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Offender Recidivism: A Quantitative Study Of Motivational Risk Factors And Counseling, Nazak Dadashazar

Walden Dissertations and Doctoral Studies

The prison system releases over 590,000 inmates annually, adding to the current 5 million ex-offenders on supervised release. The purpose of this study was to explore the problem of increasing recidivism by identifying ex-offenders' dynamic risk and criminogenic need factors using the Level of Service Inventory-Revised (LSI-R), coupled with or without mental health services during reentry in relation to recidivism. This quantitative, nonexperimental, cross-sectional study included data collected from a sample of 128 male recidivist and nonrecidivist federal ex-offenders currently on supervised release, who were recruited during probation office meetings within the South Texas region. Regression analysis yielded statistical significance …

Leadership Strategies For Addressing U.S. Pharmaceutical Drug Shortages And Supply Chain Disruptions, Adrian Grant Scioli

Walden Dissertations and Doctoral Studies

Health care providers in the United States expend more than $400 million in unnecessary direct costs annually managing the effects of widespread drug shortages. Based on the theory of complexity and complex adaptive systems, the purpose of this exploratory multiple case study was to identify the strategies that health care pharmaceutical procurement leaders from the Eastern region of the United States use to address widespread drug shortages. Data were collected from 5 semistructured interviews with pharmaceutical procurement leaders, recorded field notes, and a review of public documents from company websites. Data analysis included deductive and open coding techniques. Emergent themes …

College Health Clinic Population Health Improvement Plan Project, Kathryn M. Flynn

Walden Dissertations and Doctoral Studies

A college community health improvement plan (CHIP) focusing on the indicators of nutrition and weight status, and physical activity and fitness is designed with the goal of reducing obesity risk, improving health, and preventing chronic disease. The precede proceed model, logic model, innovative care for chronic conditions model, self-care theory, and Bandura's social cognitive learning theory were used as a research design framework for assessing, planning, and managing sustainability through a two-year college health clinic. The research questions were: what are the current health promotion inputs and activities in terms of environment, ecology, education, and policy and what could be …

Breastfeeding Perceptions Of First-Time African American Mothers, Deborah Annmarie Jarrett

Walden Dissertations and Doctoral Studies

Breastfeeding is associated with numerous health and social benefits. Although support for breastfeeding is promoted globally, disparities in breastfeeding rates and support continue. African American mothers have lower breastfeeding rates than do Hispanic and Caucasian mothers. Several researchers have focused on the benefits of breastfeeding support, but no available research has explained any specific ethnic group perceptions of breastfeeding. This study explored 10 first-time African American mothers' perceptions of the breastfeeding support they received from physicians, nurses, midwives, and lactation consultants. The purposeful criterion sampling strategy was used to recruit participants, and data were collected through semistructured telephone interviews. The …

Hassles Of African Americans With Type 2 Diabetes, Sharon H. Murff

Walden Dissertations and Doctoral Studies

There has been a steady increase in the incidence of diabetes in the United States. The purpose of this study was to determine whether there was a difference in the daily hassles of African American adults with a self-reported diagnosis of type 2 diabetes compared to those of African American adults without a self-reported diagnosis of type 2 diabetes. The theoretical underpinning for this quantitative, descriptive study was the cognitive appraisal theory (CAT), but the concept of stress and the effects stress has on the body was the broad framework that connected all the variables. The CAT was used to …

Role Of Midline Catheters In Patient Care, Tina K. Schlegel

Walden Dissertations and Doctoral Studies

Central line-associated bloodstream infections (CLABSIs) are responsible for 100,000 patient deaths per year, creating a critical need for prevention of these deadly infections that occur with central venous lines (CVLs). Alternative forms of IV access such as midline catheters (MLCs) may offer lower rates of infection than those seen with CVLs. MLCs were implemented at the practice setting in 2016; however, no evaluation of their effectiveness had been conducted. The purpose of this project was to evaluate the effectiveness of MLCs using a retrospective, pre- post- comparison of CLABSI rates and device utilization rates (DUR) obtained from the practice setting …

The Experiences Of African American Women Participating In Church-Based Weight Loss Programs, Mangle L. Shanks

Walden Dissertations and Doctoral Studies

While obesity is a nationwide phenomenon, African Americans - especially women - continue to be more severely affected than any other ethnic group. According to the Centers for Disease Control and Prevention, over 20% of African American women are obese compared to 15.6% of Caucasian women. The church is an important community center for many African Americans, and is often a site for health promotion programs, though little is known of the effectiveness of these programs. The purpose of this qualitative study was to study the experiences and attitudes of African American women who have gone through a church-based weight-loss …

Paths To Tier 1 Genomics Implementation: A Survey Of Chronic Disease Directors, Amy Ponte

Walden Dissertations and Doctoral Studies

Although evidence is currently available for population-based genetic screening and testing of individuals and their family members for certain hereditary chronic disease conditions (Tier 1), few states have integrated these genomic applications into chronic disease prevention programs. State and territorial chronic disease directors (CDDs) could provide the leadership needed to deliver these applications in more states. The purpose of this study was to determine whether an association exists between current chronic disease genomics funding or specific state genomic activities and the level of knowledge and interests in genomics by these directors. Rogers's diffusion of innovations (DIT) theory was used to …

Exploring Personal And Societal Expectations Of Blind Veterans, Malinda L. Wimbs

Walden Dissertations and Doctoral Studies

More U.S. men and women are returning from military service obligations with physical and mental disabilities which complicate their transition to civilian life. Few researchers, however, have examined the post service experiences of blind veterans and whether they are affected by societal expectations of people living with disabilities. The purpose of this qualitative study was to gain knowledge about the experiences of U.S. veterans who suffered vision loss, and the influence of societal expectations on their lives. Hermeneutic phenomenological methodology was used to explore the personal meanings 8 veterans, who lost their vision during active service, attached to their experiences …

Effect Of Therapeutic Alliance Of Clients On Methadone Maintenance Treatment Outcomes, Teresa Lyn Fresquez

Walden Dissertations and Doctoral Studies

Opioid abuse costs affect the majority of the adult population in our society directly or indirectly. The current prevailing medical treatment for opioid addiction is methadone maintenance treatment (MMT). MMT reduces infectious disease spread, illicit drug use, criminal activity, and overdose potential. MMT is only as effective as the length of time a client remains active and compliant with the program. In previous studies, therapeutic alliance (TA) has been shown to positively influence the effectiveness of substance abuse treatment. However, a gap exists in research in regards to the impact of TA on the effectiveness of MMT outcomes. The theoretical …

Role Of The Nurse During Disaster Preparedness: A Systematic Literature Review And Application To Public Health Nurses, Elizabeth Rivera-Rodriguez

Walden Dissertations and Doctoral Studies

After the 2001 attacks on the World Trade Center, public health garnered more attention. This event forced public health nurses to acquire new roles needed to respond to disasters. The purpose of this project was to synthesize the current evidence related to the role of nurses during disaster preparedness and apply that evidence to public health nurses. The practice question focused on the role of nurses during disasters which were not a part of their normal daily activity. The Fineout-Overholt, Melnyk, Stillwell, and Williamson hierarchy for grading evidence was the theoretical framework used. A systematic literature review was conducted to …

Reducing Stigma And Encouraging Help Seeking Intentions Through A Mental Health Literacy Program, Nicole Loreto

Walden Dissertations and Doctoral Studies

Many individuals do not seek help for a mental health problem due to stigma and fear of rejection by peers and family. Researchers have highlighted that the age group least likely to seek help is youth. Stigma acts as an important barrier to help-seeking. Evidence indicating how mental health literacy can reduce stigma and encourage help-seeking remains inconclusive. In this study, the health belief model was used to understand how college students perceived an individual's susceptibility to mental illness and the barriers associated with seeking help. A posttest-only randomized controlled trial evaluated the impact of the Is It Just Me? …

The Molecular Epidemiology Of Tuberculosis In South Carolina, 2005-2011: Estimates Of Recent Transmission And Risk Factors For Genotype Clustering, Amy Kathleen Roach

Walden Dissertations and Doctoral Studies

Because tuberculosis (TB) is a public health threat that continues to elude elimination in the United States, there is a need to identify contributing factors that may have implications for targeted control measures. Molecular studies of genetic clustering are crucial for pinpointing these contributing factors. It is for this reason this study was conducted. This was a non-experimental, cross-sectional population-based molecular epidemiological study of TB in SC from 2005 to 2011. Its purpose was to estimate the proportion of TB that may be due to recently acquired infection and to determine the risk factors associated with the genetic clustering of …

An Integrated Approach To Malaria Prevention And Control In Rural Cameroon, Naomi Chuiwo Azunie

Walden Dissertations and Doctoral Studies

Malaria is a life-threatening parasitic disease spread to humans through bites of an infected mosquito. In rural Cameroon, malaria is one of the major causes of morbidity and mortality. Several studies have examined the use of various malaria preventive tools; however, there is insufficient literature available on use of an integrated approach to prevent and control malaria in rural Cameroon. The aim of this study was to provide information necessary for bridging the gap in understanding the proper use of insecticide treated nets (ITNs) and antimalarial drugs and the roles of education and socioeconomic status in malaria prevention and control …

Length Of Stay And Reimbursement Rates For Medicare Patients, Wandella Ezell

Walden Dissertations and Doctoral Studies

Medicare reimbursement rates across the United States have varied by as much as 49-130% across healthcare facilities. Geographic adjustments and severity of medical diagnoses attribute to some dissimilarity; however, the source of longer hospitalization and higher re-admission rates among Medicare patients requires financial consistency. The research encompassed (N = 3000) patients with hypertension as the focus for the study because this is a critical group of Medicare patients with a chronic disease that has been identified as a silent killer. The principal goal that drove this research study was to explain the variations in length of stay for Medicare patients …

Barriers To Preventive Healthcare For Immigrants In Michigan, Sondos Ghazi Al-Hachim

Walden Dissertations and Doctoral Studies

The Affordable Care Act expanded insurance coverage to the general population; however, expanding insurance coverage to immigrants might not be sufficient to improve utilization of annual physical preventive exams. This study evaluated adult Michigan immigrants' individual demographics, perceptions, and behaviors, as well as the collective cultural and system characteristics that might act as barriers to the utilization of annual physical preventive exams. Ken Wilber's integral operating system model for medicine conceptual framework was used to create a comprehensive map of factors and bring more clarity and understanding to the barriers to annual physical preventive exam. The quantitative survey was the …

Exploring The Strategies To Implement A Sustainable Energy Program In Hong Kong Public Hospitals, Terry Ting

Walden Dissertations and Doctoral Studies

Healthcare is one of the most energy-intensive industries because of its 24 hour-a-day and 7-days-a-week operation model. Climate change, due to environmental pollution, has increased the incidence of respiratory disease, cardiovascular disease, and cancer, which further overload the financial burden of our healthcare system. The National Health Service Sustainable Development Unit suggested that a sustainable healthcare sector also requires using their resources in an efficient and responsible way. Hong Kong public hospitals are facing this problem along with high energy expenditure. The purpose of this qualitative, multiple site case study was to explore strategies for Hong Kong's public hospital leaders …

Improving Seasonal Influenza Vaccine Uptake Among Health Care Workers, Debra Gray

Walden Dissertations and Doctoral Studies

Yearly influenza (flu) immunization rates for hospital healthcare workers (HCW) continue to be lower than those suggested by the Centers for Disease Control and the World Health Organization. Vaccination is considered a valuable step in the process to protect patients against influenza infection. The goal of Healthy People 2020, and most hospital administrators, is that 90% of HCWs are being immunized. The objectives for this systematic literature review were to identify best practice recommendations for improving the vaccine rate among HCWs. The Cochrane methodology framed this systematic review, and Fineout-Overholt's and Melnyk's levels of evidence were used to evaluate the …

Hiv Testing Practices And Provider-Identified Barriers In The Acute Care Setting, Alex Ariri

Walden Dissertations and Doctoral Studies

Despite the Centers for Disease Control and Prevention recommendations to test patients ages 13 to 64 years for HIV at health care settings, routine HIV testing is lacking. As a result, many people are unaware of their HIV seropositive status. The purpose of this quantitative cross-sectional study was to examine relationships between HIV testing and provider type, knowledge, attitudes, and behaviors regarding HIV testing in the acute care setting. The study was informed by social cognitive theory. Using a convenient sampling method, a questionnaire derived from previous surveys (Society of General Internal Medicine and University of Washington) was sent to …

Social Network And Health Seeking Behavior Of Men Of West African Descent, Opeyemi Odewale

Walden Dissertations and Doctoral Studies

Men are less likely than women to seek help from health services providers regarding the health issues they face. In the United States, of the various race/ethnicity populations, Black American men are least likely to seek health related help, which is reflected in the substantially higher mortality and morbidity rates in Black American men compared to other populations. Guided by the social epidemiological framework, this study examined the relationship between social network measure and health help-seeking behavior among foreign-born and U.S.-born Black American men of West African descent residing in the state of Rhode Island. A cross-sectional study design with …

Assessment Of Postoperative And Postdischarge Wound Infection After Abdominal Hysterectomy, Jinni J. Amin

Walden Dissertations and Doctoral Studies

Surgical site infection (SSI) is the most common healthcare-associated infection. Approximately 2% to 14% of surgical patients are diagnosed with SSI, which may extend length of stay in the hospital or lead to readmission and may necessitate another surgical procedure. Patient readmission due to SSI costs health care industries about $3,000 to $29,000 per case and a total of $10 billion per year. The purpose of this quantitative cross-sectional retrospective study was to examine the association between SSI and teaching status, hospital ownership, and number of beds in the hospital. The epidemiological triad was used as a framework to describe …

Understanding The Importance Of Culturally Appropriate Patient-Provider Communication In Diabetes Self-Management, Anita Mwalui

Walden Dissertations and Doctoral Studies

According to the Centers for Disease Control and Prevention, 29.1 million people in the United States have diabetes. Among those 29.1 million people, 21 million have been diagnosed, but 8.1 million have not. Changing demographics in the United States and the prevalence of diabetes are projected to be burdens on the health care system through 2050. Guided by the social cognitive theory, the purpose of this qualitative case study was to understand the importance of culturally appropriate patient-provider communication to the self-management of Type 2 diabetes by patients who are African immigrants. Culturally based health care has unique challenges when …

Development And Evaluation Of An Evidence-Based Educational Process To Reduce Post-Transplant Infections, Erica Vanessa Henderson

Walden Dissertations and Doctoral Studies

The targeted transplant center's abdominal organ transplant unit had difficulty providing

adequate education to patients prior to discharge, which had resulted in a 24% readmission rate within 30 days due to infections. Patients and caregivers were unavailable to receive education despite multiple attempts, which made it challenging for health care providers to complete this aspect of their job, resulting in a negative impact on patients' long-term outcomes. A more structured educational environment was needed to provide appropriate and effective patient and caregiver education to increase adherence and positive outcomes. The health promotion model served as a foundation for the development …

Knowledge Of Malaria Infection And Treatment-Seeking Behavior Among Tanzanian Pregnant Women, Emebet T. Derjew

Walden Dissertations and Doctoral Studies

Despite the availability of effective drugs to prevent malaria during pregnancy using intermittent preventive treatment with Sulfadoxine-Pyrimethamine or Fansidar and insecticide bed net, use of these methods are still little used in Sub-Saharan Africa, including Tanzania. As a result, many pregnant women are at risk of malaria consequences such as maternal anemia and low birth weight babies, which increase the rate of infant mortality. Data from the Demographic Health Survey for Tanzania HIV/AIDs and the Malaria Indicator Survey 2011-2012 were used in a cross-sectional design guided by the health belief model. Logistic regression examined the association between (a) preventive treatment-seeking …

Factors Impacting Hiv Post Exposure Prophylaxis Among Health Care Workers, Ulunma Njemanze

Walden Dissertations and Doctoral Studies

Health care workers are at risk of contracting HIV as a result of occupational exposure while treating infected patients. HIV postexposure prophylaxis (PEP) is an effective antiretroviral treatment course used in preventing potential HIV infection following an accidental occupational exposure to HIV. The objective of this cross sectional study was to identify the factors that impact the practice of HIV PEP among health care workers at the National Hospital, Abuja, Nigeria. A cross-sectional survey using self-administered, structured questionnaires was conducted on 182 health care workers at the National Hospital comprising of medical doctors, nurses, and laboratory scientists. A chi-square test …

Geospatial Analysis Of Spatial Patterns Of U.S. Hospital Readmission Rates, Yamei Wang

Walden Dissertations and Doctoral Studies

Unplanned hospital readmission after a recent hospitalization is an indication of poor healthcare quality and a waste of healthcare resources. The Centers for Medicare and Medicaid Services (CMS) initiated the Hospital Readmission Reduction Program (HRRP) to improve healthcare quality and reduce costs; however, studies found the risk adjustment method used in calculating the standardized readmission rate was less accurate without hospital region or community factors. Accordingly, this cross-sectional quantitative study was designed to examine spatial patterns in hospital readmission rates following Andersen's behavioral model of health service utilization. This study was the first geospatial analysis on risk standardized hospital readmissions …

Body Piercing And Health Complications Among College Students In Puerto Rico, Elsie Goicochea

Walden Dissertations and Doctoral Studies

The incidence and prevalence of body piercing health complications among students is a public health matter that has not been researched in Puerto Rico. College students are the most consistent participants in body piercing activities and have reported health complications resulting in visits to medical offices and emergency rooms. Based on the health belief model, which is used to explain and predict health attitudes, the purpose of this quantitative nonexperimental study was to analyze the health risks and possible complications occurring after body piercing and to investigate the association between sex and age and medical complications. Data were collected from …

Compliance Of Caregivers With Polio Vaccine Dosages And Timelines In Lagos State Nigeria, Grace Olubunmi Salako Smith

Walden Dissertations and Doctoral Studies

Caregivers' compliance with polio vaccine regimens and timely receipt of the recommended 4 doses of polio vaccine are pivotal to eliminating polio. This cross sectional study, conducted in Lagos State, Nigeria, examined polio vaccine compliance and demographic attributes of caregivers' for statistically significant associations. Using an adapted health belief model theoretical framework, 1,200 participants were recruited from well-baby clinics in 8 local government areas in Lagos State. Participants completed a brief demographic survey providing data on caregivers' age, gender, residence (rural or urban), and their level of education as well as records from their children's immunization cards. Data obtained were …

Cardiovascular Disease Risk Factor Assessment And Lifestyle Adjustments In African Americans, Biruk Nigatu Nigatu

Walden Dissertations and Doctoral Studies

Multiple studies have indicated a higher burden of overweight/obesity and exposure to environmental toxins, such as alcohol and tobacco smoke, in association with higher prevalence of cardiovascular disease (CVD) in the African American population. Thus, the purpose of this research was to determine if there was a significant difference in the use of lifestyle adjustments such as moderating alcohol consumption, weight loss, and smoking cessation on the prevalence of CVD in the African American population. The theoretical foundation was social cognitive theory and the social ecological model that posits the interplay of individual, social, and environmental factors. This cross-sectional quantitative …

Attitudes And Perceptions Of Mental Health Treatment For Native American Clients, Beverly Elaine Johnson

Walden Dissertations and Doctoral Studies

The need for mental health service is increasing in American Indian/Alaska Native (AI/AN) communities. While research has examined the availability, access, and effectiveness of provided services to the AI/AN, very little is known about the influence of the attitude and perceptions of both clinicians and clients in their therapeutic relationship in the treatment process. Using the frameworks of liberation, oppression, and trauma theory, this qualitative phenomenological study explored mental health service delivery and utilization issues within an AI/AN community. Data were collected through semistructured interviews with 14 clinician and client participants. The data were sorted into themes and subthemes and …