Medicine and Health Sciences Commons^™

Diabetes Status, Predisposing, Enabling, And Oral Health Illness Level Variables As Predictors Of Preventive And Emergency Dental Service Use, Sabha Alshatrat

Health Services Research Dissertations

The purpose of this study was to clarify the relationship between diabetes and dental service use. This study addressed the question of whether individuals with diabetes are more or less likely to utilize dental services, measured in terms of preventive and emergency services during the past year. A cross-sectional study was conducted to assess the contributions of diabetes status to dental service use, relative to the contributions of Andersen and Newman Framework of Health Services Utilization dimensions (predisposing, enabling, and illness variables) in predicting dental service utilization during the past year using a nationally representative sample from a 2001-2002 National …

A Study Of A Simulated Infectious Disease On Healthcare Workers' Reaction, Knowledge, Attitudes, And Performance Towards Hand Hygiene, Lydia Wigglesworth-Ballard

Health Services Research Dissertations

Problem Statement. The high rate of healthcare worker-patient contact provides many opportunities for exposure to pathogens, which creates challenges in assessing healthcare workers' success at preventing healthcare associated infections caused by these dangerous pathogens.

Methods. This study explored the effects of a simulated infectious disease on healthcare workers' hand hygiene knowledge, attitudes, performance, and reactions using Kirkpatrick's Four levels of Evaluation. The study utilized a mixed method pre-test – 2 post-test design. The dependent variables were hand hygiene knowledge, attitudes toward hand hygiene guidelines, hand hygiene performance, and reaction to the overall experience. Data was collected three times over a …

Modeling Solutions For Prevention Of Medicare Insolvency For The Baby Boomer Generation (Born 1946 - 1964), Gregory Thomas Scott

Health Services Research Dissertations

Medicare, a United States social insurance program operated by the United States federal government, began operating in a deficit in the year 2010. More funding was expended than revenue received for medical care, creating significant shortfalls for the Medicare Trust Fund. This study examined possible initiatives to describe Medicare funding related to issues as financial shortfalls utilizing mathematical modeling and simulation. The Park Conceptual Model is a framework created to identify internal and external changes that influence bankruptcies related to municipalities, and this Model served as the theoretical basis for this study.

The following study addressed insolvency as negative cash …

Factors Associated With Quality Of Life Among Mothers Of Children With Autism Spectrum Disorder, Marian Marconyak

Health Services Research Dissertations

The increasing prevalence of Autism Spectrum Disorder (ASD) has levied associated effects upon the quality of life (QOL) of mothers of children with ASD. These mothers are subjected to various influences upon their lives as a result of their role as caregivers to children with ASD. The purpose of this study was to assess the International Classification of Functioning, Disability and Health (ICF) Body Functions and Structures, Activities, Participation, Environmental, and Personal Factors associated with QOL among mothers of children with ASD.

English literate, inhabitants of the United States, mothers over the age of 18, of children with ASD were …

Utilizing The Technology Acceptance Model To Predict System Use Of An Interactive Behavior Change Technology To Deliver Virtual Diabetes Health Education, Koren Sher'keyer Goodman

Health Services Research Dissertations

Diabetes is expected to affect more than 21% of the U.S. adult population by the year 2050 (Boyle, Thompson, Gregg, Barker, & Williamson, 2010). What is important to understand about diabetes is that there are safe, effective non-pharmaceutical lifestyle modifications and pharmaceutical treatment options that can prevent and delay the onset of complications. Telehealth efforts are practical solutions increasingly used in the health services delivery model to improve self-care management practices among patients with multiple chronic conditions (Davis, Hitch, Salaam, Herman, Zimmer-Galler, & Mayer-Davis, 2010; Eng, Gustafson, Henderson, Jimison, & Patrick, 1999; Fitzner & Moss, 2013; Gruman, 2011; Lin, 1999; …

Multilevel Analysis Of Physical Activity Among Us Adults Across Us Census Regions: The Role Of Environmental Contexts, Sariyamon Tiraphat

Health Services Research Dissertations

This study uses nationally representative data to explain the variation in physical activity among U.S. adults across four geographic regions of Northeast, Midwest, South, and West. The purpose of the study is to investigate whether environmental conditions inclusive of natural amenity, built environment, urbanization, crime, and social economic neighborhood are associated with physical activity and whether these associations are modified by geographic region. The study also investigates whether the influences of environmental contexts vary by subgroup and whether they are modified by geographic region. Determining regional factors that influence physical activity is essential to planning appropriate physical activity interventions.

The …

Factors That Influence Nonadherence Outpatient Medical Follow-Up By African Americans With Hiv/Aids At An Outpatient Infectious Disease Clinic, Cynthia Burrell Banks

Health Services Research Dissertations

Human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS) does not discriminate among different races, ethnicities or genders; however, African Americans carry a larger burden related to the HIV epidemic than others (CDC, 2010c; Cunningham, Sanchez, Heller & Sohler, 2007; Mugavero, et al., 2009). Persons living with HIV/AIDS (PLWHA) who do not adhere to their medical regimen, including failure to maintain contact with their health care provider for health care monitoring, tend to have poorer health outcomes from the disease as compared to HIV/AIDS patients who adhere to their medical regimen (Cunningham et al., 2006; Lima et al., 2009). African Americans represent …

An Examination Of Factors Affecting Non-Urgent Use Of Emergency Department Services By Patients With "Universal" Healthcare, Gregory Smith Feltenberger

Health Services Research Dissertations

The purpose of this research is to examine the factors affecting non-urgent utilization of emergency department (ED) services by individuals with "universal" healthcare using the Behavioral Model of Health Services Use. Since Air Force Medical Service beneficiaries have free and unlimited use of the full-range of healthcare services, they are ideally suited for this study. The findings of this research may also apply to other populations with free or low-cost access to healthcare (i.e., universal or single-payer healthcare). Using secondary data extracted from the Air Force Medical Service's electronic health record system at several military hospitals, this study will present …

Intimate Partner Physical Violence Against Women In Saudi Arabian Primary Healthcare Clinics, Halah M. Eldoseri

Health Services Research Dissertations

Intimate partner violence against women (IPPVAW) is a serious public health concern. The Ecological Model provides a model to study several factors associated with IPPVAW. In Saudi Arabia, studies addressing IPPVAW are limited and do not cover the various aspects of the problem. The purpose of this study was to investigate the various factors associated with IPPVAW at the personal, interpersonal, community and societal levels. Methods: 200 ever-married women attending six PHC in Jeddah, Saudi Arabia were recruited via convenient sampling method. Women were interviewed on factors related to IPPVAW using an adapted version of WHO survey for violence against …

Early Diagnosis Of Pulmonary Embolism: Review And Cost-Effectiveness Analysis, Efstathios Polychronopoulos

Health Services Research Dissertations

Pulmonary embolism (PE) is a serious, life-threatening thrombotic disease, which results in considerable health and economic consequences each year for the United States. These consequences include a toll of 83,000 deaths and an economic impact between 1,5 and 5 billion. Approaches to strategy selection by physicians and other health-care specialists are based mainly upon cost, technology availability, and cultural tolerance regarding radiation exposure. The purpose of this study was to determine the most cost-effective diagnostic strategy with patients suspected of PE among several strategies currently used by examining their detection failure rates. This objective was met by (a) assessing parameter …

Using Modeling And Simulation To Improve Oral Health Services Delivery In Hampton Roads, Virginia, Mohammad J. Alzahrani

Health Services Research Dissertations

The purpose of this study is to examine the system performance in delivering oral health services in a public health district based on the Conceptual Framework to Measure Performance of the Public Health System (PHS). Using modeling and simulation, a predictive model based on the conceptual framework dimensions: mission, structural capacity, processes, and outcomes was developed to predict the performance of public health district in delivering oral health services.

This is a retrospective longitudinal study. The main objective of this study is to use a modeling and simulation approach to predict the performance of public health district dental clinic in …

Adoption Of Electronic Health Records By Admitting Physicians: A Heuristic Model, John Sharon Hudson

Health Services Research Dissertations

Background: Although hospital electronic health records (EHRs) are generally perceived to improve care, physician resistance may hinder EHR adoption.

Purpose: This study uses constructs from diffusion of innovations and resource dependence theories to predict adoption and rate of adoption of an EHR by admitting physicians from three of ten hospitals in a highly integrated health system in Virginia. Functions evaluated: computerized physician order entry (CPOE), electronic history and physical (EH&P) and electronic discharge summary (EDS). The study tested hypotheses that adoption would be associated with: working at larger, academic hospitals; financial alignment; larger physician groups; office EHR; youth; males; medical …

The Relationship Of Financial Performance, Quality Indicators, And The Role Of Nurse Executives In Virginia Nursing Homes, Jeany V. Murphy

Health Services Research Dissertations

Problem statement. The dynamic nature of the healthcare industry has triggered changes in nurse executive functions. The job has expanded into entrepreneurial roles to be able to provide the most cost effective services while maintaining good quality outcomes for the residents. The new responsibility requires a different set of knowledge and competencies that is usually achieved through advanced education. It is not known whether nurse executives in long term care in Virginia possess the skills to influence both the financial and quality outcomes of the facility.

Methods. This descriptive research study examined the relationship of the nurse executives' technical, human, …

A Gis Analysis Of The Environmental Variables Related To Rift Valley Fever Outbreaks, Jacqueline Florette Jackson

Health Services Research Dissertations

Rift Valley fever is a mosquito-borne disease that causes widespread febrile illness and mortality in domestic animals as well as humans (Gaff, 2007). Rift Valley fever virus was first isolated in 1931 (Daubney, 1931), and since then, outbreaks have occurred in sub-Saharan Africa, southern Africa, Egypt, Saudi Arabia, Yemen and Madagascar, proving it to be a virus able to invade ecologically diverse regions (Gaff, 2007). The potential introduction of Rift Valley fever into the United States suggests the potential for human infection and major economic disruption. It is important to understand the role environmental variables have played in historical outbreaks …

Patient Centered Care Approach To Adherence With Cardiovascular Medications: Self-Determination Theory Integration, David S. Li

Health Services Research Dissertations

Problem statement. Behavioral intervention is used to improve adherence with medication in patients with cardiovascular diseases (CVD), but the effect was not sustainable. Patient-centered care (PCC) as a consumer movement has gained acceptance, but it lacks a theoretical framework. Self-determination theory (SDT) may provide an alternative to improve patients' adherence to chronic cardiovascular medication, as well as a theoretical framework for PCC. Both approaches to CVD management have not been evaluated.

Methods. The study was a quasi-experimental pretest posttest comparison design with consecutive sampling of a hospitalized cardiac patient population. Sixty patients each for the usual care (UC) …

Predictors Of Developmental Screenings For Young Children, Janice Chandler Ranne

Health Services Research Dissertations

This study examines the usefulness of the New Model of Children's Health and its Influences for the identification of predictors for health service effectiveness. Health service effectiveness is measured by probability estimations of whether young children receive formal or informal developmental screenings. Screenings lead to prevention of communication delays in later childhood. Formal screenings with standardized questions are preferred over informal screenings, which are knowledgeable observations. The theoretical framework is a child-centered socio-ecological theory that is untested for use in health service effectiveness studies until the present one. Four developmental concepts of the theoretical framework, social environment, physical environment, biological …

Using The Andersen Behavioral Model Of Health Services Use To Examine Adult Uninsured Patient Health Services Use At A Community Health Center, Jewel Shonette Goodman

Health Services Research Dissertations

Prescription medications are essential to the treatment and management of chronic conditions (Smith et al., 2005). Lack of access can result in pain, worsening of the condition and increased risk of additional health problems. Health care expenditures in the United States were reportedly 1.7 trillion in 2003 (Smithetal.,2005) and exceeded" role="presentation" style="box-sizing: border-box; display: inline-table; line-height: 0; font-size: 16.66px; overflow-wrap: normal; word-spacing: normal; white-space: nowrap; float: none; direction: ltr; max-width: none; max-height: none; min-width: 0px; min-height: 0px; border: 0px; margin: 0px; padding: 1px 0px; position: relative;">1.7trillionin2003(Smithetal.,2005)andexceeded1.7trillionin2003(Smithetal.,2005)andexceeded2.3 trillion in 2008 (Centers for Medicare and Medicaid Services, 2010). Prescription medication costs …

Test Of A Multidisciplinary Health Behavior Model Of Medicare Elders' Antihypertensive Acquisitions, Ann Marie Kopitzke

Health Services Research Dissertations

This study examined the relative utility of the enhanced Health Belief Model as compared to the proposed Pharmaceutical Acquisition Model for Medicare Elders (PAMME) in describing antihypertensive acquisition with usage intentions for Medicare elders (65 years or older) in Southeastern Virginia. Data collection included record reviews to identify hypertensive Medicare elders. Consenting Medicare elders were randomly selected for invitation, with consenting Medicare elders contacted by telephone or in-person interviews. The survey instrument utilized open and closed ended questions. The target population for this study is Southeastern Virginia Medicare elders enrolled in a Part D plan and prescribed at least one …

Identifying Determinants Of Physical Activity In Maritime Union Members Using The Theory Of Planned Behavior, Susan Atkinson Tweed

Health Services Research Dissertations

This study examined the usefulness of the Theory of Planned Behavior to predict how attitude, subjective norm, perceived behavioral control, and intention are associated with physical activity in longshoremen from the Hampton Roads Shipping Association-International Longshoreman's Association (HRSA-ILA). The study was conducted in two phases. In the first phase, five focus groups were conducted to elicit information about the health behaviors of longshoremen. From the results of these focus groups, a 90-question, theory based, self-reported questionnaire was developed to identify beliefs, attitudes, subjective norms, perceived behavioral control, and intentions that contribute to longshoremen engaging in physical activity. In the second …

Application Of The Interactional Model Of Cultural Diversity To Identify Diversity Climate Factors Associated With Organizational Effectiveness In Accredited U.S. Physical Therapist Education Programs, Elizabeth Francis Giles

Health Services Research Dissertations

Accredited U.S. physical therapist education programs are responsible for the preparation of its graduates to provide culturally sensitive care to meet the physical therapy needs of an increasingly diverse population. While the importance of workforce diversity has been articulated, the effect of diversity climate on organizational effectiveness within accredited U.S. physical therapist education programs has not been described. The purpose of this study was to evaluate the effectiveness of the Interactional Model of Cultural Diversity (IMCD, Cox, 1993) as a theoretical framework to identify diversity climate factors associated with organizational effectiveness in accredited U.S. physical therapist education programs. A descriptive, …

Modeling Physical Activity In Working Adults: How Suitable Is The Expanded Parallel Process Model?, Adwoa B-H-Sam

Health Services Research Dissertations

This study is an assessment of the usefulness of the Expanded Parallel Process Model in predicting health enhancing physical activity as an outcome variable. The theory is tested in the context of risk for coronary heart disease and involves secondary analyses of a dataset from a group of working adults. These individuals had elected first to participate in a health plan ‘Quality Improvement Study’ and were then randomly selected to receive an intervention program designed to get people to be more active.

Data on self-reported demographics, physical activity levels, health status characteristics and perceptions measured on a Likert-type scale known …

Psychometric Evaluation Of An Instrument For Assessing Policy Outcomes For Families With Children Who Have Severe Developmental Disabilities: The Beach Center Family Quality Of Life Scale, Joni Taylor Mcfelea

Health Services Research Dissertations

The purpose of the study was to evaluate the psychometric properties of the Beach Center Family Quality of Life Scale (BCFQLS) in a sample of families with children who have severe developmental disabilities. The study sought to determine whether or not the scale could be used to measure the quality of life of such families and to differentiate between the quality of life of two family groups—those whose child lives in the family home and those whose child lives outside the family home.

The study used an observational, cross-sectional design and both qualitative and quantitative methods. Self-identified primary caregivers of …

Changes In Formal-Informal Caregiving In Elderly Stroke Survivors, Holly Anne Beard

Health Services Research Dissertations

The purpose of this study is to determine the extent to which the Andersen and Aday Model of Health Services Use to predict cross-sectional and longitudinal differences in the caregiving source among stroke survivors (n=477) over a six-year period. This study involves a secondary analysis of a longitudinal panel study focusing upon three waves of interview data from the HAS/AHEAD study spanning 1998 through 2002. Multinomial logistic regression was utilized to examine caregiving source cross-sectionally at each wave. Clustered multinomial logistic regression was used to examine relationships between predictor variables in the model and caregiving source across waves while holding …

The Use Of The Tripartite Model Of Attitudes To Explain Ems Providers' Attitudes About The Ems Agenda For The Future, Carolyn Angela Rinaca

Health Services Research Dissertations

A dynamic and revolutionary health care system compels the Nation to develop a more cohesive, unified healthcare workforce. The Emergency Medical Services (EMS) profession has contributed to this development with the publication of the EMS Agenda for the Future. The EMS Agenda for the Future describes the future direction for emergency medical services agencies and organizations within the nation. It is a vision that integrates EMS systems with other health care professions. The EMS Agenda for the Future is designed to assist EMS professionals in realizing their full potential for proficiency and contributes to the development of the EMS profession. …

Using Social Cognitive Theory To Model Health Behaviors Among Chinese Children, Yan Zhang

Health Services Research Dissertations

This study examined the usefulness of Social Cognitive Theory (SCT) to model fast-food intake, fruit/vegetable consumption, and regular physical activity among a group of Chinese-American children in a Southeastern Virginia urban area.

An observational cross-sectional survey research design and snowball sampling were used. The survey employed items from the Health Behavior Questionnaire, the Youth Risk Behavior Survey, and a 24-hour Diet Recall Form. Eighty-four children completed the self-administered survey; 54 of these were enrolled in a Chinese Weekend School. The mean age of the children was 10.5 years (range 6-18) and 43% were girls. Logistic regression models were used to …

The Great Pestilence: Yellow Fever In Portsmouth, Virginia, 1855, Burden Susan Lundgren

Health Services Research Dissertations

In 1855, the town of Portsmouth, Virginia was devastated by an epidemic of yellow fever. Most citizens fled. Of those who remained, most became infected and a thousand died. The municipal government collapsed. In their place, a small organization known as the Portsmouth Relief Association assumed responsibility for ensuring the survival of the town. This organization managed the care of the sick, the burial of the dead, and the care of orphans. It was the sole agent receiving and allocating the funds and resources that poured into the community. Scarce food, drugs and other supplies were available only through the …

Factors That Influence Mammography Use Of Community Health Workers, Cynthia M. Kratzke

Health Services Research Dissertations

Community health worker (CHW) interventions promote early detection of breast cancer and mammography use to help eliminate health disparities for minority and low-income women. Data trends show lower mammography use among this population although CHW interventions have been shown to promote mammography use. However, CHW interventions have not been tested sufficiently to examine the factors that influence mammography use of CHWs.

This cross-sectional study examined the factors that influence mammography use of CHWs and the relationship of self-efficacy, social norms, and mammography use of CHWs. The PRECEDE model served as the framework combining social factors, beliefs, attitudes, behaviors, and accessibility …

Application Of The Traditional Epidemiological Model To Predict Occupational Injury Rates In Manufacturing Industries, Gary A. Morris

Health Services Research Dissertations

This study was designed to test the usefulness of the Traditional Epidemiological Model of disease causation in modeling occupational injury rates and the presence of occupational illness in the manufacturing industry. More specifically, this research involved use of the agent, host, and environment constructs of the Traditional Epidemiological Model to examine the effects of five environmental-related workplace health and safety practices on occupational injury and illness. Data from the National Occupational Exposure Survey (NOES), conducted by the National Institute for Occupational Safety and Health (NIOSH) in 1981–1983, were used to ascertain the presence of specific workplace characteristics and to calculate …

Predictors Of Oral Health Behaviors: Examining The Effect Of Patient Perceived Humanistic Attitude In The Context Of The Health Belief Model, Linda Leigh Hawkins Carroll

Health Services Research Dissertations

The purpose of this study was to test the explanatory power of The Health Belief Model with the added environmental condition of perceived humanistic attitude of a dental hygienist in its ability to predict individual's performance of oral disease prevention behaviors. A cross section survey of an intact group of 1,943 full time employees of Old Dominion University was conducted. The response rate was 52% (n = 1001). An exclusionary rule eliminated respondents who did not have a dental hygienist provide preventive services during dental visits. Seven hundred and fifty four were included in the study analyses. The study participants …

An Examinaton Of The Enhanced Primary Care Model For The Organization Of Team Care In Managing Type 2 Diabetes Mellitus In The Elderly Population, Carolyn Morcom Rutledge

Health Services Research Dissertations

The healthcare system is faced with overwhelming demands as a result of the growing elderly population, especially those with chronic illnesses. One disease that significantly impacts the morbidity and mortality of the elderly population, especially the minority and poor population, is type 2 diabetes. This population often lacks access to resources and quality healthcare that may be due to inadequate knowledge by the patients and their healthcare providers regarding available services. Current models of healthcare have not been effective in meeting the healthcare demands of this population. The purpose of this study was to evaluate the effectiveness of the Enhanced …