Medicine and Health Sciences Commons^™

Access To Primary Care In Pennsylvanian Rural Townships, Ann Eneh

Walden Dissertations and Doctoral Studies

Access to primary care is limited in rural communities across the United States. Evidence supports primary care as the cornerstone of healthcare. The purpose of this project was to explore community perceptions of barriers to primary care access with the aim of learning about ideas for possible interventions that could improve primary care access for Mifflin County residents. Penchansky and Thomas's model of healthcare access provided the theoretical framework for this qualitative phenomenological study. Using a community-based research approach, semistructured, open-ended telephone interviews and qualitative surveys were conducted with 26 participants, including physicians, nurses, and residents. Data were analyzed using …

Effect Of Socioeconomic And Neighborhood Factors On Stroke Hospitalization Rate In Virginia, Esther Musu Stephens

Walden Dissertations and Doctoral Studies

The stroke rate in Virginia is above the national rate. Stroke results in poor quality health, morbidity, and mortality. This quantitative epidemiological study was conducted to investigate whether a significant association exists between stroke and (a) socioeconomic and (b) neighborhood factors among people who were admitted to Virginia hospitals between 2010 and 2015. An ecological design, including ecosocial theory, was used to examine associations between environmental factors and stroke. Data (746 census output areas) were acquired using patients' billing zip codes from the Virginia Health Information System in combination with socioeconomic and neighborhood data by Zip Code Tabulation Area from …

Reducing Congestive Heart Failure Hospital Readmissions Through Discharge Planning, Lacy Rebaka Thomas

Walden Dissertations and Doctoral Studies

Every year, thousands of congestive heart failure (CHF) patients are readmitted to the hospital within 30 days of discharge. There is a gap in practice in the care continuum of patients with CHF within the transition from hospital to home. One of the factors known to increase a patient's risk for readmission is the lack of patient engagement and self-efficacy regarding the treatment plan. The purpose of this project was to implement a transition of care practice guideline that consisted of the use of a risk identification tool, a customized care plan for patients at high risk for readmission, and …

Changes In Beliefs About Aggression In Baton Rouge Youth Peace Olympics Participants, Shonta Manuel

Walden Dissertations and Doctoral Studies

Youth violence in the Baton Rouge inner-city area continues to create heightened concerns for the communities as well as the financial and healthcare systems. Even though violence prevention programs are in place in the area, no decline has been recorded in those who are being affected by violence. Due to lack of research in this field, a need for a sound research study exists to understand how Youth Peace Olympics (YPO) community-based program may be related to changes in attitudes about aggression and violence. A correlational cross-sectional research design was used to evaluate participants' beliefs about aggression, measured using the …

Relationships Among Vitamin D Deficiency, Metabolic Syndrome, Smoking Behavior, And Physical Activity, Ethan Pham

Walden Dissertations and Doctoral Studies

Aging increases the risk of both vitamin D deficiency and metabolic syndrome. Vitamin D deficiency and metabolic syndrome may be related, although there are mixed findings. Furthermore, literature suggests other factors such as physical fitness activity and smoking behavior are associated with Vitamin D deficiency and the development of metabolic syndrome. A number of studies have documented associations between Vitamin D levels and physical fitness activities, while other studies found correlations between Vitamin D levels, metabolic syndrome, and smoking behavior. However, no previous study has examined the links between physical fitness activity, smoking behavior, Vitamin D levels, and the risks …

Perceptions Of Private Medical Practitioners Towards The Nigerian National Tuberculosis Treatment Guidelines, Chijioke Pius Osakwe

Walden Dissertations and Doctoral Studies

Tuberculosis (TB) is a major public health problem in many parts of the world. Nigeria is one of the 30 countries in the world that has the highest burden of TB. Private medical practitioners in Nigeria play an important role in health care delivery. Motivating them to adhere to TB treatment guidelines in managing persons suspected of having TB or diagnosed with the disease is one of the strategies employed by the National Tuberculosis Program to Reduce the Burden of TB. Few studies were identified which used qualitative study approaches to study the perceptions of these practitioners towards the TB …

Exploring Burnout And Perceived Stress In Emergency Managers During Deployments, Angelika Phillips

Walden Dissertations and Doctoral Studies

The stressful nature of deploying to a disaster makes it necessary for a good emergency manager to be capable of coping in high-pressure situations. When intensified by extended work hours, deployments can often lead to burnout, job strain, and emotional stress, which can have a significant impact on an employee's well-being. The purpose of this study was to examine the effects of burnout and perceived stress amongst emergency managers working for FEMA and to determine if social support was an effective intervention. The theoretical foundation used for this study was the job demands-resources theory, which aided in understanding, explaining, and …

Health Literacy Best Practices In Policy Development, Stacie Lee Trueheart

Walden Dissertations and Doctoral Studies

Low health literacy is a problem the U.S. faces and, like health care itself, is a complex issue stemming from patient demographics and the healthcare providers being very diverse. Tools have been developed to mitigate the risks of low health literacy, however, without formal policy. The purpose of this qualitative case study was to explore and compare commonalities in health literacy best practices of organizations that are recognized as leaders in health literacy and are addressing low health literacy in their communities. By comparing the organizations' abilities to implement standards of plain language and health literacy tools/guidelines, best practice and …

African American Women Caring For Loved Ones With Alzheimer's Disease And Dementia, Lisa M. Forbes

Walden Dissertations and Doctoral Studies

Abstract

In 2016, a dramatic shift occurred in demographics in the United States because the oldest people in the baby boomer generation, which consists of people born between 1946 and 1964, reached age 65. The larger aging population and longer lifespans have produced an increased need for care and services. There are an estimated 5.4 million Americans of varying ages living with a diagnosis of dementia or Alzheimer's disease. Diagnoses of Alzheimer's disease are more prevalent among African Americans than other ethnicities. With little research found on culturally appropriate interventions for specific ethnic groups, a more detailed review of the …

Job Satisfaction And The Effects And Influences On Nurse Retention, Burke N. Kline

Walden Dissertations and Doctoral Studies

Researchers have predicted that by 2020 the United States will experience a severe shortage of registered nurses. The purpose of this correlation study, using the National Sample Survey of Registered Nurses 2008, was to investigate the relationship between nurse job satisfaction and its effect on nurse retention nationwide. Secondary data sets from the 2008 National Sample Survey of Registered Nurses and examining relationships between the variable of nurse retention and job satisfaction. Bivariate (correlation coefficient, chi squares, and simple linear regression) and multivariate (logistic regression) analyses identified and connected associations and examined measurement levels between the dependent and independent variables, …

Holistic Health And Hawaii's Renewable Energy Future, Richard M. Esterle

Walden Dissertations and Doctoral Studies

Collective efficacy, time urgency, and health literacy have been a focus of research since the 1970s. Researchers have demonstrated that these factors influence health and decision making. However, researchers have yet to establish how these factors may be connected to the achievement of policy aims that impact holistic or environmental health. This study utilized the health belief model, social cognitive theory, time urgency theory, health education and promotion theory, Bronfenbrenner's ecological systems theory, and the Meikirch model. The purpose of this quantitative study was to determine if the factors of collective efficacy, perceived time urgency, perceived health literacy, ethnicity, age, …

Chronic Care Management Services At A Clinical Medical Group, Sharon Guccione

Walden Dissertations and Doctoral Studies

The purpose of this project was to design a chronic care plan using the chronic care management (CCM) framework to improve health services at lower healthcare costs. The practice-focused question explored whether the operationalization of the CCM model would impact progress toward the management of chronic illness for the target population of Medicare beneficiaries with 2 or more chronic illnesses in an urban acute care agency located in the western United States. The middle-range theory, logic rational plan model, Lewin’s change theory, and the CCM’s coordination care and collaborative care concepts were used to guide the project. Data were collected …

Substance Abuse And Mental Illness Among Youth In The United States, Emmanuel Xavier Okoro

Walden Dissertations and Doctoral Studies

Despite the trends showing a reduction in the use and abuse of drugs among American adolescents, the prevalence rates remain high. There is also comorbidity of mental illnesses among the adolescents using drugs. The aim of this study was to determine the presence and nature of the association between the use and abuse of marijuana and alcohol and mental illnesses among the American adolescent population. The noted comorbidities and the hypothesized association between the substance abuse and mental illnesses were explained using the expectancy theory. Using a quantitative research methodology, secondary data from the National Survey on Drug Use and …

Association Between Type Of Diabetes Education And Health Status, Limitations, And Healthcare, Starr Michelle Seip

Walden Dissertations and Doctoral Studies

Diabetes is an epidemic that has started to capture political attention in the United States because of the devastating health care costs associated with the disease. Researchers in other studies have concluded that additional education face-to-face (FTF) and FTF with alternative forms of diabetes communication (FTF plus) have been beneficial. However, there is very little information on the comparison of the two groups as mentioned above when comparing chronic limitations, self-perception, health status, and healthcare satisfaction as circumscribed by specific demographic population. This study was an investigation of the above variables and explored how specific demographic characteristics (age, gender, educational …

Assessing Condom Use Among Navajo Men In The Southwest, Terra E. Yabeny

Walden Dissertations and Doctoral Studies

The Navajo tribe reports extraordinarily high number of cases of sexually transmitted diseases (STDs), such as gonorrhea, chlamydia, and human immunodeficiency virus (HIV) among men who have sex with men (MSM) and heterosexual populations. The purpose of this qualitative study was to explore the cultural value of adil' idli (self-respect) and how this cultural practice might influence health behaviors in sexual activity, condoms use, and acquiring of STDs among Navajo men. The Health Belief Model (HBM) was the theoretical foundation for providing a deeper understanding of the social, environmental, and cultural factors of condom use among Navajo men. Research questions …

Health Literacy As A Measure To Reduce Cost, Improve Health And Access, Vivian Dee

Walden Dissertations and Doctoral Studies

The United States dedicates greater than 17% of its gross national product to healthcare. This percentage is expected to go up to 20% by 2018. Despite the high cost of care, the health care system remains inefficient and ineffective. Barriers include reduced access to care related to low health literacy. Complicating low health literacy is the high readability score of patient education materials. The high readability score is in part due to tools that are not standardized and measure different aspects of education materials creating varying readability scores. The purpose of this quality improvement project was to adopt a tool, …

Implementation Of A Diabetic Resource Toolkit In A Veterans Administration Emergency Department, Caroline Hairston

Walden Dissertations and Doctoral Studies

Diabetes is the 7th leading cause of death in the United States. Uncontrolled diabetes and lack of self-care knowledge leads to increased emergency department (ED) visits, utilizing limited health care resources. The practice-focused question asked whether a patient-focused diabetic self-care toolkit could decrease the number of diabetes-related ED visits. The purpose of this project was to reduce the number of diabetes-related ED visits and was supported by the social cognitive theory. The sources of evidence included the facility's ED Information System (EDIS) data and a patient survey developed by the project lead. There were 149 participants (135 males and 14 …

Public Health Providers' Perceptions Of Electronic Health Records In A Disaster, Sherhonda Yvette Harper

Walden Dissertations and Doctoral Studies

The introduction of federal initiatives and incentives regarding health information technology fostered a movement towards the adoption of electronic health records (EHR). Implementation of EHRs sparked discussions among healthcare providers, patients, and others about the benefits or challenges of the move from the traditional paper method to the electronic version in healthcare settings. A knowledge gap in research involving the usefulness of EHRs and their impact to the delivery of care in other settings exists. The purpose of this qualitative study was to explore public health providers' perceptions of the meaningful use of EHRs in a disaster setting. Study participants …

Relationship Between Health Literacy And End-Stage Renal Disease Among Type Ii Diabetics, Joelle M. Stolte

Walden Dissertations and Doctoral Studies

The progression of End Stage Renal Disease (ESRD) among type II diabetics is preventable, yet complications continue to plague many. Reports show that 29.1 million people (9.3%) in the United States have diabetes, and 40% of those individuals develop ESRD. Four research questions explored the relationship between ESRD, health literacy, and healthcare. Data from 2010-2015 from the National Institute of Health (NIH) was quantitatively analyzed. The conceptual framework was the revised health service utilization theory. The target population included 3939 diverse males and females between the ages of 20-75 diagnosed with type II Diabetes. Results from Chi-square, cross-tabulation, binary, and …

Efficacy Of Methods Available To Remove Environmental Tobacco Smoke In Vehicles, Brian Albert Nielson

Walden Dissertations and Doctoral Studies

Environmental tobacco smoke (ETS) is a serious public health threat. Residual ETS in vehicles unknowingly exposes future occupants to environmental tobacco smoke. Reducing or removing exposure to ETS has been proven to reduce long-term health complications. This quasi-experimental study investigated 5 cleaning methods and their effect on air particulate matter2.5 (PM2.5) along with the correlation between air nicotine levels and PM2.5 levels. Study variables included cleaning methods as the independent variable, and changes in air nicotine and PM2.5 levels as the dependent variables. This study is framed within primary prevention and risk reduction based on the harm reduction theory. The …

Assessing Asthma-Specific Health-Related Quality Of Life In Children With An Ecological Systems Approach, Jamyia Clark

Walden Dissertations and Doctoral Studies

Despite initiatives and management efforts to minimize exacerbation and adverse outcomes, asthma remains a leading cause of childhood chronic disease in the United States. Environmental, personal, and social factors have been associated with an increase of asthma morbidity. However, little is known about how they cumulatively affect children's quality of life. This study applied a multifactorial conceptual model grounded by the ecological systems theory framework to ascertain which environmental, personal, and social factors were cumulatively associated with adverse health-related quality of life (HRQoL) in children with asthma ages 5-17 years. A national, cross-sectional survey, the Behavioral Risk Factor Surveillance System …

Barriers To Oral Care Among African American Adolescents In Prince George's County, Maryland, Nkiruka Soribe Mcginnis

Walden Dissertations and Doctoral Studies

When adolescents forgo oral health treatment, factors that hinder them from obtaining these services put them at risk of detrimental consequences in their oral and overall health. The purpose of this qualitative phenomenological study was to identify the various barriers that adolescents encounter causing them to defer oral treatment. Through this study, public health officials, school health care providers, the state, and parents could be made aware of these factors and work together to implement programs and supplemental aid to help adolescents become more knowledgeable of the importance of oral care and encourage them to desire and seek treatment. The …

Health Disparities Among Hispanic Americans With Type 2 Diabetes, Nelson Sitton

Walden Dissertations and Doctoral Studies

The ongoing increase in Type 2 diabetes among Hispanic Americans challenges the American public health system, particularly with health issues arising from not following appropriate health directives for the disease. This quantitative, cross-sectional, correlational study used primary data to assess the relationship between diabetes knowledge (as measured by the Diabetes Knowledge Questionnaire), health literacy level (as measured by the Short Assessment of Health Literacy-Spanish and English), education level, self-efficacy (as measured by the Diabetes Self-efficacy questionnaire), and self-reported diabetes self-care behaviors (as measured by the Summary of Diabetes Self-care Activities) among a sample of Hispanic Americans with Type 2 diabetes. …

Quality Of Life Among Entrepreneurs With Chronic Fatigue Syndrome, Brittany Kesler

Walden Dissertations and Doctoral Studies

The impacts of chronic fatigue syndrome (CFS) are far reaching, resulting in many burdens in the individual lives of CFS patients. One notable challenge lies in the inability to participate in the workforce due to associated physical, mental, and emotional symptoms. Previous research indicates that alternative employment options may help to overcome work related barriers presented with various types of chronic illness. Entrepreneurship is one path to working that offers many benefits, including autonomy, flexibility of work schedule, choice of work environment, and control. Questions though remain as to whether entrepreneurship enhances QOL or exacerbates symptoms among individuals with CFS. …

Alzheimer's Disease Dementia: Stress, Female Caregiver Burden, And Older Caregiver Health Outcomes, Nadia Muhammad

Walden Dissertations and Doctoral Studies

Alzheimer's disease dementia caregivers are heavily engaged in providing daily assistance to individuals encumbered with Alzheimer's disease, but these caregiving duties can have a devastating effect on caregivers' self-reported health and mental outcomes. The purpose of this study was to evaluate older female caregivers' background and contextual stressors and care stressors on caregivers' self-reported harm to health resulting from the stress of caregiving, health status and emotional stress. The stress process model for Alzheimer's caregivers served as the theoretical foundation for this study. Correlation and logistic and linear regression analysis were used to evaluate if a relationship exists between the …

Improving Glycemic Control In Adult With Type 2 Diabetes, Basirat Romoke Triplett

Walden Dissertations and Doctoral Studies

Ninety percent of people with diabetes have Type 2 diabetes mellitus (T2DM). T2DM is a complex disease that affects every organ in the body, which makes effective management of the disease imperative. The American Association of Clinical Endocrinologist (AACE) and American College of Endocrinology (ACE) strongly recommended early treatment initiation among the target population to delay disease progression and complications. The purpose of this evidence-based project was to examine the impact of using the T2DM management algorithm for effective management of adults with T2DM over a 3-month period. The shared experience decision-making model and the chronic care model were used …

Trauma-Informed Education Toolkit For Screening Pediatric Victims Of Sexual Abuse And Maltreatment, Analena Michelle Lunde

Walden Dissertations and Doctoral Studies

The complex challenges facing the sexual assault nurse examiners program in a midwest state are underreporting, late reporting, and poor coordination of care for pediatric victims of child maltreatment with sexual abuse. The main objective of this quality improvement project was the identification of necessary practice-related approaches to care to decrease barriers associated with reporting suspicions of abuse or neglect. An evidence-based, multidisciplinary assessment clinical toolkit that followed clinical components of trauma-sensitive, child-centered screenings triggering a coordinated response to conduct a forensic medical exam within 96 hours of the alleged incident was evaluated. During 3 rounds of surveys following the …

Impediments Of Self-Managed Type 2 Diabetes In Mgbidi Women, Nigeria, Augustina Oha

Walden Dissertations and Doctoral Studies

Type 2 diabetes is a complex metabolic disorder characterized by hypoglycemia or hyperglycemia that affects fat, protein, and carbohydrate metabolism. Researchers have identified that for individuals with Type 2 diabetes, staying on interventions for diabetes self-management is sometimes difficult and challenging. It is an increasing public health concern, especially in certain minority populations and in many developing and developed nations. This is especially true for the population of women 40 years and older in Mgbidi, Nigeria. In the Enugu State of Nigeria, women bear most of the burden of Type 2 diabetes when compared to the males in the state. …

The Lived Experiences Of Managing Uncertainty In Chronic Illness, Amanda Brown

Walden Dissertations and Doctoral Studies

Chronic illness is an increasing concern in the United States as the CDC reports that about 50% of adults have at least 1 chronic illness. When individuals must adjust to chronic illness they may experience uncertainty regarding the illness, prognosis, and symptoms. The purpose of this qualitative, phenomenological study was to explore the lived experiences of individuals living with uncertainty in chronic illnesses. A Merle Mishel's uncertainty in illness theory was the framework used to explore the lives of individuals diagnosed and living with chronic illness. In-depth interviews were conducted with 8 individuals who have chronic disease; data were audio-recorded …

Social Influences Of Suburban Black Residents Food Purchasing Decisions Using Snap Benefits, Carolyn Mccummings

Walden Dissertations and Doctoral Studies

In low-income, suburban Black communities, the prevalence of diet-related chronic illnesses is alarming. Various influences often increase diet-related illnesses among this population. One influence is the use of SNAP benefits to purchase food. In this study, the influences of SNAP as well as other influences affecting food purchase decisions among the study population was examined. A qualitative multicase study approach was used and, face-to-face interviews were conducted, to understand the experiences of 20 low-income, current recipients of SNAP who were Black and lived in suburban, New York. The data indicated the most significant influence, communicated by the participants, was that …