Medicine and Health Sciences Commons^™

Understanding Behavioral Health And Treatment Engagement With Former Users Of Prenatal Substances: A Strengths-Focused Mixed Methods Inquiry, Jennifer G. Benson, Peggy Maclean, Andrew Hsi, Sarah J. Erickson

Psychology ETDs

Accessible services for users of prenatal substances are lacking, and treatment engagement is poor with services that are available. Furthermore, legal consequences are often punitive, which ultimately damages the well-being of mother and child. Milagro and FOCUS are two New Mexico programs that provide comprehensive, coordinated care, including medication-assisted treatment, to former users of prenatal substances during pregnancy (in the Milagro Program) and for three years post-birth (in the FOCUS Program). This mixed methods study explored the lived experiences of women from this complex, high-risk population, using a high-engagement sample of women who utilized services at both Milagro and FOCUS. …

Sharing The Burden, Robert Livingston

Capstone Projects and Master's Theses

Family caregivers of hospice patients experience an increased burden due to providing ongoing care. Research on the issue produces no consensus on evidence-based programs to alleviate the burden. Respite or relief services continue to be the primary solution applied to the problem. Central Coast Visiting Nurse Association and Hospice supported a project to address caregiver burden. Hospice provides volunteers to families to reduce the caregiver burden. The project consists of outreach and recruitment to obtain new volunteers that continue to deliver respite within the community. Project duration lasted for approximately three months and was implemented by completing six tabling activities …

Youth Focus Groups: Design And Analysis Plan For The Bears Project, M. Renee Beacom Claborn

Capstone Experience

This capstone project produced a qualitative research design and analysis plan for youth focus groups as part of a Quality Improvement project at OneWorld Community Health Center (OWCHC) School-Based Health Center (SBHC) located at Bryan High School (BHS) in a program called BEARS. The intended use of this project is to serve as a reference guide for BEARS program planners to utilize as part of the data collection and analysis processes. The purpose for collecting qualitative data for this project is three-fold. 1. To explore adolescents’ perspectives of risk behaviors and associated health determinants common to their age group 2. …

Palliative Players: Project Development And Initial Implementation, Eliza Eager

Muskie School Capstones and Dissertations

The Palliative Players are screened and trained hospice volunteers who provide a low-cost, sustainable, role-playing resource for use teaching communication skills to healthcare workers who discuss serious illness with patients and their families. The Palliative Players project was conceived and developed in early 2017 by Dr. Lauren Michalakes, Medical Director of Palliative Care at Coastal Healthcare Alliance (CHA); Sarah Dwelley, RN; Flic Shooter, Director of Hospice Volunteers of Waldo County (HVOWC); and Eliza Eager, Project Coordinator; to provide believable, emotive simulated patients (SPs) for role-play in workshops teaching healthcare workers communication tools and skills for use in conversations with patients …

A Web-Based Interprofessional Education Program For School Nurses And Athletic Trainers: A Pilot Study, Lauren Ashley Welsch

Health Services Research Dissertations

Background: Interprofessional education (IPE) programs have been shown effective in improving interprofessional collaborative practice (ICP) through increased communication and teamwork amongst healthcare professionals with the ultimate goal of improving patient safety and outcomes. However, their use and subsequent outcomes have not been reported amongst athletic trainers (ATs) and school nurses (SNs) in secondary school healthcare. The purpose of this study is to develop, implement and evaluate an IPE program designed to meet the needs of this unique healthcare setting. In addition, qualitative analysis will further describe the communication between ATs and SNs. Methods: A mixed method exploratory design was employed. …

Investigating The Health Meanings Of Young Saudi Women, Tagreed Alnajjar

Electronic Thesis and Dissertation Repository

Women’s structural position within society and their family roles significantly influence their health. Previous studies have shown women hold lower health and socioeconomic status because of their gender within the Saudi culture. This study aimed to provide an understanding of how Saudi women value health and define being healthy within their social contexts. Adopting an ethnographic perspective, three focus groups (31 participants in total) were conducted with volunteer undergraduate Saudi female students on campus during a nine-week field trip to the participants’ university, King Abdulaziz University in Jeddah, Saudi Arabia. Three themes were generated from this study that characterize the …

Nonprofit Hospital Community Benefit Requirements: An Exploration Of National Health Policy Models, Justin P. Swearingen

Dissertations and Theses

Introduction: Nonprofit hospital organizations are public charities with complete tax immunity. Such exemptions are worth $24.6 billion and impact the health of hundreds of millions of people, yet what these charities must do to meet the current “community benefit standard” to maintain their tax-exempt status remains a policy debate. To help inform policymaking, an evaluation of four national requirement models was performed: Tax Value Requirement (at least the value of the tax exemptions must be spent on community benefit), Grassley Requirement (at least 5% of revenue must be spent on community benefit), Expense Requirement (at least 3% of expenses must …

Analyzing The Effectiviness Of A Prescription Drug Monitoring Program Targeting At-Risk Opioid Abuse Patients, Treadway Childs

Public Administration ETDs

The effectiveness of a prescription drug monitoring program in coordination with a prescription opioid recidivism program was examined at a semi-rural community hospital. Patients were identified by a multi-disciplinary committee to be at-risk for opioid misuse or abuse, and were denied prescription opioids. Patients were considered eligible for the program if they had over 12 emergency department visits in the previous 12 months, or 6 visits in the previous 6 months, depending on how long the hospital had records on a patient. Patients who were placed in the prescription opioid recidivism program could not receive opioids at this hospital. The …

Using A Deliberative Dialogue To Facilitate The Uptake Of Research Evidence In Rehabilitation For Children With Cerebral Palsy, Alisiyah Daya

Electronic Thesis and Dissertation Repository

This study explores how to facilitate the use of research evidence to optimize outcomes for children with cerebral palsy (CP) in practice. Findings from two studies were used as the basis for exploring how to comprehensively assess developmental trajectories of children with CP and plan individualized interventions. Seventeen affiliated stakeholders (e.g. physicians, senior leadership, frontline clinicians, families and youth with CP) participated in this study.

Data from a deliberative dialogue and interviews were analyzed using grounded theory methods with a pragmatic perspective. The results highlighted that all areas of practice must engage in knowledge translation to be effective. Stakeholders outlined …

Determining The Detective Quantum Efficiency (Dqe) Of X-Ray Detectors In Clinical Environments, Terenz R. Escartin

Electronic Thesis and Dissertation Repository

According to Health Canada, dental and medical radiography accounts for more than 90% of total man-made radiation dose to the general population. Ensuring patients receive the health benefits of diagnostic x-ray imaging without use of higher radiation exposures requires knowledge and understanding of the detective quantum efficiency (DQE). Currently, the DQE is not measured in clinics because it requires specialized instrumentation and specific DQE-expertise to perform an accurate analysis. In this regard, the goals of this thesis were to: 1) address the limitations of measuring the DQE in clinical environments that affects the accuracy of the measurement; 2) develop and …

Predicting Important Patient-Reported Outcomes For Glaucoma Management: Cross-Sectional Study, Lavanya Uruthiramoorthy

Electronic Thesis and Dissertation Repository

The initiative to understand patient-reported outcomes (PROs) has increased to improve glaucoma management. We sought to identify important predictors of four PROs: social support and community integration, presence of depressive symptoms, vision-related quality of life (VRQoL) and preference-based Health-Related quality of life (HRQoL). A cross-sectional study was conducted among patients in London, Ontario (n=250). Regression models, and classification and regression trees were built. Leave-one-out cross-validation assessed the models’ predictive performance. Mobility aid use, best corrected visual acuity (BCVA), income and living arrangements were predictors identified for VRQoL, and social support and community integration. Mobility aid use was also predictive of …

Patient-Centered Medical Home Adoption In School-Based Health Centers, Abbey Gregg

Theses & Dissertations

The patient-centered medical home (PCMH) is promoted as a primary care delivery design that can improve health care quality and patient outcomes while controlling health care costs. To achieve PCMH recognition, primary care providers must implement practice-level changes in order to deliver care that is comprehensive, coordinated, accessible, high quality, and whole-person oriented. This practice transformation requires advanced use of health information technology, staff investment in quality improvement and care coordination, and significant investments of both financial and human resources to support these activities. As a safety-net provider, school-based health centers (SBHCs) serve vulnerable children that typically experience barriers to …

Structural Violence And Gender-Based Violence In The United States, Sarbinaz Z. Bekmuratova

Theses & Dissertations

Three components of the dissertation project examined the relationship between three different constructs of structural violence and women’s experience of different violence types in their lifetime in the United States. The violence types examined in the study included psychological aggression, coercive control and entrapment, physical violence, stalking, sexual violence, and rape. 2010 National Intimate Partner Violence and Sexual Violence Survey with the final sample size of 9,827 was used for all three portions of the study to analyze the association of structural violence with six types of violence. Additional datasets used were Institute for Women’s Policy Research’s Status of Women …

Hospital Based Emergency Department Visits With Dental Conditions: Outcomes And Policy Implications In The States Of California, Nebraska And New York, Sankeerth Rampa

Theses & Dissertations

The purpose of this dissertation was to present state-level estimates of hospital-based emergency department (ED) visits with dental conditions across all ages in the states of California, Nebraska, and New York. Also, this dissertation examined the outcomes and impact of changes in Medicaid policies on the utilization of ED with dental problems. State Emergency Department Databases (California, Nebraska, and New York), a component of the Healthcare Cost and Utilization Project (HCUP) was used for this dissertation. Dental conditions were identified by using International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes. High-risk groups visiting EDs with dental conditions were …

Bariatric Surgery Recipients' Needs For Long-Term Health And Well-Being; Perspectives Of Patients And Providers, Rebecca H. Liu

Electronic Thesis and Dissertation Repository

The overall purpose of this dissertation was to examine what is needed in bariatric surgery programming to support long-term health and well-being from the perspectives of the patient and providers. Study 1 assessed what bariatric surgery recipients perceive they need to best support their long-term health and well-being from a provincial sample (Ontario, Canada), and from an international sample. Study 2 explored the physical, psychological, social, and clinic-related experiences of individuals who underwent bariatric surgery at least two years prior. Study 3 investigated what bariatric clinic staff believe surgery recipients need to best support their long-term health and well-being.

Findings …

“Do You Think I Should Be Worried?” Building A Call Structure For Hiv(-) Callers To The Nightline, Ivy Epstein

Master's Projects and Capstones

Abstract

San Francisco Suicide Prevention’s HIV Nightline provides emotional support to those living with human immunodeficiency virus (HIV) as well as support and basic medical information around relative risk and testing for who may have been exposed to HIV. Nightline counselors use a harm-reduction model, active listening, reflection of emotions, and encouragement to promote health maintenance and mental health self-care behaviors. Until now, there has been no process to assess whether callers had disproportionate anxiety about HIV given their actual risk level. Consequently, HIV(-) anxious callers could receive inconsistent information. The goal of this improvement study was to develop a …

The Effect Of Paid Sick Leave On Physician Office-Based Visits, Korvin Vicente

Theses and Dissertations

This paper uses a balanced sample of workers from cross-sections of the National Health Interview Survey to estimate the causal effects of paid sick leave on the medical care seeking behavior of individuals, as measured by physician office-based visits.

Integration Of Medical And Dental Services: Case Study Of The Terry Reilly Health Services Latah Clinic Experience, Kylie B. Pace

Boise State University Theses and Dissertations

Although evidence has demonstrated the link between oral and overall health, full integration of medical and dental services in practice is rare in the United States. The current research was designed to describe the development and implementation of the Terry Reilly Health Services (TRHS) Latah Medical-Dental-Behavioral Health integrated clinic (Latah Clinic). Data was collected through structured interviews with a purposive sample of employees from TRHS; observations of a Latah Clinic care team meeting; an environmental scan of facility space; and an analysis of intake forms used at the Latah Clinic. Seven employees from TRHS were invited to participate in structured …

During The Wait: A Phenomenological Study On Denied Social Security Dissability Applicants Awaiting Appeal, Stefanie A. Ford

Graduate Theses and Dissertations

The purpose of the present study is to investigate the essence of the experience of individuals who were denied Social Security Disability benefits and who sought the appeals process. In the first round, five semi-structured face-to-face interviews allow the participants to share their thoughts, feelings, and actions taken and, if any, what life changes occurred during the appeals process. Data analysis using phenomenological methods create textural-structural descriptions from which, in a second interview, applicants choose to confirm, edit, or add to their analyzed interviews. The findings present as seven major themes that describes the phenomenon. They are: (a) procedural unfairness …

Predictors Of Anemia Among Hiv Patients In Uganda, Catherine Nagawa

Masters Theses

HIV-related anemia is associated with increased risk of death. Prior studies suggest an inverse relationship between CD4 cell count and anemia, and a positive relationship between HIV-clinical stage and anemia. However, none have assessed the role of antiretroviral therapy (ART) treatment combinations in these relationships. Therefore, we conducted a cross-sectional study to evaluate the relationship between CD4 cell count, HIV clinical stage and anemia among 4803 Ugandan HIV-patients, and assessed the role of ART treatment combinations. We included HIV patients (> 15 years) receiving ART therapy combinations between 2010- 2015. We evaluated CD4 cell count and anemia using blood tests, …

Socioeconomic Determinants Of Health Disparities By Race And Ethnicity: The Mediating Role Of Social, Psychological And Behavioral Factors, Amanuel Zimam Melekin

Dissertations and Theses

Socioeconomic status (SES) is inversely related to health status. Disparities in health status among races and ethnic groups are partly attributable to differences in SES, but the indirect pathways by which SES may influence health status are not widely studied.

Using the Health and Retirement Study (HRS) data, this dissertation examined the pathways by which SES, via social, psychological, and behavioral factors predicted physical impairment and overnight hospitalization, and asked whether these indirect relationships differed by race/ethnicity. The HRS is a nationally representative multistage area probability sample administered biennially to respondents over the age of 51 and their spouses. Data …

Unmet Needs And Service Utilization By Informal Caregivers, Ryan Marie Diduk-Smith

Health Services Research Dissertations

The number of Americans expected to live into their 80’s and 90’s is growing at an increased rate in the United States, and the numbers of those aging adults with multiple chronic conditions also continues to grow. It is estimated that by 2050, there will be 89 million adults over the age of 65 years living in the United States. For a variety of reasons, including policy, personal, and financial reasons, many aging adults are choosing to “age in place” or to remain in the community. With the increase in the numbers of aging adults in the community, the ability …

Retention In Health: Improving Hiv Retention Within The Sf Community Health Network, Miguel A. Ibarra

Master's Projects and Capstones

Previous work on HIV retention improvement has focused on improving access to care for communities who are either at-risk of falling out of care or who have difficulty engaging in medical care for the first time due to socio-cultural barriers. The San Francisco Department of Public Health (SFDPH), with the support of Project PRIDE, a CDC three-year demonstration project geared towards supporting health departments in implementing public health strategies to reduce new HIV infections within the men who have sex with men (MSM) and transgender communities, is seeking to improve HIV patient retention throughout the San Francisco Community Health Network …

Maternal Healthcare Utilization Among Muslim Mothers From India, Pakistan, And Bangladesh: Is There Equity?, Rohin J. Krishnan

Electronic Thesis and Dissertation Repository

To date, literature exploring maternal healthcare utilization among Muslim populations has largely focused on religious differences. However, little research exists exploring maternal healthcare utilization within Muslim populations. This highlights a research gap because studies across religious groups may obscure important variation within Islamic women. The primary objective of this study assessed if there is equity in MHU among Muslim mothers in India, Pakistan, and Bangladesh. Multivariate logistic regression revealed inequities to be present in the three countries. Predicted probabilities revealed a narrower equity gap in MHU in Bangladesh compared to India and Pakistan. The successes of Bangladesh’s recent efforts to …

Cancer Center Regional Benchmarks For Psychosocial Care, Desiree R. Azizoddin

Loma Linda University Electronic Theses, Dissertations & Projects

The American College of Surgeons (ACoS) Commissions on Cancer (CoC) formulated and implemented standard 3.2 for Psychosocial Distress Screening. This standard requires that all accredited cancer centers evaluate psychosocial distress and provide appropriate triage and intervention for all cancer patients. Over the past decade, Loma Linda University Medical Oncology Center (LLUMOC) administration, physicians, nurses, psychosocial care staff, and chaplaincy collaborated to implement a psychosocial screening and referral program throughout cancer patient services. This current research includes qualitative analysis assessing strengths and barriers of the psychosocial program at LLUMOC from the perspective of LLUMOC providers and two directors of Supportive Care …

A Descriptive Study Of The Elderly In California Substance Abuse Treatment Programs, David Berenschot

Electronic Theses, Projects, and Dissertations

As gerontologists may know, there are a great deal of studies and a variety of academic literature on the misuse of alcohol and prescription medication amongst the elderly population. While there is a plethora of information on alcohol and prescription misuse, there is little reported data about the prevalence of other substance misuse experienced by this population. This study aims to help to fill that gap in the data by using quantitative methods to describe the scope of substance abuse of individuals 55-years or older. This study utilizes data from the Treatment Data Set Admission (TEDS-A). The TEDS-A is a …

The Impact Of Housing Insecurity On Community Health Outcomes: Exploring Collective Community Solutions And Housing Models In The Western Addition, Jacqueline V. Brown, Jacqueline Victoria Brown

Master's Projects and Capstones

In a city where housing is scarce and prices continue to rise, the lower income residents of the Western Addition are in panic. Historically, the Western Addition/Fillmore is ground zero for Urban Renewal. This community is still bouncing back from the negative effects of the out migration of Black residents, Japanese internment, and rapid gentrification. For twenty years, this part of the city was known as Harlem of the West due to its world-renowned Jazz and Blues composers, and is informally known as “Tha ‘Mo”. San Francisco has set the tone nationally for public, mixed income, and private housing that …

Paying It Forward: Training Doulas As A Form Of Reintegration And Support For Communities Of Color, Sandra E. Luna-Martinez

Master's Projects and Capstones

As part of the birth justice movement in Alameda County, Roots of Labor Birth Collective (RLBC) is committed to support, empower and care for birthing members of the community. RLBC works to empower people of color with education and tools to have healthy babies and positive birth experiences regardless of their: gender, size, sexuality, orientation, culture or family structure. Healthy families begin with healthy communities and with that in mind, RLBC decided to tackle two major public health issues at once: recidivism and poor birth outcomes in communities of color. Doula training is not just an intervention to improve birth …

Therapy Dogs And The Impact On Employees In The Pediatric Medical Setting, Laine Foith

Electronic Theses and Dissertations

More than 40% of nurses reported experiencing significant burnout. Burnout is characterized by disengagement, cynicism, negative views of personal accomplishment and ability, and emotional exhaustion. The healthcare providers that experience burnout can possibly expect a decrease in ability to recognize/report errors, increase of negative feelings toward the patient, and decrease levels of patient satisfaction (Ernest, 2014). One of the ways Schub (2015) suggested to regulate burnout for employees was to provide psychosocial support to colleagues to reduce stress. This study is one of the first attempts to bridge the gap between the unknown correlation between qualitative and quantitative benefits of …

New Outpatient Experience Survey Design: A Quality Improvement Case Study, Nathan Paluso

Muskie School Capstones and Dissertations

The purpose of this capstone project is to evaluate the implementation process for a new survey methodology introduced by Maine Medical Partners (MMP), by following the Plan-Do-Study-Act (PDSA) quality improvement cycle framework. This new survey has been implemented to collect data on patients’ experiences in the MMP outpatient facilities, and is offered to the patients via iPad at check-out after their appointment. Through observation at MMP practices and MMP staff interviews, strengths and weaknesses of the implementation process have been identified. Evidence-based solutions pertaining to the identified weaknesses have been selected through a literature review and are incorporated in recommendations …