Medicine and Health Sciences Commons^™

Telehealth Acceptance And Medical Mistrust Among The Elderly Of Rural Appalachia: A Correlational Study Using The Medical Mistrust Index And Technology Acceptance Model, Victoria Hood-Wells

Electronic Theses and Dissertations

Adults aged 65 years and above have grown substantially over with past decade. However, the chance of developing multiple comorbidities only increases with age. Because elderly residents of rural Appalachia often encounter barriers to healthcare, rural nurses, providers, and policy makers must overcome physical and structural barriers, but also gain a more in-depth understanding of the personal and cultural attitudes impacting the use of new and innovative forms of healthcare delivery. With a slow and variable uptake of telehealth adoption in rural Appalachia, and in the presence of well-documented medical mistrust, this study was designed to better understand the degree …

Improving Black Maternal Outcomes In Christian County, Ky: A Social Marketing Approach To Perinatal Provider Change, Ariel A. Arthur

Theses and Dissertations--Public Health (M.P.H. & Dr.P.H.)

Compared to other states in the country, Kentucky has historically poor population health outcomes. While the statewide maternal mortality rate is 16.1 per 100,000 live births, this statistic belies the stark racial disparities that exist. In 2018, the pregnancy-related death rate for Black women was 40.2 per 100,000 live births compared to 13.1 for White women. This pattern is persistent even after controlling for socioeconomic status, prenatal care, and other protective factors. Research shows that institutional and interpersonal racism when receiving obstetric care contributes to poor childbirth and postpartum outcomes for Black women. Additionally, geography and rural status may compound …

Expressive Arts Therapy To Support Positive Experiences Of Embodiment Among Rural Lgbtq+ Adults: A Literature Review, Ann Stromgren

Expressive Therapies Capstone Theses

This paper investigates the use of expressive arts therapy to support LGBTQ+ adult clients in rural communities. Caring professionals in rural areas often lack training on how to work with LGBTQ+ clients, and best practices for clinical mental health counseling with rural LGBTQ+ clients have yet to be defined. Some evidence suggests that using “metronormative” best practices with rural clients may be irrelevant or cause harm (Giano et al., 2020). Although some recommendations exist for using expressive therapies with LGBTQ+ clients, they are rarely evidence-based, as very few empirical studies exist evaluating the effectiveness of expressive therapy interventions with LGBTQ+ …

Use Of Evidence-Based Telehealth To Reduce Complications In Adults With Type 2 Diabetes In A Rural Health Facility, Joni Kelley

Doctor of Nursing Practice Projects

Background: Formal education for type 2 diabetes mellitus (T2DM) patients is essential, especially in rural areas where diabetes is approximately 17% higher than in urban areas (Bolin & Ferdinand, 2018). In 2019, diabetes was listed as the direct cause of 1.5 million deaths, and 48% of all deaths due to diabetes occurred before 70 years (American Diabetes Association, 2021). According to the American Diabetes Association (2021), approximately 550,149 people in Alabama, or 14.1% of adults, have been diagnosed with diabetes. An additional 119,000 people in Alabama have diabetes but are unaware, significantly increasing their risk of complications (American Diabetes Association, …

Mental Health Wellness In The Latino Population: Improving Phq-9 Scores In Depressed Patients With Comorbid Type Ii Diabetes, Amanda Cuellar

Doctor of Nursing Practice Final Manuscripts

Major depressive disorder is one of the most common mental health conditions. In the United States, 8.1% of the population have symptoms of depression. Patients with diabetes are 2–3 times more likely to experience symptoms of depression compared to the general population. Having these chronic conditions simultaneously can cause complications in both. The purpose of this study was to improve depression scores for patients who have comorbid type II diabetes. This project took place in a rural community with the Latino population. The nurse practitioner led an evidence-based practice project implementing treatment of depression with medication management, individual psychotherapy, and …

Exploring Barriers To Rural Mental Health Practice: A Pilot Study, Caitlin Vu

Educational Specialist, 2020-current

There is a shortage of mental health professionals in rural areas around the world. Current literature on barriers to healthcare professionals choosing to practice in rural areas mainly focuses on medical professionals, with few studies examining the barriers to rural practice for mental health professionals. Along with examining the perceived barriers and enablers to rural mental health practice, researchers wanted to further examine the reliability of the revised Barriers to Rural Mental Health Practice instrument. Researchers distributed the survey to mental health professionals across the United States. Preliminary findings support high internal reliability for the total scale and three of …

Brining Point-Of-Care Ultrasound To A Rural Primary Care Clinic, Caleb E. Migda

Culminating Experience Projects

Background and Objectives: In the rural primary care setting, the process for outpatient

ultrasound testing has multiple steps, all of which provide opportunities for delay in testing and diagnosis. Point-of-care ultrasound (POCUS) is a solution that allows the physician to perform same-day ultrasound in the primary care clinic. The objective of this program development project was to implement POCUS in a rural primary care clinic to reduce time to testing and diagnosis for those patients requiring ultrasound testing.

Methods: A 3-month chart audit was conducted to examine the average length of time required to complete ultrasound testing in the outpatient …

The Motherhood Crusade: Rural Low-Income Mothers, Support, And Empowerment, Christina Castellano

Dissertations

Previous research has shown that postpartum women with untreated mental health conditions are more likely to fail to manage their own health, have inadequate nutrition, abuse substances, experience abuse, be less responsive to their baby’s needs, have fewer positive interactions with their baby, experience difficulties breastfeeding, and question their abilities as a mother. Rural culture plays a complex role in the transition to motherhood, influencing whether mothers seek out and use resources. While more is known about location and access issues, less is known about how rural culture and, more specifically, how empowerment and social support impact postpartum experience. The …

Examining Perception And Understanding Of Stroke And Its Risk Factors In A Rural Population, Mackenzie King, Gabrielle Scarpa, Mary Gardiner

Theses & Honors Papers

Stroke, also sometimes referred to as a brain attack, occurs when there is a blockage in blood supply to the brain or when a blood vessel bursts within the brain (CDC, 2022). Rural populations have a higher incidence of stroke and higher stroke mortality in the United States (Howard et al., 2017). Although there is a higher incidence rate of stroke in rural populations, researchers have also found that these populations appear to have limited knowledge on stroke and its risk factors. The current study employed a non-experimental descriptive design that explored stroke knowledge in adults residing in rural populations …

Staff And Provider Education On Diabetic Foot Exams And Foot Care Using The Ophelia Process, Shasta Pickens

Doctoral Projects

Diabetes mellitus continues to grow in global prevalence and consumes an increasing amount of healthcare resources. Persons that live in disadvantaged groups have a higher prevalence due to a lack of understanding and access to care. Diabetes is one of the leading causes of chronic disease and limb loss worldwide. Diabetes foot care is essential, as diabetes can be dangerous to patients’ feet.

The purpose of this doctoral project was to increase diabetic foot care education and foot exams for staff and providers in a federally qualified health center (FQHC). Many people in this rural community do not understand the …

Substance Use Disorder Treatment Among African American Men Living In The Rural South Of The United States, Serge Raoul Wandji

Theses and Dissertations

Substance use disorders (SUD) affect more than 40 million Americans. African American (AA) men are disproportionally affected by the negative health and social consequences of SUD, and men in rural areas may be particularly at risk due to disadvantaged socioeconomic conditions and persistent race-related stressors such as perceived discrimination. The overall purpose of this study is to advance the understanding of factors associated with SUD treatment acceptance and relapse potential among Southern rural AA men.

This purpose was achieved by determining differences in treatment acceptance and relapse potential by race and gender among rural residents admitted in a SUD treatment …

Identifying Barriers To Dental Care Among Hispanics In Southwest Minnesota, Lissette Garza

All Graduate Theses, Dissertations, and Other Capstone Projects

The purpose of this study was to assess the different barriers for dental health care among the Hispanic population in a rural, southwestern community in Minnesota. To collect data, an adaptation of the survey written by Vazquez and Swan (2003) was distributed to Hispanic individuals at an agricultural facility, religious organization, and an early childhood organization. The findings for the research question are presented in the cross-sectional study utilizing descriptive statistics in the form of frequencies and percentages. The results of this study indicate that not having a dental provider of the same cultural background, having a language barrier, and …

Comparison Of Cultural Self-Efficacy Between Urban And Rural Nurse Educators, Denise Rene Morris

Walden Dissertations and Doctoral Studies

Integration of an inclusive educational environment requires nursing faculty to embrace a transformational change in academics. The cultural interactions of an educator teaching in an urban district may differ from the relations experienced by a rural nurse educator. The purpose of this quantitative study, guided by Bandura’s social cognitive theory, was to determine whether there is a difference between the cultural self-efficacy scores of nurse faculty teaching in a rural location compared to those in an urban location as well as whether the demographics of age, ethnic background, and years in the nursing profession predict cultural self-efficacy scores. Nursing faculty …

Increasing Access To Healthcare For Black, Indigenous, People Of Color (Bipoc) And Impoverished Populations In A Rural County Of North Carolina, Shawn Perry

Doctor of Education Dissertations

Rural healthcare has often lagged when compared to those in suburban areas and inner cities. Rural healthcare has often been less effective, lower in quality, and not as accessible. Access to healthcare has been a key factor in life quality and quantity for all. Utilizing a mixed-methods approach, qualitative and quantitative data was collected and analyzed which included the community health needs assessment (CHNA) data from the rural county (RC) and a double-blind survey distributed to organizational members by the partnering organization, the rural hospital (RH). The data identified that access to healthcare is a critical need for RC. Additionally, …

Analyzing Veterans Affairs Telehealth Services Between Rural And Urban Centers In West Virginia, Vicki J. Dix

Walden Dissertations and Doctoral Studies

Veterans often have difficulty accessing health care within the Veterans Affairs (VA) system, contributing to the growing need for health care services in rural communities. The increasing demand for health care services in rural communities is driven by the aging population, an increase in life expectancy, and an increase in chronic disease. This quantitative study aimed to explore the relationship between the type of appointment and patient location on initial primary care and telehealth primary care wait times for veterans in West Virginia. The two research questions addressed the independent variables, type of appointment (telehealth or face to face) and …

A Nursing Staff Education Module On Survivorship Care Plans In Primary Care, Janette Francis

Walden Dissertations and Doctoral Studies

Survivorship care plans (SCPs) bridge the gap in the transition of care from oncology to primary care providers (PCPs) for breast cancer survivors. Despite strong recommendations for SCPs, their use remains limited. Guided by Knowles’ adult learning theory, the project focused on, first, determining whether a predeveloped staff education activity was valid using the Lynn model criteria for validation. Second, if in a rural clinic where SCP were not consistently used providers, nurses, and staff knowledge regarding the importance of SCP would increase following an educational program. An expert panel of 5 educational experts validated the educational module for appropriateness …

Comparison Of Cultural Self-Efficacy Between Urban And Rural Nurse Educators, Denise Rene Morris

Walden Dissertations and Doctoral Studies

Integration of an inclusive educational environment requires nursing faculty to embrace a transformational change in academics. The cultural interactions of an educator teaching in an urban district may differ from the relations experienced by a rural nurse educator. The purpose of this quantitative study, guided by Bandura’s social cognitive theory, was to determine whether there is a difference between the cultural self-efficacy scores of nurse faculty teaching in a rural location compared to those in an urban location as well as whether the demographics of age, ethnic background, and years in the nursing profession predict cultural self-efficacy scores. Nursing faculty …

A Nursing Staff Education Module On Survivorship Care Plans In Primary Care, Janette Francis

Walden Dissertations and Doctoral Studies

Survivorship care plans (SCPs) bridge the gap in the transition of care from oncology to primary care providers (PCPs) for breast cancer survivors. Despite strong recommendations for SCPs, their use remains limited. Guided by Knowles’ adult learning theory, the project focused on, first, determining whether a predeveloped staff education activity was valid using the Lynn model criteria for validation. Second, if in a rural clinic where SCP were not consistently used providers, nurses, and staff knowledge regarding the importance of SCP would increase following an educational program. An expert panel of 5 educational experts validated the educational module for appropriateness …

A Descriptive And Visual Analysis Of The North Coast Fall Prevention Survey Data, Mishell Lopez

Cal Poly Humboldt theses and projects

Older adults over 65 will double from 52.4 million in 2018 to 94.7 million in 2060. Among this aging group, falls affect one out of four older adults and are a critical economic concern for our American society, with yearly costs of $50 billion. In older adults, falling can result in negative consequences such as fear of falling, injuries, mobility restrictions, and loss of independence. California has one of the highest costs per fall ($4 billion annually) and a high percentage of adults who have fallen (30.6%) compared to the nation. Moreover, two of California’s northwest rural counties, Del Norte, …

Implementation Of A School-Based Adolescent Pregnancy Prevention Program In Harlan County, Kentucky, Jaycea Frederick

Theses and Dissertations--Public Health (M.P.H. & Dr.P.H.)

Kentucky has the 6^th highest rate of adolescent pregnancy in the United States and Harlan County ranks among the highest rates in the state. Adolescent pregnancy is a public health problem and costs taxpayers in the United States around $9.4 billion each year. Overall, there have been declines in adolescent pregnancy but the national average soars above those in other Western industrialized nations such as the United Kingdom. Implementing a comprehensive sexual health education program in a public school setting is an efficient strategy to reach numerous adolescents and influence sexual health knowledge and help to delay the initiation …

Engaging Rural Providers About The Potential Of Low-Earth Orbit Internet Satellite Supported Rural Telehealth Programs, Joshua M. Cleary

Doctor of Nursing Practice (DNP) Projects

Abstract

This paper describes a DNP project that was designed to address the issue of rural mental telehealth implementation barriers. One of the main barriers to rural telehealth programs has been a technical infrastructure incapable of adequately hosting the telehealth programs. Low-Earth orbit (LEO) internet technology has emerged as a way to solve the rural telehealth conundrum by offering an improved rural technical infrastructure. An integrated review was completed based on the following PICOT question: In rural providers, how does an educational outreach compared to no educational outreach affect provider adoption of new technologies? The evidence showed educational sessions as …

Evaluating How Physical Activity Affects The Perception Of Resilience In Box Butte County, Nebraska, Eric Pulver

Capstone Experience

Physical activity is one of the modern hallmarks for good health in individuals and the public, in general. Resiliency is a growing concentration in all levels of disaster preparedness where the focus is on how to deal with the growing number of disasters stemming from global climate change. This research project’s aim is to look at the possible relationships between physical activity and resiliency in a rural Nebraska population. This was done with the use of a cross-sectional study utilizing a fifteen-question survey to gather demographics, assess the amount of physical activity, and then apply a perception of resilience tool …

Advancing Treatment For Opioid Use Disorder In A Rural Emergency Department, Jill M. Wabbel

Doctor of Nursing Practice (DNP) Projects

Background: The opioid epidemic escalated in the United States due to the availability of prescription opioids, heroin, and synthetic opioids like fentanyl. Unfortunately, access to treatment is not always accessible, especially in rural communities with limited resources.

Local Problem: Tehama County is a rural county in northern California with limited access to treatment for opioid use disorder. The local Emergency Department (ED) and primary care-based Medication-Assisted Treatment (MAT) clinic collaborated to increase access. However, services remain under-actualized due to limited understanding of MAT best practices, stigma related to substance use within the ED culture, and poor articulation between the ED …

Examining Mental Health Disparities In A Rural County: A Community Health Needs Assessment Analysis, Dustin M. Schulz

Capstone Experience

Over 20% of adults in the United States experience some form of mental illness each year. Those residing in rural areas can see increased prevalence of mental illness, and typically face disparities in access and availability of services for mental health. The goal of this project was to examine the impact of mental health in Woodford County, Illinois using data collected through the 2022 Community Health Needs Assessment (CHNA) process, with the intent of identifying areas of improvement that could be implemented at the local level. Analysis of the CHNA data was conducted using frequency analysis in SAS 9.4 through …

Management Of Youth Sport-Related Concussion By Urban And Rural Practitioners: A Pilot Study, Brett R. Fox

All NMU Master's Theses

Sport-related concussions (SRC) occur at alarming rates among high school athletes (ages 13-18), which made the Center for Disease Control and Prevention and other agencies classify it as an “epidemic”. If improperly managed, physical, mental, and emotional consequences can occur for SRC patients. Due to these consequences all 50 states in the US have passed legislation requiring medical release from a practitioner before a student-athlete can return to athletics following an SRC, yet there is no universally accepted consensus on how to medically manage this common injury. A 22-item, validated survey was distributed to Michigan practitioners who sign off on …

Implementation And Evaluation Of A Syphilis Screening Tool To Increase Patient Testing For Syphilis Among Adults 18 Years And Older In A Rural Primary Care Clinic, Valeria S. Wiggins

Doctor of Nursing Practice Projects

Background: Sexually transmitted infections (STIs) are an increasing epidemic in the United States (U.S.) that need immediate interventions to reverse the effects of syphilis on the sexual health of adults in rural populations. Many are unaware of the growing rate of syphilis and the overall impact it causes nationally. When syphilis is detected early, it can be easily treated and cured. Rural primary care providers are ideal candidates for implementing education, screening, testing, and treatment.

Purpose: The Doctor of Nursing Practice (DNP) project aims to increase the frequency of screening patients in rural primary care clinics for high-risk sexual behaviors. …

Expand Nemt Across Central And Western Nebraska, Bri Parr

Theses/Capstones/Creative Projects

The average age of adults in the US is increasing, especially in rural areas. Approximately 60 million individuals live in the rural US, including millions of Medicare beneficiaries. Older rural Americans are more likely to be in poverty, unhealthy, and medically underserved. They rely heavily on government health insurance programs, such as Medicare, to provide for their health care needs. Unfortunately, for many older adults living in rural areas, health care is both difficult to access or in some cases completely unavailable. This is due to several factors, including the lack of specialist care in rural areas (mental health specialists, …

Positive And Negative Deviant Counties: Identification Of Factors Associated With Health Outcomes, Olivia Egen

Electronic Theses and Dissertations

Rural counties in the United States vary drastically on metrics related to socioeconomic status and dominant economic industry as well as health behaviors and outcomes. This study sought to understand the underlying structural reasons why some rural counties have better or worse than expected health outcomes using a positive deviance (PD) approach. The study aimed to: 1) create an area deprivation index and divide counties into quartiles using the index; 2) identify positive, negative, and non-deviant counties using health outcome metrics; 3) analyze differences between deviance on a variety of local public health system metrics; and 4) analyze differences between …

Rural And Agricultural Natural Disaster Stress And Recovery Study: Identifying Experiences And Community Preferences, Kristin K. Gaffney

Capstone Experience

Objective: The Rural Natural Disaster Stress and Recovery study surveyed flood and tornado affected residents (N=159 for analysis) in Arkansas and Nebraska, U.S., to address three hypotheses: 1) agricultural producers have different stress and recovery experiences compared to non-agricultural counterparts, 2) rural residents prefer community resources over external resources for disaster stress relief, and 3) communities can provide effective emotional health supports after disaster.

Methods: Demographics, exposure, stress, and recovery measures, and a resource use and effect inventory were analyzed in SAS with Chi-square tests, t-tests, Wilcoxon tests, and multiple linear regression modeling to identify differences between agricultural and non-agricultural …

Epidemiology Of Children With Adhd In Rural Versus Metropolitan Settings, Miranda Nygaard

Physician Assistant Scholarly Project Papers

Attention deficient disorder with hyperactivity (ADHD) is an increasing psychiatric disorder affecting children across the world. With significant debate on diagnosis, ADHD is commonly underdiagnosed in children, even today. Approximately 4.6 million children are diagnosed with ADHD, but more than two thirds of these children are untreated. Primary care providers remain the responsible stakeholders for assessing, diagnosing, and treating children with ADHD appropriately. This literature review is aimed to investigate the correlation between the assessment and early diagnosing of ADHD among children in rural settings compared to that of the metropolitan/urban communities. Providing children with ADHD symptoms an early diagnosis, …