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Harnessing Family Empowerment To Promote Healthcare Transition For Youth With Special Healthcare Needs: The F.A.M.E. Project, Vanessa Coppola

Yale School of Nursing Digital Theses

Only 20.5% of Youth with Special Healthcare Needs (YSHCN) receive transitional health care support services. This rate is even lower for minority and low-income YSHCN, as well as among subset populations of those with certain Intellectual and Developmental Disabilities. Multiple authorities in child health emphasize the importance of effective transitional care services targeted towards YSHCN to mitigate potential adverse health outcomes and reduced quality of life. This project aimed to examine the effect of a family empowerment curriculum to promote successful healthcare transition for YSHCN. Project F.A.M.E. was conducted to assess the impact of a family empowerment curriculum among caregivers …

Implementing Prediabetes Screening During Hospitalization In An Internal Medicine Unit, Roxana Bustamante

Yale School of Nursing Digital Theses

About 1 in 3 adults in the United States have prediabetes, yet 8 in 10 of people are unaware of having this condition. The gap in timely diagnosis of prediabetes hinders opportunities for awareness of risk for type 2 diabetes (T2DM), self-management, and referral to preventative interventions. Individuals with undiagnosed prediabetes have 1.3 times higher risk for hospitalization. Extending prediabetes screening to the inpatient hospital setting offers opportunity to identify undiagnosed prediabetes. The purpose of this DNP project was to implement a prediabetes screening algorithm in the hospital setting to identify undiagnosed prediabetes and initiate patient education on preventative lifestyle …

Shifting The Paradigm Toward Intent To Stay: Creating A Nurse Career Crafting Program To Increase Nurse Engagement In An Urban Teaching Hospital, Jaclyn Davis

Yale School of Nursing Digital Theses

Nearly 50% of all RNs experience job disengagement, dissatisfaction, and signs of burnout during their career (National Academy of Medicine, 2019). RN burnout is largely the corollary of two predominant themes: perception of engagement in meaningful and motivating work and perception of personal ability to disconnect and decompress (Press Ganey, 2018). Job crafting skills guide people to make meaning of their work in difficult context, and their experience of work as a job, career, and calling. These skills help nurses align their strengths, motives, and passions within their roles. This DNP Project developed a Career Crafting Program using a modified …

Increasing Transplant Medication Knowledge Through Implementation Of A Medication Education Intervention Algorithm, Colleen Chime Karkhang

Yale School of Nursing Digital Theses

Limited health literacy (LHL) has profound implications on measured transplant outcomes as it is associated with higher incidence of graft loss, organ rejection, decreased immunosuppression medication adherence, and increased hospital re-admissions. Identification of patients with limited health literacy allows for opportunities to provide targeted medication education that allows patients to become more active participants in their care while increasing their transplant medication education knowledge and self-efficacy. The aims of this DNP projects were to develop and implement a medication education intervention algorithm that incorporates health literacy scores and evidenced based educational interventions amongst kidney transplant recipients (initial transplants and re-admissions) …

Improving Treatment Outcomes For American Indians With Posttraumatic Stress Disorder Through The Use Of Telepsychaitry, Shaylice Meserole

Yale School of Nursing Digital Theses

The prevalence of PTSD has increased from 6.8% to 20% since the start of the Covid-19pandemic. For American Indians, the prevalence of PTSD ranged between 16 to 24% prior to the start of the pandemic. American Indians living in rural and tribal communities often experience significant barriers to accessing quality mental health treatment. For these reasons, telepsychiatry is a necessary tool to increase access to care. An entirely home based telepsychiatry program was developed and adapted for PTSD patients within a tribal community and implemented over 12 weeks. 40 patients were engaged at the initiation of the program and a …

Obstructive Sleep Apnea Screening And Sleep Specialist Referral In Outpatient Psychiatric Populations, Jeremy Michael Mills

Yale School of Nursing Digital Theses

Background: Obstructive sleep apnea (OSA) affects approximately 1 billion people globally and is highly prevalent in psychiatric patient populations. Comorbid OSA can worsen psychiatric symptoms and increase suicide risk. Despite calls for OSA screening in psychiatric patient populations, it is currently underrecognized in mental health settings.

Objective: A protocol was created for OSA screening and sleep specialist referral for individuals seeking medication management services at a community mental health center.

Methods: Using the STOP-Bang questionnaire, a well-validated screening tool for OSA, individuals with positive screenings for OSA risk were referred to a sleep specialist during a 10-week implementation period.

Results: …

A Mixed Methods Exploration Of Stigma, Discrimination, And Sleep Among Those On Medication For Opioid Use Disorder, Uzoji Nwanaji-Enwerem

Yale School of Nursing Digital Theses

Insomnia occurs in as many as 75% of people with Opioid Use Disorder (OUD). The prevalence of insomnia is attributable to concurrent factors such as mental health disorders, chronic pain, and medication use; however the contribution of social factors is not well understood. Persistent social factors and concerns within this population include stigma and discrimination. People who use prescribed medication for OUD (MOUD) report stigma and discrimination related to OUD, MOUD, and possibly other characteristics (e.g., race, gender, socioeconomic status, and incarceration history). However, the relationship between OUD-related stigma and discrimination with insomnia and between intersectional experiences, perceptions of stigma, …

The Adaptation And Implementation Of A Comprehensive Retirement Transition Program For Members Of Law Enforcement, Renee White

Yale School of Nursing Digital Theses

Due to job related PTSD and identification with their intense careers, police officers areat risk for substance use disorder and mental illness when they transition into retirement. This DNP project implemented a retirement transition program modeled from a successful federal program for military personnel that was structured as a five day, in-person experience designed to be efficient and cost effective. The aims of the project were to: 1) modify an existing comprehensive retirement transition program used by the US military for police officers in an unnamed state within 5 years of their projected retirement date; 2) implement and evaluate this …

Development Of An Educational Program To Elevate The Financial Cumen Of Nurse Managers, Quyen Wong

Yale School of Nursing Digital Theses

The purpose of this QI project is to elevate the financial acumen of nurse managers (NMs) in a large urban healthcare organization through the development of an educational program to strengthen the science of managing the business, a core AONL competency domain for nurse managers. The nurse manager role has evolved in today’s rapidly changing and demanding healthcare landscape that has been stressed by an increased demand for services and a decrease in resources. The impending nursing shortage that has been accelerated by the COVID-19 pandemic is an added stressor to the workload of nurse leaders as they struggle to …

Perceptions Of Adults With Type 1 Diabetes About Diabetes Management And Exercise, Meera Swaminath

Public Health Theses

This study was conducted to understand participants’ experiences with diabetes management and relationships with exercise for a sample of adults (27-65 years old) with Type 1 diabetes living in the United States and identify potential technological features for a digital health tool supporting physical exercise and diabetes management. The sample consisted of 12 participants living across the nation. Participants were recruited online, through social media and healthcare system platforms. Participant data was collected in the form of surveys and interviews and analyzed using a constructivist framework and thematic analysis. Findings were collapsed into four major themes: 1) making exercise decisions …

A Deeper Dive Into Food Insecurity Among Women Involved In The Criminal Justice System, Jessica Robles

Public Health Theses

Background: The U.S. has the highest incarceration rate globally and a recent study found that 91% of formerly incarcerated individuals report being food insecure. Given that, women have become the fastest-growing segment in the incarceration system. Women who are involved in the criminal justice system (WICJ) are more at risk for experiencing food insecurity and chronic diseases. Therefore, this study aims to contribute to existing knowledge on the overall health of WICJ by assessing the prevalence of food insecurity and the social determinants of health (SDOH) that may contribute to food insecurity.Objective: To provide information on the overall health of …

Association Between Inflammatory And Metabolic Biomarkers And Lymphedema In Women With Ovarian Cancer, Kimberly Elizabeth Reinhart

Public Health Theses

Background: There is currently no cure for lymphedema, thus being able to predict who islikely to develop lymphedema will allow for early intervention. To date, no study has examined the association between metabolic and inflammatory biomarkers and lower limb lymphedema (LLL) in women with ovarian cancer. This secondary analysis seeks to explore the association between serum blood biomarkers and LLL in women with ovarian cancer and determine if the change in biomarkers over time is associated with a change in lymphedema status. Methods: Data from the Women’s Activity and Lifestyle Study in Connecticut (WALC), a 6- month exercise intervention randomized …

The Impact Of Climate Change On The Mental Health Of Native American Youth: A Qualitative Study Protocol, Xun Wang

Public Health Theses

Climate change can induce a significant mental health burden on youth, especially for those in Indigenous communities. Despite their vulnerability, little is known about the impact of climate change on the mental wellbeing of Native American children and adolescents. This qualitative study seeks to address this gap by exploring Native American youths’ perceptions and emotional and behavioral responses to climate change. The study is grounded in Indigenous methodologies, which prioritize Indigenous worldviews, values, and ways of interaction. We will utilize relational capital on campus to identify the collaborating tribe and ensure a respectful and reciprocal relationship is built before proceeding …

“It’S Like A Partnership”: Exploring The Primary Care Experiences And Self-Defined Goals Of People Who Use Drugs, Katherine Dunham

Public Health Theses

Background: Primary care is an important yet underutilized resource in addressing the overdose crisis. Previous studies that have explored people who use drugs’ (PWUD) experiences in primary care have found patient involvement in care decisions and goal-setting to be especially important. However, there has been limited research describing PWUD’s goals specific to primary care. This study utilized qualitative methods to explore how PWUD navigate primary care with a focus on understanding participants’ primary care goals.

Methods: From June — August 2022, we conducted 17 semi-structured interviews with PWUD currently in care at The REACH Program, a harm reduction-based primary care …

“You Are Just Trying To Make It Work”: A Qualitative Exploration Of Healthcare Provider Implementation Considerations For Integrating Mental Health And Hiv Care In Central Uganda, Divya Gumudavelly

Public Health Theses

There is a growing push to integrate mental health services within HIV care in urban Uganda. Amidst HIV clinics becoming comprehensive healthcare centers, there is a critical need to understand how providers can better adopt and implement mental health specific protocols in HIV practice. Semi-structured interviews were conducted with 16 healthcare providers at two different HIV care centers to understand current practices, routines, barriers, and facilitators to implementing mental health care services within HIV care. Abductive thematic analysis, drawing from Consolidated Framework for Implementation Research (CFIR) and Theoretical Domains Framework (TDF) frameworks, was used in conjunction with constructivist grounded theory …

Food Environment Intervention And Dietary Impacts In Blue Zones Project Communities On The Island Of Hawai'i, Katherine Fuller

Public Health Theses

ABSTRACTBackground: High intake of fruits and vegetables is associated with many health benefits including a lower risk of incident hypertension, heart disease, stroke, obesity, Alzheimer’s, and dementia. Dietary choices are impacted by a variety of individual socio-psychological and environmental factors. For this reason, Blue Zones Project (BZP) hypothesized that a multilevel intervention combining psychological, social, and environmental factors would have the largest impact on eating behaviors compared to a single-level approach. We assessed the impact of a BZP food environment intervention on fruit and vegetable intake and food insecurity among adults on the island of Hawai’i (or the Big Island). …

Understanding The Current Role Of Social Media In American Samoan Adolescent Lives, Mukund Desibhatla

Public Health Theses

Purpose: This exploratory study investigated the social and cultural factors that shape social media use among adolescents in

American Samoa. Methods: This project was a secondary qualitative analysis. Methodological considerations included an

interpretivist approach to epistemology and alignment with the Fa’afaletui Pacific framework. Phenomenology methods were

used to “bracket” researcher biases. A 21st-century flexible coding approach proposed by Deterding et al. 2021 was applied

to the dataset [31]. Transcript excerpts were re-sorted by the index code: social media/technology as a predictor of mental

illness. An abductive thematic analysis, stemming from inductive and deductive reasoning, was used to analyze the codebook …

Embedding Public Health In Climate And Energy Policy Action: Recommendations For Inflation Reduction Act Spending In Colorado, Maggie Hart

Public Health Theses

Colorado should work towards rapid, equitable, and local-level decarbonization to mitigate the adverse public health impacts from climate change. Policy makers and organizations should capitalize on new funding streams from the Inflation Reduction Act to lead this charge. Actions may take several forms, but all should be centered in the following three premises:Engage energy, climate change, and public health stakeholders in all parts of Inflation Reduction Act implementation; Prioritize local level decarbonization through weatherization, household electrification, and adoption of electric public transportation vehicles; and Match Colorado state funds with Inflation Reduction Act funding to amplify support.

The Inflation Reduction Act …

Climate Change, Reproductive Justice, And Existential Politics: Examining Histories And Implications Of Neo-Malthusianism In The U.S. Environmental Movement, Aija Zamurs

Public Health Theses

Climate change is the greatest public health threat of our time. The impacts of climate change exacerbates inequities not only among nations but also within societies. Climate action may be seen as an existential threat by political leaders and elites whose power and wealth is derived from fossil fuel-related economic activity and may push them to seek ‘solutions’ to climate change that do not require a shift away from fossil fuels, such as population control measures. The U.S. environmental movement and international NGO apparatus have a dark history of advocating for neo-Malthusian or adjacent approaches to population growth, including coercive …

Circadian Timing In Cancer Treatment: A Mini Review On Cancer Chronotherapy, Jiawei Yin

Public Health Theses

Organisms exhibit rhythmic fluctuations in their behavior and metabolism every 24 hours, a phenomenon controlled by their circadian clock to anticipate changes in the environment. In the past forty years, substantial progress has been made in our knowledge of the molecular mechanisms underlying the circadian clock and cancer. In this context, researchers have explored the possibility of leveraging the circadian clock to improve cancer treatment. Several randomized controlled trials have investigated the effects of circadian chemotherapy and radiotherapy on drug toxicity and efficacy, with many studies reporting clinically significant outcomes, although some findings remain inconsistent. This mini review aims to …

Effect Of Digital Public Health Campaigns By The World Health Organization On Self-Reported Behavior, Recall/Knowledge, And Attitude Toward Interventions Related To Covid-19: A Meta-Analysis, Zili Zhou

Public Health Theses

The COVID-19 pandemic highlighted the need for effective scientific communication. The success of public health interventions are largely dependent on public knowledge and behavior. With the global rise of social media usage, as well as the increased prevalence of social media advertisement campaigns, the platforms present a tool with the potential to be utilized by public health authorities to deliver information and influence broad populations within a short period of time. From 2020 to 2022, the World Health Organization conducted 58 social media campaigns, totaling 176 brand-lift studies, in partnership with Meta on the subject of COVID-19. The campaigns conveyed …

Urban Air Pollution Exposure Of Children In Dwight Neighborhood In New Haven, Ct, Weixi Wu

Public Health Theses

Air pollution remains to be one of the leading causes of morbidity and mortality, especially in the urban environment. Airborne contaminants exposure differs across different communities and in the US, low-income, racial minority communities bear the burdens of high exposure and adverse health outcomes. Therefore, we conducted a study among children living in the Dwight neighborhood in New Haven, CT, where the community is mainly low-income and consist of a large number of immigrants and racial minorities. The objectives of the study were 1) to characterize the distribution and magnitude of individual level of airborne contaminants exposure; 2) to determine …

Impact Of Covid-19 On Women Living With Hiv Who Are Survivors Of Intimate Partner Violence, Xinyi Zhang

Public Health Theses

Background: As the COVID-19 pandemic continues to evolve, there is a concern about elevated intimate partner violence (IPV) risk. Women living with HIV (WLWH) faced disproportionately high rates of IPV compared to women without HIV. The intersections of the co-occurring pandemics of COVID-19 and IPV present unique challenges to WLWH in different ways. Currently, we have limited evidence on the impact of COVID-19 on the experience of IPV among WLWH. Methods: This is a cross-sectional analysis of COVID-19 impact using baseline data from an ongoing, prospective, micro-longitudinal cohort study on HIV care engagement among WLWH who have experienced lifetime IPV. …

Analyzing Pediatric Department Documentation Of Patient Social Needs With Icd-10 Z-Codes, 2019-2020, Oluwatofunmi Jummie Akinwunmi

Public Health Theses

The 10th revision of the International Classification of Diseases (ICD-10) allows healthcare professionals to document social needs with ICD-10 Z-codes. Data derived from documentation of ICD-10 Z-codes can be leveraged to identify at-risk populations for targeted intervention. However, there remains concern for underutilization of these codes particularly in the pediatric population. We sought to examine the documentation of ICD-10 Z-codes in the pediatric outpatient setting of the largest Connecticut hospital network by specialty type and age group. We examined deidentified electronic health records of pediatric outpatient patients from 2019-2020. We used descriptive statistics to measure the proportion of patients with …

Decolonizing Humanitarian Aid: Addressing Racism And Health Inequities In The Context Of Africans Displaced From Ukraine, Nassim J. Ashford

Public Health Theses

The Russian invasion of Ukraine in February 2022 led to one of Europe's largest humanitarian crises since World War II. With over 14 million people forcibly displaced from Ukraine, this thesis delves into the lesser-known aspect of anti-Black discrimination impacting displaced Africans and those of African descent during the conflict. This thesis research has two primary objectives: (1) to explore the personal experiences and struggles of displaced African persons as they encountered barriers to safety while escaping the war-torn region, and (2) to examine NoirUnited International's efforts to create a framework that addresses humanitarian crises with a focus on racial …

Community Perspectives On Mental Health Stigma In American Samoa, Vanessa Luzmila Blas

Public Health Theses

Despite reports of mental health concerns among adolescents in American Samoa, little is known about the current mental health burden. Furthermore, previous literature has identified mental illness-related stigma as a significant barrier to mental health care access and treatment. By gathering various perspectives of adult stakeholders and adolescent participants, this community-partnered qualitative study aimed to describe the perceived stigmatization of mental health in American Samoa.

This study stems from a larger qualitative project on adolescent mental health in American Samoa. Employing the Fa’afaletui research framework, 28 adult informants of differing professions, ages, and gender participated in semi-structured, in-depth virtual interviews …

Exploring The Perceptions Of Genetics, Genetics Testing, And Science In People Of African Descent, Maame-Owusua Boateng

Public Health Theses

Background: Historical injustices towards Black populations in the United States have impacted how communities interact with medicine and public health such as medical experimentations, scientific racism, medical racism, and eugenics. Black communities are underrepresented in human genomics projects compared to those that identify as white or of European ancestry. Prior research has demonstrated that Black people are less likely to know about the availability of genetic testing for diseases and have less confidence in the benefits of genetic testing. These disparities make it imperative to understand the perspectives of people of African descent. Methods: The Black Genome Project is an …

“So We Create Happy Synergies” How An Overall Enabling Environment Helped Lao Pdr Legislate The Who Code On Breastmilk Substitutes: Lessons Learnt, Devina Buckshee

Public Health Theses

ABSTRACT

Background: Exclusive breastfeeding rates in Lao People’s Democratic Republic (Lao PDR) remain at 44% against a global goal of at least 50%, partly due to a weak understanding of the multifactorial and multilevel determinants of breastfeeding (UNICEF, 2021). Therefore, evidence-based advocacy efforts call for a systems approach to improve the enabling environment around breastfeeding. Aim: This study aims to stitch together the comprehensive patchwork of actors and dynamic ‘gears’ in the socio-ecological environment that came together to develop a much more enabling environment to improve child nutrition through breastfeeding promotion and protection in Lao PDR. Further, it aims to …

Honoring The Household: A Multi-Method Examination Of Family Structure, Harmony, And Conflict Among Asian Americans, Monica Jing Chen

Public Health Theses

The Asian American community is the fastest-growing racial group in the U.S. (Budiman and Ruiz, 2022), however, mental health research and practice often fail to accurately capture the scope of mental wellbeing across Asian subgroups. Despite shortcomings in the literature on Asian American mental health, researchers have still found concerning mental health outcomes within the community. Key considerations in supporting and understanding Asian American mental health include family harmony and family conflict; many of these communities greatly value family harmony but also are at risk of intergenerational conflict and other stressors within the household. A primary analysis examined the relationship …