Medicine and Health Sciences Commons^™

Dental Care Utilization Among U.S. Children Participating In Early Head Start Programs, Ahlam Ibraheem Joufi

Health Services Research Dissertations

Early childhood caries (ECC) remains one of the most common preventable diseases among children under the age of 6 years. Several national stakeholders recommend establishing a continuous collaboration of individuals involved with receiving oral health services (dental home) and routine dental care for the child by 12 months. Despite this recommendation, disparities exist among young, low-income children in preventive dental service utilization. The Early Head Start (EHS) program serves low-income children aged 0-3 years and their families and promotes oral health practices and service utilization within the program. This study aims to examine predictors of dental care utilization among children …

Tobacco Smoking Among Saudi College Students: Validation Of An Arabic Health Belief Model Instrument, Saad Abdullah S. Alotaibi

Health Services Research Dissertations

This dissertation intended to learn more about Saudi college students' behavior in relation to the use of tobacco smoking. Multiple interrelated projects have been carried out in order to achieve this ambitious goal. The goal of the first study was to evaluate the scope of the existing smoking issue as indicated by research, by systematically estimating the prevalence of tobacco use among higher education students in Saudi Arabia. The second study aimed to systematically analyze and integrate the existing information on the determinants of smoking among Saudi college students. The last project aimed to develop a psychometric instrument to evaluate …

Examining The Roles Of Acculturative Stressors And Cultural Factors In Major Health And Safety Issues Among Hispanic/Latino Farmworkers, Brenda Berumen-Flucker

Health Services Research Dissertations

Statement of the problem: Hispanic/Latino farmworkers are at increased risk of adverse health and safety outcomes. Heightened levels of acculturative stress and the unique cultural characteristics and beliefs reported by this group increase workers’ vulnerability for adverse outcomes.

Method: The first project consisted of a systematic review examining threats to the health and safety of Hispanic/Latino agricultural workers attributable to climate change, focusing specifically on their risk for heat-related illnesses (HRI) and cultural factors and beliefs increasing workers’ vulnerability for HRI. The second project was a secondary data analysis focused on identifying potential relationships between acculturative stressors, cultural factors, and …

Examining The Use Of Immersive Clinical Experiences In Athletic Training Education, Bailey Christine Jones

Health Services Research Dissertations

Clinical experiences are an essential aspect of athletic training education that offer students opportunities to practice their skills and engage in a variety of settings. The Commission on Accreditation of Athletic Training Education (CAATE) sets accreditation standards for athletic training programs to meet, including clinical education standards. In fall 2020, new standards took effect that include a few additions to the standards surrounding clinical education; these additions require programs to afford students opportunities to engage in immersive clinical experiences (ICEs), implement behaviors associated with core competencies, and identify strategies that account for patients’ social determinants of health. Educators believe ICEs …

The Assessment Of Clinical Reasoning In Preceptors Across The Athletic Training Profession, Gary Wayne Cohen Jr.

Health Services Research Dissertations

Clinical reasoning (CR) is defined as a complex multi-factorial metacognitive process for diagnosis formulation. Clinical reasoning begins as a student and develops over a career. Students are typically taught an analytical approach defined as hypothetico-deductive reasoning (HDR). Expert clinicians use a non-analytical approach defined as the Knowledge Based Model (KBM) of CR. It is accepted that clinicians use the KBM with cases that they have more experience to streamline the evaluation process. Unfortunately, because of the nuance of CR there have been limited investigations within athletic training to evaluate CR outside of the student population.

The overarching purpose of this …

Nursing Students’ Knowledge And Attitudes About Pain Management And Opioids, Hedieh Hatami Sirjani

Health Services Research Dissertations

Statement of the problem: healthcare professionals’ knowledge of using opioids for pain management safely is critical in preventing opioid abuse and overdose. Undergraduate curricula of health professional schools, including undergraduate nursing programs, need to improve and adopt a comprehensive education regarding this issue.

Method: the first project was a systematic analysis of the literature regarding the educational interventions’ impact on healthcare professional knowledge and practice behavior regarding prescription opioids. The second project was a qualitative study of nursing students to explore their experience, self-efficacy, and knowledge of prescription opioid use for pain management and whether they feel the need for …

A Three Article Study Examining Sexual And Gender Minority Competency Of Health Service Providers, Corrine N. Wilsey

Health Services Research Dissertations

Sexual and gender minority (SGM) individuals endure a number of health disparities, such as higher rates of violence, mental health conditions, and more medical conditions. These disparities are exacerbated by the fact that SGM individuals face issues such as accessing health insurance, social support programs, and health service providers who are knowledgeable about SGM health issues. Certain health service provider governing organizations (i.e., the American Psychological Association, the Association of American Medical Colleges, and the Gay and Lesbian Medical Association) have recognized the need for guidelines regarding SGM care in recent years and published guidelines for health service providers regarding …

The Determinants Of Physical Activity, Self-Monitoring Of Blood Glucose, And Poor Glycemic Control Among Individuals Diagnosed With Type 2 Diabetes In Saudi Arabia: A Cross-Sectional Study Based On The Saudi Health Interview Survey (Shis), Mohammed Abdulrahman S. Alsuliman

Health Services Research Dissertations

The prevalence of diabetes and poor glycemic control in Saudi Arabia has increased that contributed to the growing number of deaths in Saudi Arabia. It is known that type 2 diabetes (T2DM) can be prevented but there is a lack information about the magnitude of the of diabetes at national level as well as the risk factors for physical activity (PA), self-monitoring of blood glucose (SMBG), and poor glycemic. Thus, through utilizing Health promotion model (HPM), the aims are to examine the personal factors, cognitive-perceptual, and behavioral determinants of three outcomes; physical activity, SMBG, and poor glycemic control. A secondary …

Predictors Of Dental Students’ Behavioral Intention Use Of Teledentistry: An Application Of The Unified Theory Of Acceptance And Use Of Technology (Utaut) Model, Jafar Hassan Alabdullah

Health Services Research Dissertations

Shortages of dental professionals and access barriers to dental care are challenges to improving oral health and decreasing the burden of dental diseases. There are more than 57 million individuals in the U.S. who live in dental health professional shortage areas (DHPSA). The U.S. DHPSA areas need 9,951 dental practitioners to overcome the obstacles to oral care access. Due to dental care needs for these populations, it is imperative to find a new method to reach these underserved populations. Teledentistry is an innovative technology that can be used to improve access to care and oral health outcomes. Unfortunately, there is …

Examine Predictors Of Bmi Classification And Perception Of Overweght Status Of Caregivers Of Preschool Children, Beth H. Chopp

Health Services Research Dissertations

Since the 1970’s the rate of childhood obesity in the United States has tripled and now one in five school-aged children is obese (Ogden et al., 2016). The childhood obesity epidemic will have medical, social, economic implications for future generations. Risk factors for childhood obesity include genetics, food intake, and physical activity, maternal health during pregnancy, parental weight, maternal employment and sociodemographic influences. This study examined the relationship between caregiver misperception of their preschoolers’ overweight/obese weight status and possible predictors that may assist in future interventions. The study evaluated NHANES data of 1245 caregivers with a child under age five …

Understanding Young Adult Survivors Of Childhood Cancers’ Participation In Late Effects Screening: A Mixed Methods Approach, Kristen Trost Mantlo

Health Services Research Dissertations

Significant advancements in the treatment of childhood cancers have helped to increase the 5-year survival rate from 56% in the early 1970s to approximately 80-85% in the early 2000s (Greenlee, Murray, Bolden, & Wingo, 2000; Hampton, 2005). Treatment modalities such as chemotherapy and radiation have led to many serious long-term side effects, known as late effects. Between 60% and 90% of survivors develop some form of long-term chronic condition due to their treatment and up to 40% of those conditions will be life-threatening (Howlader, N. et al., 2013). While the majority of young adult survivors of childhood cancer are at …

Depression Among Expectant And New Mothers: A Multi-Study Investigation Of Rates, Correlates, And Training For Healthcare Providers, Molly M. Long

Health Services Research Dissertations

Perinatal depression (PD) is a common concern among women. PD has been shown to have negative effects on the mother, child, and mother-child relationship. Screening for PD is inconsistent and low among healthcare providers. However, several governing organizations (e.g., The American College of Obstetricians and Gynecologists, The American Academy of Pediatrics) have provided guidelines for screening and treating PD, indicating the importance and utility of screening and treating PD by a variety of healthcare providers. Few studies, with low methodological rigor, have attempted to improve PD screening, treatment, and referral practices. Therefore, it is important to implement and assess additional …

Asthma-Related Health Outcomes In New Jersey After A Natural Disaster Event, My Ngoc Thuy Nguyen

Health Services Research Dissertations

The occurrence of a natural disaster event such as a hurricane may further hinder the asthma management of asthmatic individuals. Unmanaged asthma has led to increased work absenteeism, preventable emergency department visits, costly hospitalizations and possibly death in severe cases. To improve asthma management in asthmatic adults in New Jersey (NJ) following a natural disaster event, this study examined whether predisposing, enabling and need factors are predictors for asthma exacerbation and asthma-related health care utilization in New Jersey. A retrospective secondary analysis of New Jersey Behavioral Risk Factor Surveillance System (NJBRFSS) data and New Jersey Asthma Call Back Survey (NJACBS) …

Usefulness Of An Expanded Health Belief Model With Added Constructs (Self-Efficacy And Ecological System Measures) In Modeling Compliance With Healthy Lifestyle Recommendations In Women With A Recent History Of Gestational Diabetes, Phyllis M. Woodson

Health Services Research Dissertations

Problem Statement: Gestational diabetes (GDM) has been reported to affect as many as 18% of all pregnancies in the U.S. This diagnosis is costly and presents health risks to both baby and mother. The main risk to the mother with a history of GDM is her increased risk for diabetes which has been estimated at 35% to 60% in the following 10 to 20 years; more recent studies report a 7 to 8 times occurrence in the following 3 to 6 years. It is recommended that lifestyle efforts of eating healthfully and exercise can reduce this risk

Methods: Subjects (n=153) …

Examining The Association Of Environmental Degradation And Poor Cardiovascular And/Or Respiratory Health Outcomes In A Disadvantaged Community, Khyati Niranjan Kantaria

Health Services Research Dissertations

Air pollution is associated with poor cardiovascular and/or respiratory health outcomes. The poor air quality in certain communities due to the emission of toxic air pollutants from industries and major roadways has been a growing concern. The main objective of this study was to examine whether residential proximity to environmental air pollution sources, individual-level risk factors (age, gender, and body mass index (BMI)) and number of years at same residence are associated with observed poor cardiovascular and/or respiratory health outcomes in the residents of Southeast community in Newport News, Virginia. Logistic regression was conducted to assess this association using the …

Sexual Violence Victimization, Mental Health, And University-Based Health Service Use Among College Females, Julie E. Stoner

Health Services Research Dissertations

Females between the ages of 18 and 24 consistently experience higher rates of sexual violence compared to females in any other age group (Sinozich & Langton, 2014). Approximately one in five college women experience sexual violence victimization (SVV; Krebs, Lindquist, Berzofsky, Shook-Sa & Peterson, 2016) during the academic year. Among undergraduate female students, 23.1% are victims of sexual violence due to physical force, violence or incapacitation (Cantor et al., 2015). Sexual victimization has been associated with several short- and long-term psychological health consequences, accounting for enhanced symptoms of depression, anxiety, PTSD, and suicide risk (Basile, Smith, Breiding, Black & Mahendra, …

Behavioral Determinants Of Exercise-Related Injury Prevention Program Participation, Emily M. Hartley

Health Services Research Dissertations

Lower extremity injuries are common among the physically active population. There are many negative consequences associated with these injuries which have led to a shift in clinical practice towards prevention. Exercise-related injury prevention programs (ERIPPs) were created to prevent musculoskeletal injuries that occur due to participation in physical activity. However, one of the major limitations to their effectiveness is the compliance of the users to complete the prescribed exercises. It is imperative to better understand the reasons why compliance is low to develop implementation strategies and improve compliance rates.

The overarching purpose of this dissertation was to gain a better …

An Examination Of Athletic Directors' Perceptions Of The Utilization Of Athletic Trainers In The Secondary School Setting, Stephanie H. Clines

Health Services Research Dissertations

Many secondary school athletes are lacking appropriate medical care during sport participation. Athletic trainers (ATs) are qualified healthcare professionals that can fill this need. Barriers to hiring ATs within this setting have been identified, however important information from administrators is lacking on why secondary schools choose to utilize ATs. Understanding this decision making process has the potential to guide future strategies to increase the number of secondary schools that employ ATs and improve retention of athletic training positions within the secondary school setting.

Our objective was to explore athletic directors’ perceptions of the roles and services provided by ATs working …

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

Health Services Research Dissertations

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

Effects Of A Collaborative Care For Depression Intervention On Health Service Utilization And Depression Severity, Girlyn Arganza Cachaper

Health Services Research Dissertations

Depression is the leading cause of disability worldwide, disproportionately affecting the Medicaid population. Collaborative care programs for depression are transforming primary care to increase access and coordinate physical and behavioral health services. Understanding the relationships between components of collaborative care programs, characteristics of participants, and their effect on outcomes can maximize program effectiveness. A pilot collaborative care for depression program within a Medicaid managed care organization was evaluated using administrative claims and case management data. Participants (n=444) included adults with prior Medicaid coverage and a comparison group identified using one-to-one propensity score-matching. Multivariate logistic regression models estimated the odds of …

Healthcare Outcomes And Resource Utilization Associated With Neonatal Hypoglycemia: Analysis Of Data From The Hcup Kid’S Inpatient Database, Brook T. Alemu

Health Services Research Dissertations

Neonatal hypoglycemia is the most common metabolic abnormality in infants and is associated with neurological damage and death. The risk of developing hypoglycemia among infants born from diabetic mothers is even higher. Although much work has been performed addressing issues for treatment and care, research related to neonatal hypoglycemia has been focused on the clinical or individual level risk factors. Contextual risk factors such as hospital characteristics, neighborhood economic status, and regional variations were not considered in earlier studies. Additionally, although healthcare resources utilization of hypoglycemia has been adequately addressed in the adult population, this topic has not been studied …

Alcohol And Substance Use Knowledge, Attitudes, Subjective Norms, Self-Efficacy, Perceived Behavioral Control, And Behavioral Intentions Among Omani College Students, Muna S. Bait Ajzoon

Health Services Research Dissertations

Alcohol and/or substance use among college students is a serious public health issue. In Oman, studies addressing college student’s alcohol and/or substance use are limited. The purpose of this study was to identify knowledge, attitudes, subjective norms, self-efficacy, and perceived behavioral control associated with alcohol and/or substance usage patterns among Omani college students (OCSs); identify behavioral intentions for alcohol and/or substance use among OCSs; and facilitate the development of culturally relevant evidenced-based interventions for Omani young people by communicating study findings to policymakers and healthcare program leaders.

A cross-sectional design used an online survey completed by college students from Oman …

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

Health Services Research Dissertations

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

Measuring Outcomes In Competence And Confidence In Clinical Skills Through The Use Of Standardized Patients, Jennifer W. Cuchna

Health Services Research Dissertations

Limited literature is available concerning the use of standardized patients (SPs) in physical therapy education related to outcomes which are assessed. The purpose of our study was to investigate the effects SP implementation had on first year, doctor of physical therapy (DPT) student’s communication and patient interviewing skills and their confidence in those skills.

Our study utilized a comparison group, repeated measures design with the collection of four survey instruments at pre-test and two posttest time points. The instruments for our study measured general self-efficacy (GSE), task-specific self-efficacy (Self-Perceived Communication Competence (SPCC) and Froehlich Communication Competence (FroCom) and confidence (Standardized …

Sleep Disorders And Kidney Transplant Outcomes: Findings From An 18-Year (1997-2015) Historical Cohort Study, Margaret M. Lubas

Health Services Research Dissertations

A historic cohort study of kidney transplant recipients with a failed graft was conducted to examine the associations between sleep disorders and kidney transplant outcomes. Adult kidney transplant recipients who were transplanted and failed or died with a functioning graft during the designated study time period (January 1, 1997 to September 1, 2015, inclusive) were included (n=299). The primary independent variables, any sleep disorder and any sleep-disordered breathing disorders, were defined through a diagnosis in a subject’s medical record. Transplant outcomes included: death with a functioning graft, graft survival time, and patient survival time after graft failure.

Chi-square statistics were …

School Policy, Food And Physical Activity Environment, And Childhood Obesity, Ruicui Liu

Health Services Research Dissertations

The purpose of this study is to examine the effect of school food and physical activity environments on energy balance-related behaviors and Body Mass Index (BMI) and to simulate the effect of school-based nutrition and physical activity policies on childhood obesity prevention. Four models based on the Social Ecological Framework of childhood obesity were developed. Parameters of these models were calibrated and validated with empirical data derived from the Early Childhood Longitudinal Study – Kindergarten Class of 1998-99 and the 2003-2004 National Health and Nutrition Examination Study. The correlation between observed and simulated BMI was 0.85 for 5th grade children …

A Test Of The Behavioral Model Of Health Services Use On Non-Emergent Emergency Department Use, Moira Crosby Mcmanus

Health Services Research Dissertations

Even though emergency departments (EDs) were created to treat trauma and emergent cases, there has been an increase in emergency department (ED) utilization for non-emergent reasons over the past half of a century. As non-emergent utilization grows as a result of the ED becoming a prevalent substitute for primary care, overcrowding of the ED and increased wait times will continue. Additionally, unnecessary cost to both the ED and the patient will be incurred. Previous research has examined and determined various reasons and risk factors driving non-emergent ED use, among them the influence of living location and the number of non-emergent …

Response Shift And Functional Outcomes In Individuals With Chronic Ankle Instability, Cameron J. Powden

Health Services Research Dissertations

Ankle sprains are one of the most common injuries sustained by those who are physically active. One in three individuals will develop a condition known as chronic ankle instability (CAI) after suffering a single ankle sprain. These individuals suffer from recurrent bouts of ankle instability, residual symptoms, and a myriad of other mechanical and functional impairments as well as health-related quality of life (HRQL) deficits. Due to the abundance of health consequences associated with this condition it is imperative to establish evidence based interventions that are focused on restoring function and HRQL to pre-injury statuses.

The overarching purpose of this …

The Information-Motivation-Behavioral Skills Model: An Examination Of Obesity Prevention Behavioral Change In Children Who Participated In The Afterschool Program Virginia Beach Let’S Move, Marilyn Miroshlava Bartholmae

Health Services Research Dissertations

The purpose of this study was to examine the utility of the Information-Motivation-Behavioral Skills Model (IMB) as a foundation to design childhood obesity prevention afterschool programs. This study employed a secondary analysis of pre (n=172), post (n=170), and 1-year follow-up (n=32) evaluations of the obesity prevention afterschool program Virginia Beach Let’s Move for children ages 5-11 years. Independent variables included demographic characteristics for the participating children and their parents. Dependent variables used in this study were the IMB constructs information and motivation. Motivation was measured by the attitudes of the children and information was measured by the children’s knowledge.

The …

A Model To Predict Pre-Hospital Endotracheal Intubation Success, Leigh Ann Diggs

Health Services Research Dissertations

Background: Pre-hospital endotracheal intubation (ETI) is one of the most critical skills performed by paramedics and is considered the “gold standard” of airway management. Pre-hospital ETI success rates are variable, ranging from 33% to 100% across EMS systems in the U.S. Previous investigative efforts have identified factors associated with pre-hospital ETI success, but the generalizability of findings is limited. Few researchers have controlled for the concurrent effects of multiple factors when examining pre-hospital ETI success. Methods: In this retrospective exploratory study, we used national data from the National Emergency Medical Services Information System (NEMSIS) and data from a four state …