Medicine and Health Sciences Commons^™

Understanding Veteran Perceptions About Mental Health And Its Treatment, Quinn Turner Stoddard

Dissertations and Theses

Mental health illnesses are a growing issue for a large part of the country, and veterans in particular are vulnerable to the numerous negative effects they pose. Despite the high number of people that may benefit from treatment, a variety of issues with trust, stigma, and attitudes may act as barriers to care utilization. In response, this study investigated the perceptions that veterans within the Pacific Northwest hold in regards to mental health treatment as well as their intentions to seek it out should they require it. Using the integrated model of behavioral prediction (IMBP), data was gathered about veterans’ …

Investigating Interpersonal And Community Drivers Of Taenia Solium Prevention To Reduce Acquired Seizure Disorders In Northern Peru: An Analysis Of Social Networks, Social Capital, And Community-Identified Barriers And Facilitators, Angela Gayle Spencer

Dissertations and Theses

Background: In Northern Peru and other low- and middle-income countries (LMICs) worldwide, the Taenia solium parasite causes an estimated 30% of acquired epilepsy -- an entirely preventable disease burden. Sanitation development and pork production regulation would reduce infection risk in endemic communities, but large-scale systemic improvements are not likely to occur in the near future. In the meantime, communities can reduce infection risk by adopting protective behaviors. Social networks can provide role modeling and support for health-promoting behaviors, and deliver social capital in the form of trusting relationships, norms of reciprocity, and information exchange in support of T. solium control. …

A Hierarchical Decision Model To Evaluate Healthcare Organization's Readiness To Implement Clinical Decision Support Systems, Mohammed Oussama Laraichi

Dissertations and Theses

Clinical Decision Support Systems (CDSS) are essential tools for healthcare organizations as well as for healthcare providers to improve clinical care. However, successful implementation of CDSS can be challenging. Therefore, before implementing CDSS, it is crucial to assess the readiness of healthcare organizations to implement these tools.

Through a literature review, the first step of this research explores the concept of clinical decision support and CDSS, discussing their features, characteristics, and organizational hurdles to implementation. It also provides perspectives on CDSS adoption in the context of Information Systems and Health Technology. The review helped identify research gaps, objectives, and questions. …

Experiences Of People With Serious Mental Illness Seeking Services At Community Mental Health Centers During The Covid-19 Pandemic, Emily Leickly

Dissertations and Theses

Community mental health centers (CMHCs) have been underfunded and overburdened since Reagan-era disinvestment and the United States' move toward neoliberalism. Rates of mental illness have been rising consistently, particularly in Oregon, as CMHCs face continuing financial pressures and staff retention issues. This was before the COVID-19 pandemic. Today, we are still trying to understand the ongoing pandemic's impact on people with serious mental illnesses (SMI). Most of the studies in this area thus far are quantitative, and first-hand accounts of the pandemic from people with SMI are largely absent. Additionally, research in this area fails to draw on critical alternative …

Understanding The Experiences Of Latino Medical Students In A Learning Medical Environment, Leslie García

Dissertations and Theses

Very little is known about the experiences and perceptions of underrepresented minority (URiM) medical students in the U.S. allopathic medical schools. The limited literature posits URiMs experience more adverse experiences in the learning environment and have different learning outcomes in comparison to their White peer counterparts. Latino medical students represent 7.1% of all entering medical students across all U.S. medical schools. While they represent the largest ethnic minority in the United States within parity lack representation among the physician workforce [sic]. There is a dearth of knowledge of what factors contribute to the success of Latino medical students progressing in …

An Assessment Model Of The Healthcare Entrepreneurship Ecosystem To Foster Solutions For Underserved Communities, Abdalilah Saleh Owaishiz

Dissertations and Theses

There are significant disparities in access to healthcare treatment and this study investigates the healthcare entrepreneurship ecosystem and the challenges and considerations associated within. There is a lack of research on how to evaluate and assess the healthcare entrepreneurship ecosystem especially when applying multi-criteria decision-making (MCDM) methods. The Hierarchical Decision Model (HDM) has been utilized to identify several perspectives and factors grouped under them by the expert’s quantification. This research concentrates on underserved communities because that is where the biggest needs and impact can be made to support achieving health equity and universal health coverage. The findings of this research …

Health Literacy And People Diagnosed With Mental Illness, Beckie Child

Dissertations and Theses

Health literacy is a well-studied concept that has a large literature base. Yet, little is known about health literacy and people diagnosed with mental illnesses, and even less health literacy research speaks to people diagnosed with mental illness. I used a framework and approach of lived experience of psychiatric diagnosis and psychiatric survivor research to conceptualize and inform the study. It explores health literacy with people diagnosed with mental and physical health diagnoses using a small quantitative survey, focus groups, and an individual interview. The findings suggest that health literacy is a dynamic and complex construct that interacts with the …

Examining Demographic And Environmental Factors In Predicting The Perceived Impact Of Cancer On Childhood And Adolescent Cancer Survivors, Nazan Cetin

Dissertations and Theses

Cancer survivors' perceptions on how cancer has impacted their lives has been identified as a "critical predictor" of psychosocial well-being and quality of life outcomes. Given the dramatic increase in survival rates and the long-term health and psychosocial challenges, as well as survivorship care barriers, this study focuses special attention on childhood and adolescent cancer survivors and is guided by Tedeschi and Calhoun's theory of posttraumatic growth and Hammond's theory of distinctiveness. This study aims to examine the influence of demographic (i.e., age at diagnosis, biological sex, race/ethnicity, type of cancer) and environmental factors (i.e., geographical location and insurance type), …

Treatment Disparities In Emergency Medical Services: The Influence Of Race/Ethnicity, Obesity, And English Proficiency, Jamie Kennel

Dissertations and Theses

Different treatment in healthcare settings provided to different social groups of people may lead to disparities in health, quality of life, and life span. Despite the critical role among healthcare services that Emergency Medical Services (EMS) provides disproportionately for marginalized communities, it remains unclear if and to what extent treatment disparities take place in the pre-hospital setting. Guided by the theoretical frameworks of social worth, aversive racism, and stigma, this study utilizes medical chart data from three different public and private datasets to investigate treatment disparities by Emergency Medical Service providers for racial minority, obese, and limited English proficiency patients. …

The Effects Of Language Proficiency On Narrative Macrostructure In Spanish-English Bilinguals, Jenny Magallon

Dissertations and Theses

Bilingual children of the same age may have different narrative skills depending on the quantity and quality of their experiences in the two languages. Thus, children's storytelling skills can vary depending on children's oral proficiency in each language. The present study examined the effects of oral proficiency on story structure in forty 5- to 7-year-old Spanish-English speaking children using Spanish and English samples from story retelling tasks. Language proficiency was measured as continuum of performance using the Spanish-English Language Proficiency Scale (SELPS; Smyk et al., 2013). To estimate the effects of Spanish and English proficiency on story structure, linear regressions …

Augmentative And Alternative Communication Use, Service Delivery Experiences, And Communicative Participation For People With Amyotrophic Lateral Sclerosis, Betts Peters

Dissertations and Theses

People with amyotrophic lateral sclerosis (ALS) often experience changes to their speech, and may use augmentative and alternative communication (AAC) devices and techniques to maintain the ability to communicate. The use of AAC may facilitate the participation of people with ALS in various life situations involving communication. There is limited data in the literature about the AAC approaches currently used by people with ALS, the professional services they receive to support communication, or the effects of AAC on their communicative participation. This dissertation involved a nationwide online survey of people with ALS, and comprises three papers intended to add to …

Fortunate People In A Fortunate Land: Dwelling And Residential Alienation In Santa Monica's Rent-Controlled Housing, Lauren E.M. Everett

Dissertations and Theses

The importance of safe and stable housing for individual and community wellbeing is widely acknowledged. However, for the one third of Americans who rent their homes, housing-related stress and precarity (residential alienation) may undermine stability and a sense of home. Rent control is perhaps the most well-known tenant protection policy in the United States, but it remains highly controversial and its efficacy has been debated for decades. This research is the first academic inquiry to examine the policy through the experience of residents of rent-controlled housing. In academic discourse dominated by quantitative inquiry from the discipline of economics, this study …

Antipsychotic Medication Administration In Oregon Assisted Living/Residential Care Settings: Analyzing An Action Situation, Sarah Dys

Dissertations and Theses

Antipsychotic medication use (APU) in assisted living and residential care (AL/RC) settings is an under-studied and controversial health policy issue. APU in older adults with dementia is associated with an increased risk of falls, hospitalizations, and early mortality. I operationalize the Institutional Analysis and Development Framework using a situational analysis approach, an extension of grounded theory methods, to explore the APU in Oregon AL/RC settings. Regulatory deficiency citations, Oregon AL/RC population data, and semi-structured interviews suggest that staff role clarity, organizational characteristics, and perceived agency influence decision-making around APU. AL/RC providers and caregivers are forced to simultaneously balance and prioritize …

The Longitudinal Effects Of A Family And Sleep Supportive Intervention On Service Member Anger And Resilience, Shalene Joyce Allen

Dissertations and Theses

The vast majority of workplace intervention research on employee anger and resilience primarily focuses on individual-level strategies for mitigating employee anger and resilience outcomes in the workplace, with no studies having examined these outcomes with tangible occupational health interventions utilizing organizational-level techniques. Thus, the current study extends the literature on how to provide improvements in employee anger and resilience using higher system and organizational change mechanisms by providing evidence-based support for the effectiveness of a Total Worker Health® intervention, referred to as the Family and Sleep Supportive Intervention Training (FaSST). This approach employs both health protection and health promotion strategies …

Affecting Absenteeism Through School-Based Health Services Delivery: A Configurational Comparative Methods Study Of Oregon's Public Secondary Schools, Kelly Elizabeth Coates

Dissertations and Theses

A student's ability to attend school regularly can be profoundly affected by poor health-related behaviors, illnesses, and chronic diseases that are left unaddressed and unattended. The delivery of health services in the school environment is uniquely positioned to interrupt the effects these health barriers to learning (HBLs) can have on subsequent diminished educational and health outcomes. The literature widely acknowledges the intersectionality between health and education, but no comprehensive overview exists of how different structures and processes within a school work (or do not work) together to lead to higher or lower student absenteeism. This research sought to fill that …

Ancillary Data For Refining Computer Adaptive Algorithms For The Assessment Of Anomia, Emily Kathryn Tudorache

Dissertations and Theses

Computer adaptive testing formats, based in item response theory (IRT), are becoming an increasingly popular approach to testing in healthcare because they offer numerous psychometric and practical advantages to assessment when compared to static tests that rely on classical test theory. Fergadiotis and colleagues (2015) have developed computer adaptive versions of the Philadelphia Naming Test (PNT) short-forms, which have demonstrated acceptable precision and standard error of measurement when compared to the static short-forms and original full-length assessment. This study sought to use synthetic data simulations using the catIrt R package (Nydik, 2014) to investigate possible advantages of the use of …

Incarceration And Suicide: Do The Risk Factors Differ For Civilians And Veterans?, Rheannon Gail Ramsey

Dissertations and Theses

Suicide is one of the leading causes of death in United States jails and prisons. Many researchers have looked at suicides in prisons and what can potentially cause suicidal ideation but there are conflicting findings among civilian incarcerated populations and United States military veteran incarcerated populations.

The intent of this study is to examine which risk factors are most prevalent among adults in custody, with a focus on mental health and substance use or abuse and how these risk factors differ between incarcerated civilians and incarcerated veterans. Using survey data from the 2002 Survey of Inmates in Local Jails conducted …

The Digital Divide And Health: Examining Digital Access As A Social Determinant Of Health, Elizabeth Melissa Withers

Dissertations and Theses

This dissertation is comprised of three papers that consider ways in which one's level of digital access may impact self-rated health. Data are from multiple years of three separate nationally representative cross-sectional surveys: National Health Interview Survey, General Social Survey, and Health Information National Trends Survey to address the primary overarching research question: Is there an association between digital access and health? The examination of the relationship between digital access and health is situated within a social determinants of health perspective and draws on van Dijk's (2005) causal and sequential model of digital access. Education, income, race and ethnicity, work …

Identifying The Cost Of Preventable Chronic Disease In Prison: Can Illness Prevention Of Adults In Custody Save Money?, Molly Bineham

Dissertations and Theses

This study investigates the cost of preventable health problems and ailments when compared to other costs of incarceration. The purpose of this study is to examine the impact of imprisonment on the costliest chronic illness. The health of adults in custody related to the general population and the overall fiscal cost of the deadliest chronic illness among incarcerated adults is discussed. Linear regression is used to analyze the occurrence of heart disease and diabetes among adults in custody while controlling for other factors. The results of this analysis provide insight that chronic diseases like heart disease and diabetes should be …

Technology Management Maturity Assessment Model In Healthcare, Amir Shaygan

Dissertations and Theses

Significant gaps in the practical transformation of clinical knowledge into practices, increasing healthcare costs, costly medical errors, healthcare institutions' obligations towards improving safety, clinical outcomes, and efficacy of care from one side; and the rise of disruptive innovations, the adoption of electronic health records and novel diagnostic tools, and the plethora of data from the other side has made the need for a new approach in managing the U.S healthcare systems an imperative. Continuous learning has been utilized to mitigate some of these issues have been in healthcare organizations. Continuous learning is especially important in the research centers that act …

Returning To Rejection: Outcomes And Boundary Conditions Of Mental Illness Stereotypes, Stefanie Fox

Dissertations and Theses

Mental illness is a common condition in the United States, with over 20% of working age adults managing a mental illness condition in a given year. Disclosure of mental illness is often required for workers to take advantage of employer-provided resources (e.g., accommodations), yet use of resources is exceedingly low (less than 10%). Negative stigma-related outcomes are a top reason for which individuals delay the use of resources. Using an experimental design in an online data collection of 242 participants over two time points, the current study builds on existing organizational diversity literature to examine the stereotypes associated with mental …

Exploring "What Works" In Veterans Affairs Home-Based Primary Care, Elizabeth Catherine Hulen

Dissertations and Theses

Home Based Primary Care (HBPC) is an interdisciplinary care model involving comprehensive primary care services for patients with chronic illness who are unable to access clinic-based care. The largest HBPC program in the United States is run by the Department of Veterans Affairs (VA) and provides team-based primary care service to Veterans with complex, chronic conditions. The VA HBPC model includes primary care visits from a physician, nurse practitioner, or physician assistant, nurse care management, service coordination by a social worker, mental health services from a social worker or psychologist, nutrition counseling from a dietician, and help with medication management. …

Get Your Model Out There: Advancing Methods For Developing And Using Causal-Loop Diagrams, Erin Suzanne Kenzie

Dissertations and Theses

As simple visual diagrams of key dynamics in complex systems, causal-loop diagrams could meet known needs in settings such as theory-based program evaluation and qualitative research. Methods for developing and using causal-loop diagrams, however, are underdeveloped. This dissertation comprises three articles that advance these methods. The first paper describes a systematic review of evaluation studies utilizing causal-loop diagramming to illustrate program theory. The second paper pilots an improved method for systematically generating causal-loop diagrams from qualitative data. The third paper presents a protocol for an interview-based approach to mapping mental models. Together, this research contributes to recognizing the modeler as …

Assessment Of The Blockchain Technology Adoption For The Management Of The Electronic Health Record Systems, Saeed Mohammed Alzahrani

Dissertations and Theses

Blockchain is an emerging technology that holds great promises in healthcare despite slow adoption and previous unsuccessful implementation projects. Blockchain adoption in healthcare has been slow, partly because healthcare is a heavily regulated and complex industry. Blockchain applications span various areas of healthcare such as patient data management, health information exchange, health supply chain management, financial and insurance claims, clinical trial, biomedical devices tracking, and pharmaceutical counterfeit. The main challenges with blockchain technology in healthcare are: scarcity of real applications, the high level of failing projects, and the need for various parties to function together. There is, however, a lack …

Decolonizing Healthcare: A Black Feminist Analysis Of Sisters Informing Sisters On Topics Of Aids (Sista), Joy Mutare Fashu Kanu

Dissertations and Theses

This mixed methods project combines the conceptual insights offered by institutional ethnography, the deductive and inductive attributes of content analysis, semi structured interviews, and quantitative data analysis to study Sisters Informing Sisters on Topics of AIDS (SISTA), a social skills training program designed for sexually active, heterosexual African American women. This progressive program serves as a site to examine the complex relationship the U.S. state has had, and continues to have, with marginalized populations, particularly African Americans. The program reveals how the state, through the public health service, partners with scholars, researchers, and community-based organizations to produce, reproduce and perpetuate …

Aligning Food Environments With Institutional Values: A Mixed Methods Study Of Oregon Health Care Organizations, Elizaveta Walker

Dissertations and Theses

A major driver of the obesity epidemic is obesogenic food environments, characterized by nutrient-poor and energy-dense foods that saturate the collective physical, economic and sociocultural conditions that influence nutritional status. Food environments in organizations such as hospitals and public health agencies warrant special consideration given their health-focused mission. Improving food environments within health care settings has been highlighted by the Centers for Disease Control and Prevention (CDC) as one of seven key strategies to prevent obesity. However, most of the refereed literature examining healthy food environment policies (HFEPs) within hospitals focuses on the inpatient dietary environment, leaving a paucity of …

Smoking Behaviors In Patients Offered Lung Cancer Screening, Sara Elizabeth Golden

Dissertations and Theses

In the United States, smoking causes preventable diseases, including lung cancer, which is the leading cause of cancer deaths. Improving smoking cessation rates is important to decrease lung cancer deaths. Health care visits with a discussion about lung cancer screening (LCS) may help in increasing prevalence of smoking cessation. Importantly, insurers now require clinicians to have a shared decision-making discussion with patients that includes discussion of smoking abstinence before they can receive an LCS scan (i.e., a low-dose computed tomography scan). This discussion may represent a unique opportunity to encourage smoking cessation since it may prompt positive smoking behavior change. …

Inclusion For Speech-Language Pathology Minority Graduate Students, Teresa Michelle Roberts

Dissertations and Theses

Speech-language pathologists provide assessment and intervention for communication, cognition, and swallowing disorders for individuals across the lifespan in educational, medical, and private practice settings. The demographics of professionals in the field do not reflect those of the general public in regard to race and ethnicity, gender, socioeconomic status, LGBTQ+, and disability. Lack of representation of minorities limits research, policy, and services designed to serve diverse populations. Although initiatives have sought to address lack of diversity of speech-language pathologists, limited research on the graduate training experience for minority students is available. Since a master's degree is required to become a speech-language …

Implicit Learning Of Children With And Without Developmental Language Disorder Across Auditory And Visual Categories, Wanchi Yu

Dissertations and Theses

The current study examined implicit sound- and visual-meaning-mappings of children with and without Developmental Language Disorder (DLD).

One child with DLD and 29 children with typical language development (TLD) were included in the study, based on results from a hearing screening and standardized assessments of cognitive and expressive language skills. Participants completed two computer-based experiments, which were designed to investigate: 1) sound discrimination (pitch and duration), implicit mapping of sound stimuli to objects; 2) visual discrimination, implicit mapping of visual stimuli to objects.

The current study showed that children with TLD who implicitly learned pitch categories showed better mapping of …

The Role Of Strategic Governance In Reducing Infant Mortality Under Crisis Conditions, Lynn Christine Finley

Dissertations and Theses

The infant mortality rate (IMR) in some developing countries has decreased faster than the global average even though these countries lack strong economic growth, good governance, and democracy (often acknowledged precursors to improved health outcomes). What accounts for the improvement of the IMR in the absence of these traditional pathways to health gains? Some scholars suggest that the concept of "strategic governance" might help direct attention to intermediary factors that reduce neonatal deaths in countries that experience crisis conditions. The main objective of this dissertation is to investigate the set of governance practices that have reduced IMR in two such …