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2021

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The Buffering Effects Of Resilience On Alcohol Use: A Phenotypic And Genotypic Investigation, Shannon Cusack Jan 2021

The Buffering Effects Of Resilience On Alcohol Use: A Phenotypic And Genotypic Investigation, Shannon Cusack

Theses and Dissertations

The college years encompass a time of vulnerability for problematic alcohol use/alcohol use disorder (AUD) and exposure to traumatic events (TE), which is a transdiagnostic risk factor for AUD, posttraumatic stress disorder (PTSD), and comorbid AUD-PTSD. However, not all who experience a TE develop these disorders, highlighting the need to identify factors that impact post-trauma outcomes. Resilience has been shown to be associated with lower alcohol consumption and related problems following TE, though the buffering effects of resilience on alcohol use have not yet been examined. Further, twin studies demonstrate that resilience is moderately heritable, but further research is needed …


Live Cell Biomass Tracking For Basic, Translational, And Clinical Research, Graeme Murray Jan 2021

Live Cell Biomass Tracking For Basic, Translational, And Clinical Research, Graeme Murray

Theses and Dissertations

Single cell mass is tightly regulated throughout generations and the cell cycle, making it an important marker of cell health. Abnormal changes in cell size can be the first indication of dysfunction in response to environmental stimuli such as cytotoxic drugs. Described here is the further development of high-speed live cell interferometry (HSLCI) to concurrently measure the changes in single cell mass of thousands of cells over time. Critically, the high-throughput nature of HSLCI provides realistic pictures of tumor heterogeneity. This throughput enabled HSLCI to correctly predict in vivo carboplatin sensitivity of three triple negative breast cancer patient derived xenografts, …


Nurse Cognition In Response To Alert Generation During Bar Code Medication Administration (Bcma): An Examination Of Human Factors, Elizabeth A. Sloss Jan 2021

Nurse Cognition In Response To Alert Generation During Bar Code Medication Administration (Bcma): An Examination Of Human Factors, Elizabeth A. Sloss

Theses and Dissertations

Introduction: Nurses are at the forefront of care delivery, spending more time with patients than most other providers. Paramount to patient safety is the ability for nurses to make clinical decisions free from human error. Yet, the dynamic clinical environment in which nurses work is characterized by uncertainty, urgency, and high consequence, necessitating that nurses make quick and critical decisions. Notably, medical errors related to clinical decision-making, including medication administration errors, may occur more frequently among new graduate nurses. Therefore, the aims of this dissertation study are to 1) examine patterns of alert generation and alert response decisions (decision outputs) …


Symptom Self-Management In Adolescents Following A Concussion, Amanda Hodges Jan 2021

Symptom Self-Management In Adolescents Following A Concussion, Amanda Hodges

Theses and Dissertations

Background: Adolescents experience a variety of symptoms following a concussion that affect their everyday life. Initial management consists of physical and cognitive rest followed by a gradual return to activities while monitoring symptoms. Managing concussion symptoms in adolescents is a challenge due to their lifestyle and developmental needs but it is the key to improving adolescents’ lives. Symptom self-management is the prevention and control of symptoms and has been shown to improve health outcomes but has not been studied in adolescents with concussion symptoms. Using the Individual and Family Self-Management Theory (IFSMT), the purpose of this study was to …


Targeting Transferrin Binding Protein A For Vaccine Development In Neisseria Gonorrhoeae, Ashley Greenawalt Jan 2021

Targeting Transferrin Binding Protein A For Vaccine Development In Neisseria Gonorrhoeae, Ashley Greenawalt

Theses and Dissertations

Neisseria gonorrhoeae, the causative agent of the sexually-transmitted infection gonorrhea, has recently been labeled a superbug. With dwindling treatment options, there is urgent need for a gonococcal vaccine. TonB-dependent transporters (TDTs) are important gonococcal virulence factors that allow the gonococcus to pirate metals directly from host proteins. The TDTs, TbpA and TbpB, are promising vaccine targets because both proteins are expressed and highly conserved in gonococcal strains, and they are not subject to high-frequency antigenic variation. Because the Tbps bind to host protein as their natural function, our immune system does not recognize them as foreign antigens; thus, immunogenicity is …


“Insurance Doesn’T Care About The Patient”: An Institutional Ethnography Of The Influence Of Professional Autonomy On The Provision Care For Medicaid Dental Patients With Disabilities, Stephanie Lau Jan 2021

“Insurance Doesn’T Care About The Patient”: An Institutional Ethnography Of The Influence Of Professional Autonomy On The Provision Care For Medicaid Dental Patients With Disabilities, Stephanie Lau

Theses and Dissertations

In terms of unmet needs for people with disabilities (PWD), dental care is number three behind residential care and employment (Fisher, 2012). Regardless of disability, oral healthcare traverses all disability diagnoses and can be a significant factor in quality of life (Deckler, 2011; Griffin et al., 2007; Norwood & Slayton, 2013). When attempting to secure oral healthcare, people with disabilities face many challenges, including lack of access, lack of provider education on proper care of PWD, and difficulty finding a willing dental provider (Deckler, 2011; Fisher, 2012; Kennedy, 2009).

The purpose of this study was to investigate professional practices and …


The Relationships Between Adolescents’ Future Aspirations And Postsecondary Enrollment: Finite Mixture Models, Chu Yi Lu Qiu Jan 2021

The Relationships Between Adolescents’ Future Aspirations And Postsecondary Enrollment: Finite Mixture Models, Chu Yi Lu Qiu

Theses and Dissertations

This study took person-centered statistical approaches to explore the multidimensional construct of adolescents' future aspirations and its associations with three covariates (i.e., gender, race, and SES) and a binary, distal outcome measure, postsecondary enrollment. Fourteen survey items representing the multidimensionality of adolescents' future aspirations were extracted from two-waves of Educational Longitudinal Study:2002 student data. The multidimensionality or the latent construct of the adolescents' future aspirations were explored using two finite mixture models called latent class analysis (LCA) and latent transition analysis (LTA). Based on the students' response patterns on the fourteen indicators, three latent classes representing three levels of aspiration …


Straight Through My Heart, Raul A. Aguilar Canela Jan 2021

Straight Through My Heart, Raul A. Aguilar Canela

Theses and Dissertations

Straight through my heart is an exhibition that explores the concept of heartbreak as a socio-political phenomenon. Through the affect of sadness the thesis analyses the way in which subjects are formed under cognitive capitalism. Paying particular interest to the collateral effects of neoliberal culture —hyper-stimulation, self-exploitation, competition, and obsession with productivity—and the pathologies they create —depression, anxiety, body aches, fatigue— this work shifts the burden of sadness from the individual to the community. By doing so it proposes heartbreak as a public feeling.


Perceived Efficacy Of Extrusion Of Maxillary Lateral Incisors With Aligners, Mason T. Bates Jan 2021

Perceived Efficacy Of Extrusion Of Maxillary Lateral Incisors With Aligners, Mason T. Bates

Theses and Dissertations

Purpose: To assess the perceived efficacy of aligners (Invisalign, Align Technology Inc) at performing extrusive movements of maxillary lateral incisors, determine a general threshold of when a maxillary lateral incisor is not extruding as predicted and requiring intervention, evaluate the frequency and methods of intervention to achieve the predicted extrusion, and to evaluate any related differences between orthodontists and general dentists, and between clinicians having treated various numbers of patients with Invisalign in the past 12 months.

Methods: An original 18-question survey was sent by mail to a randomized and geographically proportionate selection of orthodontic specialists (N = …


Systematic Structure-Activity Relationship Studies Of Nalfurafine, Mengchu Li Jan 2021

Systematic Structure-Activity Relationship Studies Of Nalfurafine, Mengchu Li

Theses and Dissertations

Today’s opioid crisis is one of the most challenging public health emergency. Two million Americans suffer opioid addiction. Over 20 million adults are affected by daily pain without non-addictive analgesics.

Kappa opioid receptor (KOR) is one of the most studied new pain targets void of abuse liability. KOR agonists have shown potent analgesia and also potential in alleviating opioid addiction. The only approved KOR agonist in clinic is nalfurafine (NFU). Though not leading to addiction, the analgesic effects of NFU are accompanied by sedative side effects. Therefore, we designed a systematical structure-activity relationship study of NFU for developing non-addictive analgesics. …


Beyond Black Or White: An Examination Of Intersectional Identities, Blame Attribution, And Sexual Violence, Ashlynn D. Bell Jan 2021

Beyond Black Or White: An Examination Of Intersectional Identities, Blame Attribution, And Sexual Violence, Ashlynn D. Bell

Theses and Dissertations

While there may be more discussions of sexual violence than there have been in previous years, cases continually arise where the responsibility of those who have been assaulted is called into question (Alaggia & Wang, 2020). Secondary victimization, or victim blaming, is partially responsible for the continued misattribution of responsibility to survivors. These perspectives minimize the experiences of survivors, which dissuades individuals from the reporting of perpetrators. The current study aimed to evaluate whether particular intersecting identities influenced perceptions of responsibility, in a hypothetical scenario depicting an assault. The race, gender identity, as well as perceptions of respectability of the …


Detrimental Role Of Irf1 In Myeloid Cells During Influenza Infection, Bianca L. Baum Jan 2021

Detrimental Role Of Irf1 In Myeloid Cells During Influenza Infection, Bianca L. Baum

Theses and Dissertations

The influenza virus is constantly evolving new ways to overcome both innate and vaccine-induced host defenses, making the innate immune response a critical therapeutic target for minimizing morbidity and mortality caused by infection. Here we examined the role that interferon regulatory factor 1 (IRF1) plays in regulating host innate immune responses in myeloid cells. We found that knocking out IRF1 from myeloid cells in mice (IRF1DMy) led to a partial protection during IAV infection. Interestingly, recruitment of bone marrow derived myeloid cells as well as NLRP3 inflammasome expression were decreased in the lungs of IRF1DMy mice, whereas …


Il-36g Cytokine Induction In Oral Epithelial Cells Triggered By Treponema Denticola And Their Role In Chronic Periodontitis, Christopher Blake Jan 2021

Il-36g Cytokine Induction In Oral Epithelial Cells Triggered By Treponema Denticola And Their Role In Chronic Periodontitis, Christopher Blake

Theses and Dissertations

Periodontal disease is a polymicrobial disease affecting 10-15% of the population. Periodontal disease affects the quality of life by reducing mastication and potentially causing tooth loss. Periodontal disease is also linked to more severe, systemic diseases such as cardiovascular disease and rheumatoid arthritis. Development of the diseased state occurs when the plaque biofilm shifts from healthy to dysbiotic. The shift to a dysbiotic biome brings with it a shift in bacterial presence, specifically an increase in gram-negative bacteria, such as T. denticola. T. denticola is a gram-negative, anaerobic spirochete whose relationship with oral epithelial cells is poorly understood. Preliminary data …


Canalpro Eal Accuracy Compared To The Root Zx Eal, Benjamin T. Brown Jan 2021

Canalpro Eal Accuracy Compared To The Root Zx Eal, Benjamin T. Brown

Theses and Dissertations

CanalPro Electronic Apex Locator Accuracy Compared to the Root ZX Electronic Apex locator

Benjamin Brown, Garry Myers, Caroline Carrico, Duane Schaefer

Department of Endodontics, Virginia Commonwealth University

Objectives: Electronic apex locators (EAL) are an effective instrument in measuring the working length of a canal. The Root ZX is considered the gold standard by many. The aim of this research is to compare the accuracy of the CanalPro EAL to the Root ZX.

Methods: The actual length of 43 single rooted extracted teeth were measured with a #10 hand file when the tip was visualized at the foramen under a microscope. …


Validation Of A Screening Tool For Pediatric Obstructive Sleep Apnea: A Pilot Study, Julia A. Giardina Jan 2021

Validation Of A Screening Tool For Pediatric Obstructive Sleep Apnea: A Pilot Study, Julia A. Giardina

Theses and Dissertations

Purpose: The purpose of this study was to evaluate the Pediatric-Modified-STOP-Bang (PM-STOP-Bang) as a screening tool to assess sleep related breathing disorders (SRBD) within a pediatric population. The specific aims of this study were: 1) compare the PM-STOP-Bang scores with those from the validated Pediatric Sleep Questionnaire (PSQ), 2) determine the ability of the PM-STOP-Bang and the PSQ screening tools to accurately detect children of high risk for SRBD from a one-night home sleep apnea test (HSAT).

Methods: Orthodontic patients were screened using the PM-STOP-Bang at VCU Graduate Clinic. Patients (n=10) who were recruited and enrolled. Five were determined to …


Hamburger Helper Recipes, John Alex Goss Jan 2021

Hamburger Helper Recipes, John Alex Goss

Theses and Dissertations

Hamburger Helper Recipes is a collection of essays and public addresses that aim to recuperate castoff and misfit material surrounding industries and tools which produce science-fiction fantasies, specifically videogames and television shows. The following essays confront the normative violence of capitalism, whiteness, and hetero-patriarchy that socially and technologically haunt these imaginary worlds and build hegemonic idealogy into their audiences. This collection takes industrial materials and software from their intended commercial purposes of production and “success” into places of abjection and quiet breakdown. The author’s own proximity to masculine and often toxic "work cultures'' within industrial spaces of coding and manufacturing …


Patient Perspectives On Teledentistry And Face-To-Face Doctor Interaction During Orthodontic Treatment, Jackson K. Griffeth D.M.D. Jan 2021

Patient Perspectives On Teledentistry And Face-To-Face Doctor Interaction During Orthodontic Treatment, Jackson K. Griffeth D.M.D.

Theses and Dissertations

Purpose: Orthodontic patients were surveyed to determine the perceived value of doctor-to-patient face-to-face interaction, the desire for convenience and attitudes toward specific uses of teledentistry.

Methods: Participating private practice orthodontists emailed the survey to active patients. 75 self-pay patients from VCU Orthodontic clinic were also invited to complete the survey. Patients 18 years or older were asked to complete the survey regarding their own treatment. Parents of patients under age 18 were asked to complete a separate survey regarding their child’s treatment. Questions asked patients about the importance of face-to-face interaction with their orthodontist and their preferences for the inclusion …


Radiographic Comparison Using Cbct-Pai And Volumetric Analysis Of Endodontically Treated Teeth: A Retrospective Cohort Study, Jeremy Hargrove Jan 2021

Radiographic Comparison Using Cbct-Pai And Volumetric Analysis Of Endodontically Treated Teeth: A Retrospective Cohort Study, Jeremy Hargrove

Theses and Dissertations

Purpose: To assess the changes in CBCT-PAI score as well as 3-D volume of periapical findings associated with endodontically treated roots and to see how these findings change over time.

Methods: Retrospective chart review with the following inclusion criteria: 1. At least one tooth was endodontically treated at the endodontic private practice; 2. Patient had a recall examination and the treated tooth was asymptomatic, functional and a CBCT was exposed; 3. CBCT interpretation found a periapical finding associated with the treated tooth; 4. A follow-up recall examination was completed and CBCT exposed. Cases that fulfilled the inclusion criteria had the …


Virtual Reality Tool For Visualizing The Oral Microbiome, Alexus M. Harris Jan 2021

Virtual Reality Tool For Visualizing The Oral Microbiome, Alexus M. Harris

Theses and Dissertations

There are limited teaching tools for helping both students and patients understand the oral microbiome. It is important to understand the oral microbiome as it heavily influences the health of your oral cavity and the dysbiosis of disease. The oral microbiome influences other aspects of health and serves as an indicator for health. With a greater understanding of the oral microbiome, patients can make healthier lifestyle changes and dentists can better educate their patients. For that reason, the goal of this project was to create a virtual reality tool for visualizing the oral microbiome. The assets for the VR tool …


Development Of Analytical Methods For Analysis Of Glycosaminoglycans And Their Mimetics In Human Plasma, Rawan M. Fayyad Jan 2021

Development Of Analytical Methods For Analysis Of Glycosaminoglycans And Their Mimetics In Human Plasma, Rawan M. Fayyad

Theses and Dissertations

Glycosaminoglycans (GAGs) are linear, polydisperse polysaccharides consisting of alternating amino sugars and either a uronic acid or galactose residue. They are ubiquitous components of the extracellular matrix and are present on cell surfaces and in basement membranes. GAGs are highly negatively charged as a result of many sulfate and carboxylic acid groups, and are extremely heterogeneous in both their structure and in their physicochemical properties. This complexity in structure is attributed to the alterations in residue types, glycosidic bond linkage, sulfation levels, sulfation positions, and chain lengths during biosynthesis. GAGs interact with a wide number of proteins and modulate various …


Molecular Basis Of Cross-Sensitization In Colonic Inflammation-Induced Somatic Hypersensitivity, Parshva K. Mehta Jan 2021

Molecular Basis Of Cross-Sensitization In Colonic Inflammation-Induced Somatic Hypersensitivity, Parshva K. Mehta

Theses and Dissertations

A major portion of pain experienced by patients with an Irritable Bowel Disease (IBD) or Irritable Bowel Syndrome (IBS) can be attributed to visceral hypersensitivity. Visceral stimuli transmitted through primary afferent neurons in the dorsal root ganglia (DRG) induce a nociceptive response. Notably, a subset of patients has also experienced the development of somatic pain, such as leg pain, after diagnosis of a bowel disorder. The aim of this investigation is to ascertain which biochemical mediators are involved in the development of such viscerosomatic cross-sensitization. Initially, the Von Frey Test was used to find behavioral evidence of somatic referred pain; …


Modulation In Nmda Receptor Function Alleviates Safety Learning Deficit In Females Who Experienced Chronic Stress During Adolescence, Zuby C. Okafor Jan 2021

Modulation In Nmda Receptor Function Alleviates Safety Learning Deficit In Females Who Experienced Chronic Stress During Adolescence, Zuby C. Okafor

Theses and Dissertations

Anxiety disorders disproportionately impact women and are more prevalent in people with a history of chronic stress. Post-traumatic stress disorder (PTSD) is a type of stress and trauma-related disorder that is largely characterized by hyperarousal to fear-based cues. The inability to dissociate the fear-response from a non-threatening cue is known as impaired safety learning. Given that N-methyl-D-aspartate (NMDA) receptors are key mediators of learning behaviors, we examined the role of NMDAr function in deficient safety learning. Previous studies have shown that female rats with a history of stress have altered NMDAr gene expression and altered glutamatergic signaling; therefore, we hypothesized …


Reproducibility And Accuracy Of The Virtual Occlusal Record, Anne M. Harper Jan 2021

Reproducibility And Accuracy Of The Virtual Occlusal Record, Anne M. Harper

Theses and Dissertations

Purpose: To evaluate the reproducibility and accuracy of the virtual occlusal record compared to the gold standard physical bite record

Methods: Two physical bite records of PVS and two virtual bites using an iTero Element scanner were obtained from 22 participants. Intraoral scans were exported as STL files, and virtual occlusal records were created. CBCT images were taken of physical occlusal records and converted to STL files. STL files were superimposed using Geomagic Control X™ Software. Root mean square (RMS) and percent similarity within 0.25 mm tolerance were compared at a significance level of 0.05.

Results: Average …


In Vitro Evaluation Of The Solubility Of Endosequence Bc Sealer In Acidic Solutions, Inderpal S. Sappal Jan 2021

In Vitro Evaluation Of The Solubility Of Endosequence Bc Sealer In Acidic Solutions, Inderpal S. Sappal

Theses and Dissertations

Purpose: In recent years, bioceramic sealers (BCS), such as EndoSequence BC Sealer, have gained popularity in endodontic practices. Previous research has found BCS difficult to remove from canals during retreatments when compared with other endodontic sealers. Acidic solutions have been found to inhibit the set of BCS and increase their solubility. The purpose of this study was to evaluate the efficacy of acidic solutions in the removal of BCS as compared with a traditional retreatment solvent.

Methods: Roots of extracted human single rooted teeth (N=15) were prepared into 17 mm sections, then instrumented with ProTaper Gold (PTG) rotary files up …


The Effect Of Local Anesthesia When Used In Dental Restorative Cases Under General Anesthesia On Control Of Intraoperative Physiologic Parameters And Post-Operative Comfort, Kathryn S. Skarda Jan 2021

The Effect Of Local Anesthesia When Used In Dental Restorative Cases Under General Anesthesia On Control Of Intraoperative Physiologic Parameters And Post-Operative Comfort, Kathryn S. Skarda

Theses and Dissertations

Purpose:

To determine the effect of local anesthesia on post-operative pain and physiologic parameters intraoperatively in patients undergoing dental care under general anesthesia.

Methods:

This study was modeled as a double-blinded randomized control trial. Patients included healthy children under the age of six scheduled for restorative dental treatment under general anesthesia. Patient behavior was evaluated pre and post-operatively using the FLACC score and post-operatively using the Parental Pain Score Measure. Intraoperatively, all participants followed a standardized general anesthesia protocol and were given either local anesthetic infiltration by the dental surgeon performing the surgery or no anesthesia was utilized. Intraoperatively physiologic …


Opioid System's Involvement In Ketamine's Antidepressant-Like Effects, Fan Zhang Jan 2021

Opioid System's Involvement In Ketamine's Antidepressant-Like Effects, Fan Zhang

Theses and Dissertations

Depression is one of the most debilitating disorders in the world. The currently available medications typically have a 2-4 week delay in their therapeutic effects and are ineffective for about 40% of patients. In 2000, a subanesthetic dose (0.5 mg/kg i.e.) of the dissociative anesthetic ketamine was reported to have both rapid and robust antidepressant effects in in treatment-resistant depressed patients. However, the mechanisms responsible for ketamine’s antidepressant effects remain unclear. In 2018, a clinical study reported that pretreatment with the nonselective opioid antagonist naltrexone attenuated the rapid antidepressant effect of ketamine in depressed patients. The current study investigated the …


Perovskite Thin Films Annealed In Supercritical Fluids For Efficient Solar Cells, Gilbert Annohene Jan 2021

Perovskite Thin Films Annealed In Supercritical Fluids For Efficient Solar Cells, Gilbert Annohene

Theses and Dissertations

In the field of photovoltaics, scientists and researchers are working fervently to produce a combination of efficient, stable, low cost and scalable devices. Methylammonium lead trihalide perovskite has attracted intense interest due to its high photovoltaic performance, low cost, and ease of manufacture. Their high absorption coefficient, tunable bandgap, low-temperature processing, and abundant elemental constituent provide innumerable advantages over other thin film absorber materials. Since the perovskite film is the most important in the device, morphology, crystallization, compositional and interface engineering have been explored to boost its performance and stability. High temperatures necessary for crystallization of organic-inorganic hybrid perovskite films …


Cognitive Debiasing Intervention For Assessment Of Prolonged Grief Disorder, Farah Aslanzadeh, M.S. Jan 2021

Cognitive Debiasing Intervention For Assessment Of Prolonged Grief Disorder, Farah Aslanzadeh, M.S.

Theses and Dissertations

Cognitive debiasing is an approach to reducing diagnostic decision-making errors resulting from the misuse of cognitive heuristics and biases. This study built on prior research that has successfully used a multi-modal debiasing approach to reduce diagnostic errors. Clinicians were recruited and randomized into a general presentation on the changes in the stress and trauma section of ICD-11 (including the diagnostic criteria of prolonged grief disorder [PGD]) or the same general presentation plus and a cognitive debiasing intervention for PGD. All clinicians were then asked to diagnose three patient vignettes in which biases/potential decision-making errors were embedded in the text. Results …


Pro-Environmental Behaviors Among Black Environmentalists: A Critical Race Perspective, Kimberly S. Compton Jan 2021

Pro-Environmental Behaviors Among Black Environmentalists: A Critical Race Perspective, Kimberly S. Compton

Theses and Dissertations

Environmentalist narratives have left out the labor of Black environmentalists, mischaracterizing Black communities as disinterested in environmental problems or solutions. The purpose of this critical transformative exploratory qualitative study, guided by critical race theory, was to explore the meaning of pro-environmental behaviors among Black environmental advocates. Ten adult Black environmental advocates and organizers were interviewed using semi-structured interviews which were transcribed and analyzed using directed content analysis and thematic analysis. The findings demonstrated divergences between definitions of the environment and how that impacts what is considered pro-environmental behavior; the breadth of the pro-environmental behaviors in which Black environmentalists are engaged; …


A Mixed Methods Approach To Examine Racial Disparities In Adherence To Surveillance Mammography Among Breast Cancer Survivors, Megan C. Edmonds Jan 2021

A Mixed Methods Approach To Examine Racial Disparities In Adherence To Surveillance Mammography Among Breast Cancer Survivors, Megan C. Edmonds

Theses and Dissertations

PURPOSE: Annual surveillance mammography is a critical part of routine cancer care for breast cancer (BC) survivors; reducing mortality by 39%. However, disparities exist with regard to adherence to surveillance mammograms among BC survivors; Black women are 44% less likely to adhere than their White counterparts. Despite the existence of this racial disparity for over a decade, little is known about factors that explain reasons for Black BC survivors’ non-adherence. This is because most studies have not evaluated the role of healthcare delivery or psychosocial factors. Guided by the Behavioral Model for Vulnerable Populations, the purpose of this mixed methods …