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The Impact Of Vaccination Schedules On Infants' And Children's Physio-Psychological Health: A Qualitative Investigation, Dina A. Alsalih Jan 2014

The Impact Of Vaccination Schedules On Infants' And Children's Physio-Psychological Health: A Qualitative Investigation, Dina A. Alsalih

Walden Dissertations and Doctoral Studies

Many people may have become increasingly concerned about the risks associated with vaccines. At the same time, there is a lack of qualitative research on the impact of various vaccinations schedules on individuals' physio-psychological health. In addition, "mandatory" versus "nonmandatory, but recommended" vaccines are still under debate in some Western countries. The purpose of this ethnographic study was to provide an in-depth understanding of the beliefs, experiences, and perceptions of adolescents, parents, and health care providers regarding different vaccination schedules. The health belief model was used as the theoretical framework. The sample consisted of adolescents and parents from different vaccination …


Correlates Of Asthma Among The Minority Population In South Bronx,New York, Veronica Chibumma Uwanaka Jan 2014

Correlates Of Asthma Among The Minority Population In South Bronx,New York, Veronica Chibumma Uwanaka

Walden Dissertations and Doctoral Studies

Asthma among children has become an inherent problem in many communities in the United States, especially among the minority population. The South Bronx has a large minority population and a high prevalence of asthma. However, no study to date has explored the factors associated with this high prevalence rates in this population. Drawing from theories of social ecology and environmental health, the objective of this quantitative cross-sectional study is to investigate the correlates of asthma among children in the South Bronx by studying the sociodemographic and environmental risk factors, including parental occupation; neighborhood and housing characteristics, air quality, and poverty. …


The Sociocultural Basis Of Epidemiology Of Hypertension Among Residents Of Ogun State, Vernon E. Norman Jan 2014

The Sociocultural Basis Of Epidemiology Of Hypertension Among Residents Of Ogun State, Vernon E. Norman

Walden Dissertations and Doctoral Studies

There is a high prevalence of hypertension in Nigeria. Limited knowledge of hypertension, how to prevent it, its outcomes, rapid urbanization, and the adoption of Western eating habits are implicated. Hypertension is an important issue because chronic disease places economic, social, and disease burdens on society. The purpose of this mixed-methods study was to investigate lifestyle practices, knowledge, and attitudes on risks and prevention of hypertension among residents of Ogun State, Nigeria (N = 79). The conceptual framework for this study focused on how knowledge, attitudes, and practices influence the dietary habits, behaviors, and ultimately blood pressure . The PEN-3 …


Symbolic Imprisonment, Grief, And Coping Theory: African American Women With Incarcerated Mates, Avon Marie Hart-Johnson Jan 2014

Symbolic Imprisonment, Grief, And Coping Theory: African American Women With Incarcerated Mates, Avon Marie Hart-Johnson

Walden Dissertations and Doctoral Studies

African American men have been incarcerated at unprecedented rates in the United States over the past 30 years. This study explored how African American females experience adverse psychosocial responses to separation from an incarcerated mate. The purpose of this qualitative grounded theory (GT) study was to construct a theory to explain their responses to separation and loss. Given the paucity of literature on this topic, helping professionals may not understand this problem or know how to support these women. Disenfranchised grief and the dual process model of bereavement were used as a theoretical lens for this study. Data were collected …


The Burden Of Avian Influenza Viruses In Community Ponds In California, Zin Htway Jan 2014

The Burden Of Avian Influenza Viruses In Community Ponds In California, Zin Htway

Walden Dissertations and Doctoral Studies

Emerging influenza viruses continue to challenge public health. The problem is public health science professionals have been battling emerging human influenza diseases with tactile and reactionary methods because there is a lack of knowledge and data at the human-animal interface. This research was a baseline study of the proportion of influenza A virus (IAV) in urban and rural communities in California. The population was artificial recirculating water ponds in the geographic locations of rural and urban Californian communities. Surface water samples [N = 182] were collected from artificial recirculating ponds in California. Positivity for IAV was verified by real time …


Sexual Scripts And Sexual Risk Behaviors Among Black Heterosexual Men: Development Of The Sexual Scripts Scale, Gary Burkholder, Seth Noar, Michelle Teti Jan 2013

Sexual Scripts And Sexual Risk Behaviors Among Black Heterosexual Men: Development Of The Sexual Scripts Scale, Gary Burkholder, Seth Noar, Michelle Teti

Walden Faculty and Staff Publications

Sexual scripts are widely shared gender and culture-specific guides for sexual behavior with important implications for HIV prevention. Although several qualitative studies document how sexual scripts may influence sexual risk behaviors, quantitative investigations of sexual scripts in the context of sexual risk are rare. This mixed methods study involved the qualitative development and quantitative testing of the Sexual Scripts Scale (SSS). Study 1 included qualitative semi-structured interviews with 30 Black heterosexual men about sexual experiences with main and casual sex partners to develop the SSS. Study 2 included a quantitative test of the SSS with 526 predominantly low-income Black heterosexual …


Dr. William Gorgas And His Management Style In The Eradication Of Yellow Fever During The Panama Canal Construction: A Historical Case Study, Faisal H. Aboul-Enein Jan 2013

Dr. William Gorgas And His Management Style In The Eradication Of Yellow Fever During The Panama Canal Construction: A Historical Case Study, Faisal H. Aboul-Enein

2010-2016 Archived Posters

This study describes the style of management of Dr. William Gorgas as he led the public health effort to reduce diseases to a level that permitted the completion of the Panama Canal construction. Initially, Gorgas was skeptical of the mosquito vector theory. He fully accepted this theory after participating in Walter Reed's massive cleanup of Havana, Cuba during the Spanish American War of 1898. During 1905 to 1914, Gorgas was selected to lead the sanitary effort during the construction of the Panama Canal. The lessons learned from this historical case study provide public health administrators with guidance to effectively lead …


2013 Walden University Research Symposium, Walden University Jan 2013

2013 Walden University Research Symposium, Walden University

2010-2016 Archived Programs

Welcome to the 2013 Walden University Research Symposium. Again this year we are excited to be able to showcase research projects from our academic community, including work by our recent graduates, in two different formats. Poster presentations provide an opportunity for researchers to engage with all individuals attending the symposium and potentially to network with other interested researchers. Within the roundtable presentation format, a select group of researchers will be available for interactive discussions of their work, with handouts and visual materials available to support the discussion. The topics and approaches are diverse as usual, but this year we see …


Malnutrition In Sickle Cell Anemia: Implications For Infection, Growth And Maturation, Hyacinth I. Hyacinth, Oluwatoyosi A. Adekeye, Christopher S. Yilgwan Jan 2013

Malnutrition In Sickle Cell Anemia: Implications For Infection, Growth And Maturation, Hyacinth I. Hyacinth, Oluwatoyosi A. Adekeye, Christopher S. Yilgwan

Journal of Social, Behavioral, and Health Sciences

Sickle cell anemia (SCA) is a genetic disease that affects mostly individuals of African and/or Hispanic descent, with the majority of cases in sub-Saharan Africa. Individuals with this disease show slowed growth, delayed sexual maturity, and poor immunologic function. These complications could partly be explained by the state of undernutrition associated with the disease. Proposed mechanism of undernutrition include protein hypermetabolism, decreased dietary intake possibly from interleukin-6-related appetite suppression, increased cardiac energy demand/expenditure, and increased red cell turnover. All the above mechanisms manifest as increased resting energy expenditure. Nutritional intervention utilizing single or multiple nutrient supplementation has led to improved …


An Innovative Approach To Action Research In Family Violence Prevention, Linnaya M. Graf, Nancy K. Rea, William M. Barkley Jan 2013

An Innovative Approach To Action Research In Family Violence Prevention, Linnaya M. Graf, Nancy K. Rea, William M. Barkley

Journal of Sustainable Social Impact

Violence prevention remains a priority in the current public health agenda because of continuing high rates and debilitating effects of violence that exist across the globe (U.S. Department of Health and Human Services, Administration on Children, Youth and Families [USDHHS-ACF], 2009; World Health Organization [WHO], 2013). This article presents the use of an innovative qualitative study developed from community action research methods in the area of family violence. By applying the combined framework of force field analysis (Lewin, 1958) and the public health model (Centers for Disease Control, 2002; Knox & Aspy, 2011), the current study identified factors that positively …


A Geographical Analysis Of Hiv/Aids Infection In Nigeria, 1991-2001, Chinekwu Azuka Obidoa, Robert G. Cromley Jul 2012

A Geographical Analysis Of Hiv/Aids Infection In Nigeria, 1991-2001, Chinekwu Azuka Obidoa, Robert G. Cromley

Journal of Social, Behavioral, and Health Sciences

Abstract

Objectives: Within the gradually accumulating literature on the Acquired Immune Deficiency Syndrome (AIDS) in Nigeria, investigations concerning the spatial dimensions of the infection are virtually non-existent. An understanding of the spatial dimensions of the epidemic is central in the development and implementation of appropriate intervention strategies. This study is a geographic analysis of HIV/AIDS infection in Nigeria from 1991 – 2001. The three objectives of this study were: 1) to examine the geographic pattern of the epidemic, 2) to examine the spatial-temporal trend and diffusion pattern of the epidemic, and 3) to explore the factors associated with the spatial …


The Emerging Hiv Epidemic On The Mexico-U.S. Border: An International Case Study Characterizing The Role Of Epidemiology In Surveillance And Response, Steffaine Strathdee, Carlos Magis-Rodriguez, Richard Jimenez Jun 2012

The Emerging Hiv Epidemic On The Mexico-U.S. Border: An International Case Study Characterizing The Role Of Epidemiology In Surveillance And Response, Steffaine Strathdee, Carlos Magis-Rodriguez, Richard Jimenez

Walden Faculty and Staff Publications

Purpose

Human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome surveillance data are critical for monitoring epidemic trends, but they can mask dynamic subepidemics, especially in vulnerable populations that underuse HIV testing. In this case study, we describe community-based epidemiologic data among injection drug users (IDUs) and female sex workers (FSWs) in two northern Mexico-U.S. border states that identified an emerging HIV epidemic and generated a policy response.

Methods

We draw from quantitative and qualitative cross-sectional and prospective epidemiologic studies and behavioral intervention studies among IDUs and FSWs in Tijuana, Baja California, and Ciudad Juarez, Chihuahua.

Results

The recognition that the HIV epidemic …


Extending The Progressive Tradition To Poor Countries: The Role Of Universities And Colleges, Shiko Gathuo Oct 2011

Extending The Progressive Tradition To Poor Countries: The Role Of Universities And Colleges, Shiko Gathuo

Higher Learning Research Communications

American universities and colleges have always been a bastion of liberalism and progressive thought. Historically, the academic community has supported social justice issues, given a voice to the poor, minorities and the disadvantaged, and brought to light subjects that are considered taboo elsewhere. Indeed, many social movements have either started in American universities or been energized by the actions of university students and faculty, and often with the support of university administrations. Yet, when it comes to dealing with global issues that affect poor nations, universities have not always acted as change agents. In some cases, universities have to been …


Patients' Perspectives On Discussing Complementary And Alternative Medicine Therapies With Conventional Doctors, Deborah A. Mcninch Jan 2011

Patients' Perspectives On Discussing Complementary And Alternative Medicine Therapies With Conventional Doctors, Deborah A. Mcninch

Walden Dissertations and Doctoral Studies

Currently, little is known about patients' perceptions and beliefs in discussing complementary and alternative medicine (CAM) with their conventional medical (CM) doctor. The purpose of this descriptive research was to show whether CAM-using patients have an interest in discussing CAM treatments with their CM doctor for comprehensive care as described by the health belief model (HBM) constructs of perceived susceptibility, perceived seriousness, and perceived benefits of taking action. A sample of 165 participants age 18 or older from 2 chiropractic clinics in the midwestern United States completed a Likert-scaled survey. The data were analyzed using descriptive statistics and multiple regression …


Effect Of Clinical Laboratory Practitioner Licensing On Wages, Mary Hotaling Jan 2011

Effect Of Clinical Laboratory Practitioner Licensing On Wages, Mary Hotaling

Walden Dissertations and Doctoral Studies

Professional licensing directly affects about 29% of U.S. workers and is considered a primary means to establish and maintain health care practitioner competence. Clinical laboratory practitioner licensing was largely ignored in the literature with only 2 studies 30 years apart that provided conflicting conclusions regarding wage effects. This research provided the first study of clinical laboratory practitioner licensing effects on wages after controlling for human capital and individual characteristics wage determinants. This nonexperimental correlational study extended the literature on licensing effects on wages, including women's wages and professions not uniformly licensed across 50 states. The theoretical foundation relied on the …


Leadership And Attitudes On Adopting Evidence-Based Practice For Influenza Vaccination, Pamela A. Paparone Jan 2011

Leadership And Attitudes On Adopting Evidence-Based Practice For Influenza Vaccination, Pamela A. Paparone

Walden Dissertations and Doctoral Studies

The United States has set a 90% benchmark for influenza vaccinations for healthcare personnel. Unfortunately, healthcare personnel fall far short of that mark with current rates as low as 62%. Low vaccination rates are responsible for influenza, nosocomial influenza, influenza-like illness, and mortality during influenza season. The purpose of this quantitative correlational study was to understand the relationship between leadership styles, attitudes towards evidence-based practice, and vaccination intention among New Jersey registered nurses (RNs). Diffusion of innovations theory was the theoretical foundation. The 3 instruments used were the Multifactor Leadership Questionnaire, Evidence Based Practice Attitude Scale, and Behavioral Intention Scales, …


Gatekeeper Suicide Prevention Training And Its Impact On Attitudes Toward Help Seeking, John Angelo Cascamo Jr. Jan 2011

Gatekeeper Suicide Prevention Training And Its Impact On Attitudes Toward Help Seeking, John Angelo Cascamo Jr.

Walden Dissertations and Doctoral Studies

Gatekeeper Suicide Prevention Trainings such as Question Persuade and Refer (QPR) are used to increase suicide awareness and teach participants basic suicide intervention skills. Previous researchers showed that QPR training increases knowledge of suicide risk factors and increases participants' willingness to intervene with individuals at risk of suicide. It was hypothesized that completion of QPR would also increase positive attitudes toward the utilization of mental health services and that this outcome would be more pronounced among male participants. The examination of attitudes was rooted in the theoretical framework of Ajzen's theory of planned behavior. The Inventory of Attitudes toward Seeking …


Efficacy Of Fixed Infrared Thermography For Identification Of Subjects With Influenza-Like Illness, Christopher M. Hinnerichs Jan 2011

Efficacy Of Fixed Infrared Thermography For Identification Of Subjects With Influenza-Like Illness, Christopher M. Hinnerichs

Harold L. Hodgkinson Award for Outstanding Dissertation

Due to pandemic threats and the occurrence of biological terrorism, technological advancements are being vetted, developed, and implemented as part of surveillance systems and tools. A potential surveillance tool is infrared thermography (IRT), and its efficacy for screening was the focus of this dissertation. IRT-screened participants' temperatures were compared to laboratory diagnostics to confirm the presence or absence of influenza-like illness (ILI). An archival dataset of personnel on United States Navy and Marine vessels that were identified as exceeding an ILI threshold limit provided the data for the 320 study participants. Using a guiding thermo-science framework, derived from past IRT …


Surveillance And Reporting Of Zoonotic Diseases: Perception Of Partnership And Communication Between And Among State Animal Health Officials And State Public Health Veterinarians, Kimberly Leigh Mcdonald, Steven Little, Angeleque Akin-Little Jan 2011

Surveillance And Reporting Of Zoonotic Diseases: Perception Of Partnership And Communication Between And Among State Animal Health Officials And State Public Health Veterinarians, Kimberly Leigh Mcdonald, Steven Little, Angeleque Akin-Little

Journal of Social, Behavioral, and Health Sciences

The transmission of zoonotic diseases from wild and domestic animals to human beings is considered a global public health threat. Developing guidelines to establish communication between and among animal health and health public agencies is paramount. Constant monitoring of the exchange of information and the reporting of zoonotic disease episodes constitute effective surveillance techniques. However, past research has indicated that communication and reporting methods vary widely among U.S. states, with some states having minimal or no collaboration between and among animal health professionals and public health agencies. Therefore, guided by a social network theory, the current research examined whether communication …


Assessing City Preparedness For A Biological Attack, Joseph T. Moore Jan 2011

Assessing City Preparedness For A Biological Attack, Joseph T. Moore

Walden Dissertations and Doctoral Studies

The lack of preparedness by local communities in the event of a biological attack is a predicament that will result in chaos and an increase in casualties. Assessing city preparedness is essential in the event of a biological attack. The potential for an enormous number of casualties is real; it is imperative, therefore, for local communities to be prepared in the event of a biological attack. This descriptive single case study investigated whether one city in the southeastern United States is prepared for a biological attack. System theory provided the theoretical framework for this research, with the unit of analysis …


Psychiatric Disorders As Potential Predictors In Medical Disease Development, Linda Kay Taliaferro Jan 2011

Psychiatric Disorders As Potential Predictors In Medical Disease Development, Linda Kay Taliaferro

Walden Dissertations and Doctoral Studies

Millions of individuals suffer disability or death from immune-based inflammatory diseases. If psychiatric disorders could be empirically linked to the prediction of immune-based inflammatory diseases, there would be a basis for promoting disease prevention measures for individuals diagnosed with one of four psychiatric disorders. Psychoneuroimmunology provided the theoretical base for understanding emotionally induced medical disease development. In this quantitative study, a parallel archival research design was used to investigate the degree to which generalized anxiety disorder, posttraumatic stress disorder, major depression recurrent, and dysthymic disorder predicted the presence of atherosclerosis, cardiovascular heart disease, rheumatoid arthritis, cancer, and type II diabetes. …


Assessing Doppler-Derived Pressure Gradients And Liver Echogenicity To Predict Liver Disease, Joy D. Guthrie Jan 2011

Assessing Doppler-Derived Pressure Gradients And Liver Echogenicity To Predict Liver Disease, Joy D. Guthrie

Walden Dissertations and Doctoral Studies

Liver disease causes an estimated 36,000 deaths in the United States each year. Currently, to detect liver disease, an invasive biopsy is required. Other, less invasive diagnostic alternatives are needed. The purpose of this study was to assess the efficacy of a modified form of sonographic screening, including portal, hepatic, and splenic venous pressure, hepatic venous waveform analysis, portal vein diameter, and echogenicity of liver parenchyma in predicting liver disease. The study was based on conversion of a velocity measurement to a pressure gradient, allowing a fluid comparison between known catheterization venous pressures and sonographic Doppler-derived pressure gradients. This study …


Assessing The Influence Of Socioeconomic Factors, Knowledge Level, Attitudes, And Practices On Malaria Prevention Among The Gusii People Of Kenya, Christopher Nyakundi Arori Jan 2011

Assessing The Influence Of Socioeconomic Factors, Knowledge Level, Attitudes, And Practices On Malaria Prevention Among The Gusii People Of Kenya, Christopher Nyakundi Arori

Walden Dissertations and Doctoral Studies

Global morbidity and mortality associated with malaria is rampant, and most of the clinical malaria cases are found in sub Saharan Africa. Previous and current research show that malaria is both preventable and treatable and that socioeconomic variables have a profound influence on how persons in rural Africa respond to malaria infections and the associated preventive strategies. This study assessed two key research questions for malaria cases in the Gusii region of Kenya regarding: First, whether a community education program on malaria has an impact in changing malaria preventive behaviors; and, second, if a relationship exists between socioeconomic factors and …


Effect Of Education On Stigma Of Epilepsy In South Eastern Nigeria, Augustina Chinyelu Maduakor-Ugo Jan 2011

Effect Of Education On Stigma Of Epilepsy In South Eastern Nigeria, Augustina Chinyelu Maduakor-Ugo

Walden Dissertations and Doctoral Studies

There is a need for epilepsy-based health education programs to enlighten Nigerian communities and reduce the stigma associated with epilepsy. Epilepsy in Nigeria is viewed by some as a contagious and an infectious disease or a condition imposed from the gods, possessed by demons, as the work of witchcraft, or punishment from ancestral spirits, which are all related to a lack of knowledge about epilepsy leading to stigmatization of persons with epilepsy. Guided by the stigma theory, the purpose of this community-based, cross sectional study was to quantitatively examine the effect of an educational program on interpersonal, internalized, and institutional …


Evaluation Of Capacity For Best Practice Of Clinical Vaccine Research In Western Kenya, Sylvie Anne Kwedi Jan 2011

Evaluation Of Capacity For Best Practice Of Clinical Vaccine Research In Western Kenya, Sylvie Anne Kwedi

Walden Dissertations and Doctoral Studies

African institutions that perform health research need to continuously evaluate their practices in order to ensure compliance with international standards of good clinical practice (GCP). This mixed-methods study, undertaken at one clinical research site in Western Kenya, was an evaluation of GCP compliance at the site, research participants' satisfaction with research procedures, and research participants' comprehension of informed consent. The qualitative portion of the study involved audit of the site's compliance with GCP standards. The quantitative portion was an assessment of participant satisfaction and informed consent comprehension, undertaken through interviews with a sample of 297 participants. Thematic analysis of the …


The Relationship Between Overweight And Obesity And Acculturation Of 12- To 19-Year-Old Mexican American Children, Elsa Ramirez-Brisson Jan 2011

The Relationship Between Overweight And Obesity And Acculturation Of 12- To 19-Year-Old Mexican American Children, Elsa Ramirez-Brisson

Walden Dissertations and Doctoral Studies

Mexican Americans, one of the fastest growing segments of the population, have been identified as having above-average rates of obesity. Yet, among this group, obesity rates seem to differ by immigrant status: recent immigrants, immigrants who have lived in the United States more than 15 years, and U.S.-born Mexican Americans. Guided by the acculturation phenomenon and the social ecological model, the current study assessed all 1,732 Mexican American children 12-19 years old who participated in the National Health and Nutrition Examination Survey between 2003 and 2008 to determine the association between body mass index (BMI) and language, years living in …


Effect Of Stress, Emotional Lability And Depression On The Development Of Pregnancy Complications, Servitje, Estibalitz Laresgoiti Servitje Jan 2011

Effect Of Stress, Emotional Lability And Depression On The Development Of Pregnancy Complications, Servitje, Estibalitz Laresgoiti Servitje

Walden Dissertations and Doctoral Studies

Chronic stress and other emotional factors may have relevant impacts on pregnancy outcomes because they are related to neuroendocrine changes that lead to alterations in immunomodulation during pregnancy. In this quantitative prospective cross-sectional study, the relationship of emotional lability, depression, and stress during pregnancy and the development of preterm labor, preeclampsia, placental abruption, and low birth weight for gestational age babies was examined. Additionally, social support scores were compared to levels of stress/anxiety, depression, and emotional lability in pregnant women. Two hundred and forty two pregnant women who received prenatal services at the National Institute of Perinatology in Mexico City …


The Impact Of Infectious Disease On Chronic Disease: A Review Of Contemporary Findings, Wendy Berke Jan 2011

The Impact Of Infectious Disease On Chronic Disease: A Review Of Contemporary Findings, Wendy Berke

Journal of Social, Behavioral, and Health Sciences

Infectious diseases are among the top causes of death in adults and children. Chronic diseases such as cardiovascular disease and cancer are among the top causes of death in adults. Associations between bacterial and viral infectious agents and subsequent development of chronic disease have been made in the past but are currently being reexamined with more rigor and specificity. This review examines infectious disease agent causes and associations with cancer, cardiovascular disease, metabolic disease, and neurodegenerative disease. These associations will impact future research, surveillance, treatment, and prevention of both infectious and chronic diseases.


Racial /Ethnic Disparities In Hypertension In United States Residents: A Cross-Sectional Study Of Potential Explanatory Covariates, Franklin I. Opara Jan 2010

Racial /Ethnic Disparities In Hypertension In United States Residents: A Cross-Sectional Study Of Potential Explanatory Covariates, Franklin I. Opara

Walden Dissertations and Doctoral Studies

Racial/ethnic disparities persist in hypertension (HTN) prevalence in the United States, and African Americans are disproportionately affected. The incidence is more than two-folds in African Americans compared to Caucasians, and mortality is highest among African Americans. Understanding the risk factors in HTN and how these factors vary across racial/ethnic groups is essential to reducing the mortality among African Americans. This study examined the prevalence of HTN among a sample non-institutionalized U.S. residents (N = 30,852), assessed racial/ethnic disparities and determined factors associated with racial/ethnic variance in HTN. A cross-sectional design was used to address these aims, utilizing the National Health …


Managing Health Care In A Libyan Public Hospital: A Case Study, Alexandria K. Osborne Jan 2010

Managing Health Care In A Libyan Public Hospital: A Case Study, Alexandria K. Osborne

Walden Dissertations and Doctoral Studies

Libyan citizens who can afford private health care are opting out of the public health care system. They have a perception that the quality of public health care has deteriorated. The negative perceptions have resulted in a lack of trust by many of Libyan's citizens in the Libyan public health care system and consequently to unequal access to quality health care. The purpose of this study was to identify the factors that have led to the negative perceptions and mistrust. The conceptual support for the study was based on a construct of trust that defines trust as the state of …