conflict intensity in Nigerian tertiary care. Methods: A cross-sectional survey of 400 patients (response rate 82.3%) and 150 healthcare providers (response rate 71.2%) from three Nigerian tertiary hospitals was conducted using stratified random sampling. Validated, culturally adapted scales measured unrealistic treatment expectations, communication barriers, organizational constraints, trust, and conflict intensity. Data were analyzed using Structural Equation Modeling (SEM) with maximum likelihood estimation and bootstrapping for mediation testing. Multi-group confirmatory factor analysis established measurement invariance across samples. …

A Modern Playbook For Trust Across The Health Ecosystem, Erin O'Malley

Patient Experience Journal

Public trust in health care delivery, public health, and biomedical innovation is at a historic low. While many place the blame on the COVID-19 pandemic and the proliferation of social media, the reality is that distrust is a deeply rooted structural challenge that has plagued the U.S. for centuries. It is tied to historical movements for medical freedom and centuries of systemic discrimination and earned mistrust among minoritized communities. Today, this crisis is compounded by a lack of shared values and facts and the rising dominance of tribal identity over objective science. The Coalition for Trust in Health & Science …

The Registered Dietitian Nutritionist’S Implementation Of Dysphagia Screening In Clinical Practice: A Commentary, Nicole Wiksten, Holly Estes-Doetsch, Laura C. Boucher, Sarah Rusnak, Kristen M. Roberts

Journal of Dietetic Education

Background: The Accreditation Council for Education in Nutrition and Dietetics (ACEND) amended the competencies for the future education model (FEM) in dietetic education to include competency 3.6 stating that the Registered Dietitian Nutritionist (RDN) must be able to "Initiate and conduct bedside swallow screenings". There is no clear process for RDNs to implement dysphagia screening in practice or academia. The aim of this review is to inform clinicians and educators on current literature discussing current RDN and speech language pathology approaches to dysphagia screening and to provide a proposed curriculum for implementation of competency 3.6 in clinical practice and academia.

Assessing And Addressing Cultural Competence And Cultural Humility In Dietetic Education, Zoe Duran, Nicholas Slagel, Lisa Caldwell, Katie Kage

Journal of Dietetic Education

Limited theory-informed, dietetic-specific resources are available to guide the development, evaluation, and refinement of culturally competent (CC) curricula. This pilot study used a mixed-methods, theory-informed approach to evaluate CC integration within an undergraduate dietetics curriculum and examine the applicability of existing CC self-assessment tools for dietetic students. A senior-level undergraduate community nutrition curriculum was evaluated using the Tool for Assessing Cultural Competence Training (TACCT), guided by the Campinha-Bacote Model of Cultural Competence in Healthcare Delivery. James Banks’ Model of Multicultural Curriculum Reform was then applied to refine curricular content and learning activities. In addition, 74 students enrolled in a didactic …

A Case For Societal Provenance: Marguerite Harper As Told By The Men She Represented, V. Emily Cranwell Deinert

Journal of Contemporary Archival Studies

This paper argues for making societal provenance the grounding framework for archival descriptive standards to ensure that important voices already present in archives are no longer buried. This study reclaims from archival obscurity the career of literary agent Marguerite E. Harper to illustrate the need for this expansion. Harper proves strikingly absent from some of the archives for the authors she represented. Likely an unwitting omission from archivists that uncritically accepted the narratives of these male authors, Harper’s erasure provides a potent example of the ways that archival descriptive standards may unintentionally further silence historically marginalized voices within archives. The …

Emotion-Attention Relationships In Anxiety: A Multimodal Psychophysiological Network Analysis, Kyle O'Brien

Clinical Psychology Dissertations

Anxiety has long been associated with changes in attention processing, emotional salience detection, and emotional affect. Traditional methods of measuring anxiety frequently utilize self-report symptom measures, behavioral performance measures, and psychophysiological indicators. The current study integrates behavioral accuracy, self-report measures of psychological distress and well-being, and event-related potential markers of attention processing into an exploratory multimodal psychological network analyses to identify meaningful patterns across these indicators. The final sample of nonpatients included 36 anxious (low depression) and 24 control (low anxiety and depression) participants who completed an Emotion Attention Blink task while EEG data were collected to assess early, more …

The Screening Tool Of Behavioral Self-Regulation “Head-Toes-Knees-Shoulders” Task: A Preliminary Adaptation To Greek Older Adults, Eleni Rachanioti, Dimitra Magkavila, Olga Fragkomichelaki, Magda Dinou, Effie Katsadima, Theodora Foti, Anastasia Tzalla, Anna Dougali, Christina Bourmpou, Maria Staikopoulou, Aphrodite Papantoniou, Fotini Varlami, Irene Dinaki, Maria Tsiountala, Konstantinos Staikopoulos, Tryfon Mavropalias, Efthymia Efthymiou, Demetra Tomprou, Maria Georgiadi, Dimitra Katsarou, Georgios Kougioumtzis, Ioanna Giannoula Katsouri, Harilaos Zaragas, Despina Moraitou, Maria Sofologi, Georgia Papantoniou

All Works

The aim of the present study was to examine the psychometric properties of the Head-Toes-Knees-Shoulders (HTKS) behavioral self-regulation (executive function) measure in a sample of Greek older population. Specifically, 88 cognitively healthy Greek older adults over the age of 65 participated in the study. The Greek version of HTKS was administered along with the Greek versions of the Mini-Mental State Examination (MMSE), the Raven's Educational CPM, the Number Series (NS) test, the Positive and Negative Affect Scale (PANAS), the Barratt Impulsiveness Scale (BIS-11) and the Impulsive Behavior Scale (UPPS-P). Exploratory factor analysis supported the unidimensional structure of the HTKS. The …

Fighting With Data: Design Implications For Ai-Enabled Mission-Command Systems, C. Anthony Pfaff

Books, Monographs & Collaborative Studies

Fighting with Data examines how artificial intelligence (AI) is reshaping military decision making by changing both the speed of command and the structure of cognition within mission-command systems. Rather than treating AI as a tool that merely accelerates existing staff processes, this monograph recognizes AI redistributes cognitive labor across a network of people, data, tools, and operational processes. In this new environment, commanders and staffs spend less time assembling information and more time interpreting meaning, judging uncertainty, and deciding how to act.

This shift in the human role requires a new way of thinking about trust in military AI. Traditional …

Evaluating Gender Equity In The Berenstain Bears Picture Books, Christy Tisnawijaya, Geni Kurniati

Bahasa dan Seni: Jurnal Bahasa, Sastra, Seni, dan Pengajarannya

Picture books serve as a foundational medium in early childhood education, utilizing interrelated visual and verbal elements to foster linguistic, cognitive, and social development. Despite their pedagogical utility, certain literary works inadvertently perpetuate traditional gender roles, constraining children's conceptualizations of identity. This study evaluates gender representation within eleven selected titles of The Berenstain Bears series. Employing a qualitative multimodal content analysis, the study integrates Butler's gender performativity framework (1990), Callow's multimodal narrative approach (2020), and Adam and Harper's evaluative criteria (2021) to examine how domestic, social, and recreational roles are constructed. This study offers novelty by establishing a dual-lens multimodal …

Physical Activity, Trauma, And Posttraumatic Stress: The Indirect Role Of Exercise Addiction, Anastasiia Rozumna

Theses and Dissertations

Exercise is often conceptualized as a protective factor for mental health, including for individuals exposed to trauma. However, less is known about whether exercise may relate to posttraumatic stress symptoms differently when it is accompanied by compulsive or addictive features. The present study examined whether volume and intensity of physical activity were associated with posttraumatic stress symptom severity indirectly through exercise addiction symptoms. This secondary cross-sectional analysis included 557 adults living in the United States who reported regular participation in sport or physical activity. Participants completed self-report measures of physical activity behavior, exercise addiction symptoms, trauma exposure, and posttraumatic stress …

A Systematic Review Of Posttraumatic Stress Disorder Among Hispanic Immigrants In The United States, Rashel Acireale

Theses and Dissertations

This study systematically reviews the literature on posttraumatic stress disorder (PTSD) among Hispanic immigrants in the United States, a population exposed to cumulative trauma across the migration process. Stressors may occur before, during, and after migration and include violence, family separation, dangerous travel conditions, discrimination, and fear of deportation. Despite these risks, findings on PTSD prevalence remain mixed, and Hispanic immigrants are underrepresented in clinical research and culturally informed interventions. This review examines sample representation, types and timing of trauma, PTSD measurement approaches, and the inclusion of cultural and contextual factors such as acculturation and immigration-related stress. It also evaluates …

#Narctalk: Analysis Of Perceptions Of Personality Disorders In Tiktok Content, Amanda C. Dediego, Auna Nelson, Feven Seifu, Amanda D. Tracy, Madeline Grubb, R.J. Schoen

Journal of Technology in Counselor Education and Supervision

No abstract provided.

Clinicians’ Reflections On Explainable Ai (Xai) In Counselor Education And Diagnostic Training: An Exploratory Qualitative Study, Kuo Deng, Xiaomeng Ye, Yi Li-Brown, Cara Miles, Angelina F. Pennino

Journal of Technology in Counselor Education and Supervision

Current approaches to teaching clinical diagnosis in counselor education and supervision often

rely on self-reports, brief vignettes, and supervisors’ recollections—methods that can be resource- intensive and prone to bias, contributing to diagnostic inaccuracy among trainees. While artificial

intelligence (AI) has gained traction in healthcare, many machine learning (ML) models function as “black boxes,” limiting transparency and educator trust. Explainable AI (XAI), which focuses on making AI processes interpretable, offers a potential solution for counselor training. This exploratory qualitative study examined eight licensed psychologists’ reflections after viewing a live demonstration of an original XAI model trained to predict depression. Using Reflexive …

Toward A Triadic Therapeutic Alliance: Understanding Client, Therapist, And Ai Relational Processes In Counseling, Jennifer Young

Journal of Technology in Counselor Education and Supervision

Artificial intelligence (AI) is integrated into counseling through chatbots, digital companions, and clinical decision-support tools. This integration challenges traditional models of the therapeutic alliance, which have historically centered on the dyadic relationship between client and therapist. To address this gap, the Triadic Therapeutic Alliance (TTA) Model of Client-Therapist-AI Relational Dynamics offers a new framework for understanding how relational processes unfold when AI becomes an active participant in therapy. The model extends alliance theory into a triadic structure that includes the client-AI and therapist-AI relationships alongside the traditional human alliance. Drawing on research in human-computer interaction and ethical frameworks of trust …

Exploring Chatgpt As A Simulated Client: A Feasibility Study In Undergraduate Counselor Training, Kayla E. Hayes, Rebecca L. Wilson, Joshua Wilson

Journal of Technology in Counselor Education and Supervision

Generative artificial intelligence (AI) offers new possibilities for simulation-based counselor training by enabling scalable, text-based interactions that mimic human dialogue. This exploratory feasibility study examined whether ChatGPT can serve as a simulated counseling client and feedback provider for undergraduate students learning counseling skills. Five upperclassmen completed a 45–60-minute text-based session with ChatGPT portraying “Sarah,” a college student experiencing depression and loneliness, followed by AI feedback and a semi-structured interview. Trained raters judged ChatGPT’s client portrayal and feedback as generally accurate, particularly for tone, empathy, and identification of students’ strengths. Accuracy was lower for rapport, summarizing, and pacing characteristic of an …

Generative Artificial Intelligence In Counselor Development: Examining Systemic Influences On Training, Lauren Dollarhide, Leo Gonzalez Jr., Rachel M. Smith

Journal of Technology in Counselor Education and Supervision

The use of large language models (LLMs) and generative artificial intelligence (AI) tools (e.g., ChatGPT, AI-assisted supervision platforms, and AI-powered role-play simulations) in counselor education is changing the way counselors-in-training (CITs) are trained and has both risks and benefits for the field. This conceptual article applied Bronfenbrenner’s ecological systems theory to evaluate the impact of these technologies at multiple levels within the counseling training environment. The microsystem is described as the interactions between CITs and the AI they use to support their training experiences (e.g., AI-based learning tools, role-playing simulations). The mesosystem refers to the movement of AI across different …

Simulation-Based Education In A Counseling Skills Course: A Mixed-Methods Pilot Study, Alexandra Gantt-Howrey, Hana Shewamoltot Meshesha, Renyi Huang, Elizabeth A. Doughty Horn, Renee Howells, Adenike Ololade Adedapo

Journal of Technology in Counselor Education and Supervision

Simulation-based education (SBE) is a technique that introduces students to real-world experiences (Gaba, 2004) in a safe way (Holmes et al., 2023). Scholars have suggested that SBE may be a promising means of enhancing counselor education (e.g., Pope & Hilliard, 2024). We recruited a sample of N = 12 counseling skills students who completed up to 12 simulation-based education (SBE) activities using Simucase (2025) across one semester. We conducted an embedded, qualitatively-driven mixed methods pilot study (Creswell & Plano Clark, 2017) to understand participants’ perspectives on and impacts of the SBE activities on their perceived counseling self-efficacy and multicultural competence. …

Padres Ayudando A Padres: Co-Constructing A Family-Centered Mental Health Intervention Of, By, And For Central American Immigrant Parents, Rachael Goodman, Colleen K. Vesely, Maribel Tohara Nakamatsu, Victoria Stone, Valeria Quintana, Bethany Letiecq, Amigas De La Comunidad

Trauma Counseling and Resilience

In the wake of the COVID-19 pandemic, our partners in a Central American immigrant enclave reported an increasing need to support parents and children whose mental health was negatively impacted by the confluence of underlying systemic stressors and traumatic experiences. Using our existing family-centered participatory action research (FCPAR; Letiecq, Vesely, et al., 2022) approach and guided by the transcreation model (Nápoles & Stewart, 2018), we co-constructed a mental health intervention in partnership with community members, via our community advisory board (CAB). Essential to this process was building the intervention with the community, ensuring that it was culturally and contextually grounded …

Flows That Teach: Multimodal Hip-Hop Pedagogy For Equity In Special Education, Camille O'Quin, Sara Jozwik

Journal of the Arts and Special Education

Hip-Hop can be more than a soundtrack played at home, it can be a bridge between culture, language, and learning at school. This article shows how Hip-Hop pedagogy, translanguaging, and code-meshing can support students with disabilities, especially those who speak African American Vernacular English (AAVE), in the classroom setting. Grounded in culturally relevant pedagogy and translanguaging theory, the approach uses rhythm, storytelling, and performance to build narrative fluency, language awareness, and confidence. Examples include students drafting rap verses about personal experiences, holding structured cypher circles to practice turn-taking and self-expression, and blending AAVE with Mainstream American English in writing for …

Extreme Heat And Its Impact On Public Transit Ridership In Nyc, Craig Denton

Theses and Dissertations

This thesis explores the connection between extreme heat events and public transit ridership patterns in New York City, with a particular emphasis on low-income communities. It investigates the intersection of socioeconomic factors and heat-related challenges, analyzing how extreme temperature periods influence overall transit use and why certain routes or neighborhoods experience greater declines in ridership during these events.

Utilizing existing literature, NYC-specific transit and climate datasets, and the broader context of transit equity, this research aims to inform strategies that strengthen climate resilience within urban transportation systems. The study’s findings are intended to support policy development and planning initiatives that …

Applications And Insights Of The Use Of Ethnographic Research In A Local Context Of Nepal, Dipak Raj Rai, Sunita Dangol, Megh Raj Dangal

The Qualitative Report

This paper expounds on ethnographic research in comprehending the cultural, economic, and social nuances in the Nepali local community. The paper also emphasizes the significance of ethnographic research in providing profound insights into the daily lives, traditions, and interactions of cultural groups. This writing aims to describe the historical concept of ethnography, its philosophical standpoint, types of ethnography, fields of ethnographic research and commonly used methods for collecting ethnographic data. The main idea of the paper is to present the methods employed such as participant observation, ethnographic interviews, self-reporting, and artifacts that enable the researcher to obtain the true lived …

Interviewing Elite-Experts: When The Few Matter More Than The Many, Jo B. Helgetun, Thibault Coppe

The Qualitative Report

In this methodological essay, we discuss the ontology and epistemology of research interviews. We anchor our methodological reflection in our experiences interviewing elite-experts. Our goal is to highlight the strengths of research interviews, particularly elite-expert interviews, as well as the importance of using a qualitative rather than quantitative logic when conducting and analyzing such interviews. In discussing this case, we reflect on qualitative research and take a critical stance toward practices that undermine the field of qualitative research. Specifically, we reflect on the process of analyzing interviews—what we refer to as “the quantification of qualitative research”—and how it has become …

Sexual Grooming And Other Barriers To Disclosure Of Childhood Sexual Abuse, Lillian A. Steedman

Theses, Dissertations and Culminating Projects

Child sexual abuse is a serious and prevalent problem in the United States and is associated with negative consequences across numerous life domains (e.g., psychological, physical, socioeconomic). Disclosure of sexually abusive experiences may facilitate victims’ abilities to obtain psychological, social, and legal support. It has been theorized that sexual grooming plays a role in decreasing the likelihood of disclosure and of disclosures being believed. Therefore, this dissertation examined associations among sexual grooming, other barriers, and disclosure decisions and timing. Participants were recruited and screened online for eligibility to participate in a survey examining details of the abuse, trauma-related shame, disclosure …

The Internet Did This To Me: Forms, Consequences, And Coping Strategies Of Cyberbullying, Isaac Oppong

Electronic Theses and Dissertations

This study examined self-reported cyberbullying experiences recounted in a subreddit (r/cyberbullying) to identify forms of cyberbullying, its effects, and ways to cope with it. The findings indicate that there are several types of cyberbullying, such as verbal aggression, deceptive manipulation, privacy invasion, and coercive control. These experiences led to emotional, social, and behavioral consequences, including fear, anxiety, withdrawal, and decreased online activity. Based on concepts from Social Information Processing theory and Symbolic Interactionism, this study reveals how cyberbullying can produce the same or similar consequences as traditional bullying. People experienced disturbances in their self-presentation, contended with spoiled identities, and dealt …

Teen Suicide And The Outcomes Of Surviving Peers, Emily Cuddy, Janet Currie, Elisa Jácome, Lucy Manly

Cowles Foundation Discussion Papers

By age 17, a quarter of U.S. students have experienced a peer suicide. Using linked administrative data from South Carolina and a matched difference-in-differences design, we find that exposure to a peer’s self-harm death increases the probability of a self-harm diagnosis by nearly 50% and both the incidence and frequency of mental health visits. Effects on care use and criminal behavior are concentrated among white boys, and responses diverge by prior mental health history: students without a prior diagnosis increase felony offending rather than care-seeking. Deaths from assault and transportation accidents produce no comparable rise in self-harm, consistent with contagion.