Medicine and Health Sciences Commons^™

Blenderized Tube Feeding Formulas: Attitudes, Barriers, And Clinical Benefits As Perceived By Registered Dietitians In Pediatric Care, Savannah Smiley Keeler

Master's Theses

Blenderized tube feeding formulas (BTFF) are increasingly recognized as a viable alternative to conventional commercial tube feeding formulas (CTFF) for pediatric patients requiring enteral nutrition. This cross-sectional, exploratory study aimed to assess the experiences, attitudes, and perceived clinical benefits of BTFF use among Registered Dietitian Nutritionists (RDNs) working with gastrostomy-tube-dependent pediatric populations in the United States. A total of 146 RDNs completed a 45-item online survey, which gathered quantitative and qualitative data on BTFF familiarity, feasibility, clinical outcomes, caregiver factors, and institutional barriers. Findings revealed that while BTFF use remains variable across clinical settings, 55.8% of RDNs reported increased utilization …

Lactation Management Training In Graduate Nutrition And Dietetics Programs: A Preliminary Report, Laura Ashton Gillin

Master's Theses

The American Academy of Pediatrics recommends exclusive breastfeeding (BF) for the first six months and continued breastfeeding for at least two years with complementary food. Despite this recommendation, only 24.9% of infants in the United States are exclusively breastfed at six months (Breastfeeding Report Card 2022). Breastfeeding support and lactation management are critical to promoting a successful breastfeeding experience. Specifically, qualified support from a Registered Dietitian Nutritionist (RDN) is recommended, yet graduate students in Nutrition and Dietetics do not receive adequate training regarding breastfeeding intervention. This study aimed to evaluate graduate Nutrition and Dietetic programs to determine the amount of …

Vitamin B12 Deficiency: Confidence, Perspectives, And Practices Among Registered Dietitian Nutritionists, Avery Miller Adams

Master's Theses

Vitamin B12 deficiency is common in the United States, occurring in 20% of adults aged 60 and above (Andres et al., 2004). Veterans are susceptible to B12 deficiency due to tobacco product usage, alcohol consumption, and poor diet quality. Megaloblastic anemia is the second most prevalent vitamin deficiency disorder recorded in military personnel from 1997 to 2015 (Knapik et al., 2021). This exploratory, analytic research aims to assess registered dietitian RDN nutritionists’ (RDN) knowledge, perceptions, and intentions regarding treating vitamin B12 deficiency in a clinical setting. Due to population prevalence differences, responses from VA and non-VA practicing registered dietitian-nutritionists (RDNs) …

Is There An Association Between Food Literacy And Diet Quality In Young Adult College Men?, Morgan Claire Mayeux

Master's Theses

Food literacy skills can improve dietary intake in young adults as it provides them with the tools they need to make healthier food-related decisions. The benefits of improving food literacy includes the reduction in the risk of prevalent, preventable dietrelated diseases such as obesity, T2DM, heart disease, and other chronic diseases that plague the Unites States today. Previous literature reports primarily on college female samples. Because a large proportion of the samples in the available studies are female, the current literature may not reflect young adult men’s food literacy and its comparison to their overall diet quality. The purpose of …

A Developmental Evaluation Of A Dental Hygiene Program And A Community Health Partnership, Laura Jacob

Higher Education: Doctoral Research Projects

Today, dental hygiene education commonly occurs in community college settings which are removed from dental schools thus dental hygiene students graduate with relatively little to no exposure to dentistry or directly with a clinically practicing dentist. With dental hygiene workforce shortages at an extremely high level, locally and nationally, it is imperative to matriculate students who are poised to be successful in the changing landscape of healthcare.

The purpose of this program evaluation was to investigate via the developmental program evaluation model, the perceived benefits of a potential collaboration between the Colorado Mountain College (CMC) dental hygiene program and a …

Using The R = Mc2 Heuristic To Assess Whole-Of-School Physical Activity Implementation In Elementary Schools: A Cross-Sectional Study, Derek W Craig, Kevin Lanza, Christopher D Pfledderer, Andjelka Pavlovic, Kempson Onadeko, Natalia I Heredia, Jizyah Injil, Laura F Defina, Timothy J Walker

Faculty, Staff and Student Publications

Background: Schools are recommended to use a whole-of-school (WOS) approach to promote physical activity opportunities before, during, and after school. Yet, the barriers and facilitators to implementing a WOS approach successfully are not well understood. The R = MC2 heuristic, which defines readiness for implementation as a combination of an organization's motivation and capacity to implement, can enhance our understanding of implementation in the school setting. This study examines associations between constructs from the R = MC2 heuristic and schools' implementation of a WOS approach.

Methods: We conducted a secondary analysis of cross-sectional data from U.S. elementary schools participating in …

Targeting Sting To Disrupt Macrophage-Mediated Adhesion In Encapsulating Peritoneal Sclerosis, Juan Sun, Yuxiang Sun, Dandan Guo, Huolin Ye, Qiang Huang, Hu Zhou, Canming Li, Mei Liao, Yujia You, Hongli Shang, Pan Zhou, Dongxuan Wu, Janusz Witowski, Zhaoyong Hu, Hui Peng

Faculty, Staff and Students Publications

Encapsulating peritoneal sclerosis (EPS) is a life-threatening fibrotic condition characterized by severe abdominal adhesions, chronic inflammation, and significant morbidity. The lack of effective treatments for EPS stems from a limited understanding of its underlying mechanisms. In this study, we developed a modified mouse model of PD-induced EPS and investigated the role of the STING signaling pathway in disease progression. Our findings reveal that STING activation in peritoneal mesothelial cells significantly increases the secretion of the macrophage chemokine CCL2, leading to enhanced macrophage infiltration and the formation of pathological adhesions. Notably, pharmacological inhibition of STING using the inhibitor H151 effectively reduced …

Placental Polycyclic Aromatic Hydrocarbon (Pah) Levels Are Associated With Spontaneous Preterm Birth, Gwendolynn Hummel, Sohini Banerjee, Vasanta Putluri, Inaara Malick, Grace Johnson, Abu Hena Mostafa Kamal, Chandra Shekar R Ambati, Nagireddy Putluri, Lori Showalter, Cynthia D Shope, Joseph Hagan, Kjersti M Aagaard, Bhagavatula Moorthy, Melissa A Suter

Faculty, Staff and Students Publications

While the cause of preterm birth (PTB) (i.e., delivery before 37 weeks of gestation) is likely multifactorial, ambient exposure to environmental chemicals has been postulated to play a role in its etiology. Our prior studies of exposure to polycyclic aromatic hydrocarbons (PAHs) in pregnancy have shown an increased level of placental PAH-induced bulky DNA adducts with increasing levels of PAH exposures. In this investigation, we hypothesized that higher levels of placental PAHs would be associated with an increased risk of PTB. Using gas chromatography and mass spectrometry (GC-MS/MS), we measured levels of benzo(a)pyrene (BaP), benzo(b)fluoranthene (BbF) and dibenz(a,h)anthracene (DBA) from …

Enhancing Cataract Surgery Outcomes: Optimal Use Of Pre- And Post-Operative Eye Drops, Keith Skolnick M.D., Anu Valiaveedu

Mako: NSU Undergraduate Student Journal

Many preoperative and postoperative cataract patients struggle with comprehending the use of prescription medication as directed. Language barriers and low health literacy levels are major factors contributing to improper use of prescriptions. To increase patients comprehension, the Fort Lauderdale Eye Institute employed an educational intervention consisting of a live presentation and an instructional video. Results found that 44% of patients were hesitant to ask questions to clinical staff, 32% felt overwhelmed, and nearly 70% lacked confidence in using their prescribed eye drops. Following the intervention, 91% of patients reported increased confidence in their medications, and most indicated that the video …

Premenopausal And Postmenopausal Malignant Cervical Cancer Diagnosis Among Disaggregated Subethnic Groups Of Asian American Women In The United States, Nilofar Haider Mirza

Walden Dissertations and Doctoral Studies

Despite being the United States' fastest-growing and diverse population, Asian Americans are often aggregated with Native Hawaiian and Pacific Islanders in prior research, resulting in masking disparities in cervical cancer screening/diagnosis among Asian American subethnic groups. Guided by Bronfenbrenner's ecological model, the association between disaggregated subethnic groups and cervical cancer diagnosis among Asian American women aged 20+ in the United States was examined using binary logistic regression. How histology type/behavior and age at diagnosis moderate the relationship between disaggregated subethnic groups and cervical cancer diagnosis was also explored. A quantitative cross-sectional design was employed using cases (N=1014) from the U.S. …

The Impact Of Physician Precepting On Medical Education And Healthcare Delivery: A Qualitative Secondary Analysis, Hannah E. Gutjahr, Steven A. Fasko

SIU Journal of Medical Science Scholarly Works

This qualitative study investigates the impact of physician precepting on medical education and healthcare delivery, prompted by the need for consistency in precepting practices across various institutions and specialties. Physician preceptors, who bridge the gap between theoretical learning and practical application, play a critical role in shaping competent and compassionate healthcare professionals. However, inconsistencies in precepting quality and challenges such as time constraints, inadequate training, and balancing clinical duties with teaching responsibilities necessitate a comprehensive evaluation of precepting's effectiveness.

A systematic literature review was conducted to explore these issues, focusing on secondary data from peer-reviewed journals, case studies, and policy …

Understanding And Predicting Flossing Behavior In A Rural Appalachian Community Using The Multi-Theory Model, Rahib K. Islam, Manoj Sharma, Amanda H. Wilkerson, Bradford Layman, Clyde Dunn, Shamima A. Somi, Ratnesh Sharma, Karen Gruszynski, Syed S. Quadri, Vinayak K. Nahar, Robert E. Davis

School of Medicine Faculty Publications

Effective flossing is essential for preventing periodontal disease. However, in a rural Appalachian community, adherence to flossing routines remains low, contributing to significant oral health disparities. The purpose of this study was to conceptualize intention of initiation and sustenance of flossing behaviors using the multi-theory model (MTM) of health behavior change. A cross-sectional survey was administered to individuals recruited from a shopping mall in rural Appalachia. The MTM constructs were measured and data were analyzed using multiple linear regression models. Of the 228 participants, 55% did not floss daily. Behavioral confidence (β = 0.571, p < 0.001) was a significant predictor for the intention of initiation of flossing among non-daily flossers, while emotional transformation (β = 0.377, p = 0.836) significantly explained sustenance among non-daily flossers. For daily flossers, changes in the physical environment (β = 0.432, p = 0.003) significantly predicted the intention of initiation of flossing, whereas emotional transformation (β = 0.344, p = 0.008) and practice for change (β = 0.594, p < 0.001) significantly predicted sustenance of flossing behavior. The MTM appears to be a robust framework for understanding and predicting flossing behaviors in rural Appalachian populations. Interventions designed to enhance behavioral confidence, physical environment changes, emotional transformation, and practice for change could improve flossing adherence. Further research should explore these constructs to develop targeted public health strategies.

A Religious Etiology Of Genito-Pelvic Pain And Pain With Penetration, Emily L. Carlson

Theses and Graduate Projects

Pelvic pain during penetration (PPDP) has been described using various diagnostic terms, including vaginismus, dyspareunia, and vulvodynia. The most recent and comprehensive classification is Genito-pelvic pain/penetration disorder (GPPPD) which is characterized by psychological distress associated with pain during or in anticipation of vaginal penetration (DSM-5-TR; American Psychiatric Association [APA], 2022). The etiology of PPDP is multifactorial, involving a complex interplay of biological, psychological, and relational factors. Religious and cultural influences may play a significant role in shaping individuals’ experiences of sexual pain. This study investigated the etiology of PPDP in relation to the religious influences among women raised in Judeo-Christian …

Germline Structural Variations Involving The Pediatric Brain Tumor Transcriptome Include Disease-Relevant And Ancestry-Related Genes, Fengju Chen, Yiqun Zhang, Luis F Paulin, Fritz J Sedlazeck, Chad J Creighton

Faculty, Staff and Students Publications

Background: Germline Structural Variants (SVs) represent an important source of genetic diversity, in large part due to their influence on gene transcription. It is necessary to systematically catalog germline SVs and their associated impacted genes across different cohorts and tissue and cellular contexts, including pediatric brain or Central Nervous System (CNS) tumors.

Methods: We combined RNA with whole genome sequencing across 1430 pediatric brain or CNS tumor patients from the Children's Brain Tumor Network. We set out to systematically identify genes for which the proximity of germline SVs was recurrently and significantly associated with differential expression in the tumor sample …

Is Health Insurance Related To Breastfeeding Duration?, Anna De La Paz

Population Health Research Brief Series

Breastfeeding duration, which plays an important role in shaping maternal and infant health, can be influenced by insurance type. This data slice uses data from the 2022-2023 National Survey of Family Growth (NSFG) to described differences in breastfeeding duration by insurance type among females ages 15-49 in the United States. Findings show that mothers with private insurance breastfeed longer than mothers with public insurance, such as Medicaid, net of controls for maternal age, race, education, and income.

Editorial: Disclosure In Sexual And Reproductive Health, Pooja Chitneni, Shan Qiao Ph.D., Simon M. Manga, Janet M. Turan

Faculty Publications

No abstract provided.

Causes Of Symptoms And Symptom Persistence In Long Covid And Myalgic Encephalomyelitis/Chronic Fatigue Syndrome, Anthony L Komaroff, Robert Dantzer

Faculty, Staff and Student Publications

Debilitating symptoms for many years can follow acute COVID-19 ("long COVID"), myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS), and various post-acute infection syndromes (PAISs). Together, long COVID and ME/CFS affect 60-400 million individuals, globally. Many similar underlying biological abnormalities have been identified in both conditions including autoantibodies against neural targets, endothelial dysfunction, acquired mitochondrial dysfunction, and a pro-inflammatory gut microbiome. Each of these abnormalities may directly cause some of the symptoms. In addition, the symptoms also may be caused by ancient, evolutionarily conserved symptomatic and metabolic responses to vital threats-sickness behavior and torpor-responses mediated by specific, recently discovered neural circuits. These neural …

Proteogenomic Characterization Unveils Biomarkers Associated With Chemoresistance In Muscle-Invasive Bladder Cancer, Matthew V Holt, Yongchao Dou, Meggie N Young, Alexander B Saltzman, Meenakshi Anurag, Jonathan T Lei, Antrix Jain, Mei Leng, Beom-Jun Kim, Lacey E Dobrolecki, Stefanie F Faucher, Sara Savage, Chenwei Wang, Zhiao Shi, Hugo Villanueva, Karoline Kremers, Kyle D Drinnon, Patricia D Castro, Michael M Ittmann, Mehak Mehboob Khatani, Sung Han Kim, Matthew J Ellis, Bing Zhang, Anna Malovannaya, Seth P Lerner

Faculty, Staff and Students Publications

To explore potential chemoresistance mechanisms and identify therapeutic opportunities in muscle-invasive bladder cancer (MIBC), we conduct comprehensive proteogenomic characterization of 46 pre- and 14 post-treatment MIBC tumors incorporating genomics, transcriptomics, proteomics, and phosphoproteomics. Multi-omics clustering not only recapitulated established molecular subtypes but also revealed subtypes associated with chemotherapy sensitivity. Protein isoform level analysis identifies protein abundance of a short isoform of ATAD1 and RAF family proteins as biomarkers of chemosensitivity. Integration of proteomic and phosphoproteomic data reveals Wnt signaling via GSK3B-S9 phosphorylation and the JAK/STAT pathway as potential targets to overcome chemoresistance. Correlations between PD-L1 and TROP-2/NECTIN-4 indicate an additive …

Changes In Self-Reported Excessive Daytime Sleepiness Are Associated With 5-Year All-Cause Mortality Risk Among Veterans, Katherine G Bay, Arash Maghsoudi, Amin Ramezani, Drew A Helmer, Amir Sharafkhaneh, Javad Razjouyan

Faculty, Staff and Students Publications

Excessive daytime sleepiness (EDS) is linked to adverse clinical outcomes. This study evaluated changes in a validated tool to assess EDS, the Epworth Sleepiness Scale (ESS) and mortality risk. This retrospective cohort study included Veterans receiving sleep-related services in the Department of Veterans Affairs (VA) from October 4, 1999 to August 18, 2018, with two qualifying ESS measures. ESS values were extracted from patient notes using a validated natural language processing (NLP) pipeline (96% accuracy). ESS scores were categorised as Normal (0-10) or Abnormal (11-24). Patients were grouped based on ESS changes: Normal-Normal, Normal-Abnormal, Abnormal-Abnormal and Abnormal-Normal. Cox proportional hazards …

Promising Practices To Address Healthcare Needs Voiced By Local Native Americans, Noelle Taylor, Mykin R. Higbee, Raiden Gaul

Transforming Communities

Purpose

To examine barriers and facilitators to nursing education among Native Americans and identify evidence-based strategies to increase the number of Native American nurses working in their local communities to address health disparities.

Background

Native Americans experience significantly higher rates of chronic illnesses such as diabetes and heart disease, and lower life expectancies. Only 4% of registered nurses identify as Native American, with no growth despite increased funding for diversity in nursing education. This underrepresentation contributes to culturally insensitive care and persistent healthcare inequities stemming from historical marginalization and trauma.

Methods

A comprehensive literature review was conducted using CINAHL, PubMed, …

Understanding Loss To Follow-Up: The Role Of Social Determinants Of Health In Infants Referred After A Positive Newborn Screening – A Quantitative Analysis, Betsy Graham-Moeller Graham-Moeller

Walden Dissertations and Doctoral Studies

Newborn screening (NBS) is a vital U.S. public health initiative that identifies medical conditions shortly after birth. Patients with positive screenings are referred for medical follow-up or evaluation. However, many patients do not receive the recommended long-term follow-up, posing concerns for healthcare providers and public health professionals working to ensure timely treatment and care continuity. Based on the Social Determinants of Health framework, this quantitative, retrospective cohort study aimed to examine demographic and clinical factors associated with follow-up adherence among 691 infants identified through NBS in Colorado and Wyoming. The purpose of the study was to determine whether race, ethnicity, …

Mechano-Signal Transduction Pathways Of The Diaphragmatic Muscle And Role Of Cytoskeleton, Junaith S Mohamed, Patricia S Pardo, Aladin M Boriek

Faculty, Staff and Students Publications

Mechanotransduction, also referred to as mechano-signal transduction, is a biophysical process wherein cells perceive and respond to mechanical stimuli by converting them into biochemical signals that initiate specific cellular responses. This mechanism is fundamental to the development and growth, and proper functioning of mechanically active tissues, such as the diaphragm-a respiratory muscle vital for breathing in mammals. In vivo, the diaphragm is subjected to transdiaphragmatic pressure, and therefore, its muscle fibers are subjected to mechanical forces not only in the direction of the muscle fibers but also in the direction transverse to the fibers. Previous research conducted in our laboratory …

Old Vs New Local Ancestry Inference In Hchs/Sol: A Comparative Study, Xueying Chen, Hao Wang, Iris Broce, Anders Dale, Bing Yu, Laura Y Zhou, Xihao Li, Maria Argos, Martha L Daviglus, Jianwen Cai, Nora Franceschini, Tamar Sofer

Faculty, Staff and Student Publications

Hispanic/Latino populations are admixed, with genetic contributions from multiple ancestral populations. To uncover genetic associations in these populations, researchers often turn to admixture mapping, which relies on inferred counts of "local" ancestry, i.e. the source ancestral population at a locus. Local ancestries are inferred using external reference panels that represent ancestral populations, making the choice of inference method and reference panel critical. This study used a dataset of Hispanic/Latino individuals from the Hispanic Community Health Study/Study of Latinos (HCHS/SOL) to evaluate how updates in local ancestry inference (LAI) affect results, specifically, the 'old' LAI performed using a popular inference method …

A Feasibility Study To Mitigate Arsenic Exposure In Well Water In Oregon, Christine Lucas-Woodruff, Veronic L. Irvin, Laura Nielsen, Meghan Megowan, Lilly Anderson, Julia Pavlosek, Molly Kile

Journal of Extension

Approximately 13 million households in the United States rely on private wells for their drinking water. It is the homeowner’s responsibility to manage the quality of water in their private wells. There are many toxic contaminants that can be present private wells that can negatively impact health. Extension Agents are well positioned to assist homeowners in understanding how to manage toxics in private wells. This study demonstrated the feasibility that motivational education provided by an Extension Agent’ trained in motivational interviewing techniques is able to help homeowners with private wells mitigate their exposure to arsenic by adopting appropriate water treatment.

The Silent Epidemic: Equipment Maintenance Failures And Patient Outcomes In Ghana's Healthcare System, Ramseyer Adekorang Asamoah, Celene Dzreke, Evans Dzreke, David Kanzin

Health & Biomedical Sciences Faculty Publications

Broken tools indicate a broken system. This new study reveals how medical equipment failures destroy Ghana's public hospitals, turning life-saving technologies into silent murderers that disproportionately affect rural areas. Moving beyond technical diagnostics, we study the cascading systemic failures, chronic underfunding, critical staff shortages, and fragmented supply chains that leave 40% of vital equipment, such as ventilators, MRI scanners, and dialysis machines, inoperable at any given time. We quantify the devastating human toll through rigorous mixed-methods analysis of equipment downtime records across ten regional hospitals (2018-2023) and profound narratives from 50 frontline stakeholders, doctors forced to improvise without working incubators, …

The Association Of Adult Medicaid Beneficiaries’ Characteristics And Their Experience During The Covid-19 Pandemic, Frank R. Tortorella

Dissertations and Theses (Open Access)

Background: The COVID-19 pandemic disrupted the United States’ safety net program, Medicaid, for low-income individuals affecting access to care, increasing enrollment, and requiring new approaches to care delivery. The literature shows that beneficiaries’ personal characteristics influence their healthcare experience. This study investigated the association between Medicaid beneficiary characteristics and experience with their Medicaid health plan, examined if COVID-19 negatively impacted experience, and tested if COVID-19 moderated the relationship between beneficiary characteristics and experience.

Methods: The research sample was 76,976 adult Medicaid beneficiaries who voluntarily completed the annual Consumer Assessment of Healthcare Providers and Systems (CAHPS) health plan surveys in 2018 …

Hot Spring Associated Infectious Diseases In The Great Basin And Southwest, Matthew Bentz

UNLV Theses, Dissertations, Professional Papers, and Capstones

Like all bodies of freshwater, natural hot springs can harbor pathogenic microorganisms that carry the threat of infectious disease. The unique chemistry, increased temperature, and popularity for bathing may alter the risk profile of hot springs compared to other natural bodies of water. Despite this risk, the role of hot springs as a reservoir for infectious diseases remains understudied, particularly within the context of regional public health. Nevada and the Great Basin/Southwest have increasingly promoted hot springs for the purposes of tourism, and they share a strong link to the cultural heritage of the region. The unknown risk profile and …

More Than A Feeling: A Mixed-Methods Examination Of Transgender Community Connectedness And Associations With Suicidality, Erin Rook

UNLV Theses, Dissertations, Professional Papers, and Capstones

Transgender adults experience significantly higher rates of suicidal ideation than the general population. A sense of transgender community connectedness (STCC) may reduce this risk, but predictors of STCC and its association with suicidal ideation are understudied. This cross-sectional mixed methods study examined STCC and past-year suicidal ideation in relation to dimensions of transgender community connectedness (TCC) at each level of the Social Ecological Model using data from a U.S. survey of transgender adults (n = 126). About half (52.4%) felt connected to the transgender community, and 27.0% reported past-year suicidal ideation. Hierarchical logistic regression models for both outcomes showed good …

Nevada Hpv Vaccine Completion Time And Adherence Among 9-14-Year-Olds From 2017-2023, Emily Sandoval

UNLV Theses, Dissertations, Professional Papers, and Capstones

The HPV (Human Papillomavirus) is one of the most common sexually transmitted infections, in the United States. Since its development in 1991, the HPV vaccine has been proven to be highly effective against the infection (Centers for Disease Control and Prevention [CDC], 2024). In order for an individual to receive optimal protection, the CDC has given guidelines dependent on age. It is important to understand changes in HPV vaccine completion for future public health immunization campaigns and objectives. To analyze how HPV completion and adherence has changed from 2017-2023 among the 9-14-year-old population, a retrospective cohort study was conducted utilizing …

Earth Care Trusted Messengers: Vaccine Access Project, Camille Velarde, Theresa H. Cruz

Reports & Documents

Spanish-speaking communities in New Mexico continue to face persistent barriers to vaccine access, confidence, and culturally relevant health information. The Earth Care Trusted Messengers Vaccine Access Project was implemented in Santa Fe to address these inequities using a peer-to-peer, community-rooted model. Trusted Messengers, respected community members, participated in a full-day training covering vaccine science, misinformation, communication strategies, and resource navigation, and subsequently facilitated small “house meetings” to engage peers in open conversations about vaccines. A mixed-methods evaluation assessed changes in confidence, knowledge, and community connectedness using pre-/post-/follow-up surveys, weekly implementation logs, and a final focus group. Quantitative findings showed large …