Medicine and Health Sciences Commons^™

The Impact Of Transmission Mode On Hiv/Aids Medication Adherence, Lindsey Wilde

Walden Dissertations and Doctoral Studies

Medication adherence amongst HIV/AIDS infected individuals can be challenging for many reasons. I examined whether there was an association between mode of HIV transmission, such as sexual intercourse, mother to child, or IV drug use, and medication adherence among HIV+ individuals 18 years and older living in New York City. The theoretical base for this study was the Social Ecological Systems Theory. Logistic regression analyses were conducted on field data obtained from the New York State Medicaid Agency from 2015. Results indicated that transmission mode, age, race, and poverty level all have statistically significant associations with the dependent variable of …

Nigerian Hospital-Based Interprofessional Collaborative Patterns And Organizational Implications, Osaeloka Christiandolus Ekwueme

Walden Dissertations and Doctoral Studies

Interprofessional collaboration is recognized as the innovative, evidence-based strategy that strengthens health systems and improves performance and health outcomes. While resource-rich countries have benefited much from the implementation of this initiative, literature is scarce regarding sub-Sahara Africa. This quantitative cross-sectional descriptive study described the extent of interprofessional collaborative practice at the tertiary care level in Nigeria and its implications on patient health outcomes, professionals' performance, satisfaction, and healthy practice environment. The relational coordination theory (RCT) provided the conceptual framework for the study. Key research questions were on the association between the extents of interprofessional practice and each of the outcome …

Association Between Genetic Ancestry And Body Mass Index Among A Cohort Of Hispanic American Children, Sahel Hazrati

Walden Dissertations and Doctoral Studies

Childhood obesity is disproportionately higher among children from Hispanic backgrounds. Ethnicity is a social and cultural construct and does not capture true ancestral heterogeneity. Hispanic Americans have a wide variety of genetic admixture proportions of European (EUR), Native American (AMR), and African (AFR) ancestry. The objective of this cross-sectional study was to assess the contribution of ancestral genetic composition to body mass index (BMI), and to evaluate the relationship of obesity risk factors to BMI among 154 2-year-old Hispanic American children. The theory of Evolutionary Developmental Biology was utilized to investigate the relationship between children's growth process and ancestral background. …

Educating Oncology Nurses About The Emotional Impact Of Cancer Diagnosis, Jonnell Ortiz Zayas

Walden Dissertations and Doctoral Studies

Anxiety and depression are common mood disorders in cancer patients, regardless of mental state prior to diagnosis. A gap in the education of oncology nurses in an eastern Caribbean island was discovered regarding their ability to identify anxiety and depression symptoms and to help patients who suffered from these disorders. The purpose of this project was to improve oncology nurses' assessment skills by reviewing appropriate use of the Hospital Anxiety and Depression Scale (HADS) tool and familiarizing nurses with resources to help patients who score high on the HADS. The Levine conservation model was the theoretical framework for this project. …

Kono Members' Perceptions Of Burial Practices And The Spread Of Ebola Virus Disease, Comfort Kenyeh Panda

Walden Dissertations and Doctoral Studies

Sierra Leone was heavily affected by the West African Ebola virus disease (EVD) epidemic from 2013 to 2016. Ongoing EVD transmission during the epidemic was connected to several factors including unsafe traditional burial practices. This phenomenological qualitative study addressed Kono members' perceived knowledge, attitudes, and beliefs regarding how burial practices influenced EVD transmission. Rosenstock's health belief model provided the framework for the study. The participants purposefully selected from various religions and professions were interviewed individually and in focus group settings. Similar phrases and comments were identified from the interview responses resulted which resulted in the following 5 main themes: (a) …

An Evidence-Based Clinical Practice Guideline For Childhood Obesity, George Peterson

Walden Dissertations and Doctoral Studies

Childhood obesity is a national problem in the United States and has known implications as a potential cause of chronic illnesses as the child transitions into adulthood. A primary care clinic in the southwestern United States had a high percentage of obese Hispanic children within its population; therefore, the nurses and the pediatrician needed an evidence-based clinical practice guideline (CPG) to manage Hispanic children with a body mass index greater than the 95th percentile for their age. The purpose of the project was to develop a culturally competent CPG to manage childhood obesity in this primary care practice. The social …

Racial And Cultural Etiology Of Body Satisfaction Among Obese, Young Adult Women, Deirdre Lynnett Moyer

Walden Dissertations and Doctoral Studies

Obesity, a public health issue in the United States, has been linked to numerous chronic diseases. A gap exists in the literature related to racial and cultural etiology of body satisfaction for obese women. The purpose of this qualitative phenomenological study was to describe the racial and cultural etiology of body satisfaction for obese Black women and White women residing in a rural area of the state of North Carolina. Social comparison theory provided the theoretical underpinning for this examination. The central research question was how do obese, young adult Black women and White women describe their perceptions about and …

A Community Oriented Solution To Access To Care, Margaret Louise Thornell

Walden Dissertations and Doctoral Studies

Access to primary health care services is a significant issue for many communities seeking to improve the health of their populations. This single case study describes the 12-year journey of 2 adjoining rural counties in 2 states towards meeting the primary and specialty care needs of the uninsured and underinsured population. Data were triangulated using historical documents, first-person interviews, and health utilization data. The community leadership moved through various models including a free clinic and a university-sponsored health center before finally establishing a federally qualified health center, which now serves 40,000 citizens in these counties. The site is now hosting …

Quality Of Nutrition Services For Children And Pregnant Women In Ntungamo District, Uganda, Church Tophill

Walden Dissertations and Doctoral Studies

Inadequate nutrition during infancy and early childhood seriously interferes with brain development, leading to neurological and behavioral disorders. Such effects are detrimental to children under 2 years of age. The purpose of this cross-sectional study was to better understand the quality of nutrition services offered to children and pregnant women in Ntungamo District in southwestern Uganda. The cross-sectional design facilitated comparison of different variables, using a research-question-driven approach, assessing existing secondary data from SPRING Uganda database. Stepwise, backward multiple logistic regression was used to identify the independent variables that influenced the provision of quality nutrition assessment, counseling, and support (NACS) …

Financial Strategies And Initiatives For Preventing Rural Hospital Closure, Chinue Uecker

Walden Dissertations and Doctoral Studies

In the United States, rural hospital closures increased 34% since 2015 due to financial reasons, affecting access to healthcare services in rural communities. For rural hospital leaders, improving the hospital's financial performance is a valuable strategic goal. This multiple case study was designed to explore strategies that rural hospital leaders implement to improve their hospital's financial performance in Arizona, Georgia, Illinois, Oklahoma, Pennsylvania, and the United States Virgin Islands. The strategic decision-making framework supported the study because top leaders make decisions that affect the organization's health and survival. Fifteen rural hospital leaders who maintain their hospital's financial stability provided hospital …

Development Of A Clinical Nurse Leadership Orientation Program, Sunita Waddell

Walden Dissertations and Doctoral Studies

Nurses are often promoted or hired into leadership positions without the benefit of a formal orientation to their new leadership positions. The challenge of navigating the various expectations of the role of clinical nurse leader (CNL) such as fiscal ownership, staffing patterns, payroll, and disciplinary action process can be overwhelming. The lack of a formalized orientation process and an identified nurse leader to function as a mentor can contribute to the novice CNL feeling unsupported and overwhelmed. The purpose of this project was to identify, develop, and evaluate a CNL orientation manual, outline, and program for newly appointed CNLs. The …

Type 2 Diabetes Management For Geriatric Veterans, Fachecia L. Fort

Walden Dissertations and Doctoral Studies

Managing diabetes in the geriatric long-term care population can be challenging, yet important because diabetes is a chronic, progressive disease. The purpose of this project was to identify clinical practice guidelines for managing Type 2 diabetes in geriatric veterans and to develop a class to educate providers on diabetes management in the geriatric long-term care population at a community living and rehabilitation center. The practice focused question asked if providing education to providers about the clinical practice guidelines for managing Type 2 diabetes in geriatric long-term care veterans would improve knowledge as measured by a pre- and posttest. The project …

Implementation Strategies For Quality Assurance Performance Improvements In Nursing Homes, Ameer Gilyard

Walden Dissertations and Doctoral Studies

The healthcare industry, and more specifically the nursing home sector, is changing operations and services due to a healthcare mandates and enactment of the 2010 Affordable Care Act. Such changes are termed quality assurance performance improvements (QAPI), to receive government subsidies and indemnification compensations. The purpose of this single case study was to explore effective strategies implemented by 4 healthcare leaders to comply with QAPI regulations. Total quality management theory was the conceptual framework used in this study. Data were collected through semistructured, open-ended, face-to-face interviews with 4 participants who serve in a management capacity at an organization located in …

Impact Of Free Maternal And Child Health Services On Health Care Utilization In Jigawa State, Nigeria, Nura Ibrahim Kazaure

Walden Dissertations and Doctoral Studies

In spite of a decrease globally, the maternal mortality rate (MMR) in Nigeria and its

Jigawa State has remained persistently high. Few efforts to address the MMR in Nigeria have been undertaken. The purpose of this study was to investigate the impact of Jigawa State's Free Maternal and Child Health Program (JSFMCHP), education, employment, and parity of pregnant women on health care utilization (the outcome variable), as measured by antenatal care (ANC) visits. Anderson's behavioral model served as the study's theoretical framework. The sample size included 400 antenatal records of pregnant women who were randomly selected from the state's Health …

Parental Influence On Hiv Vertical Transmission In Kenya, Hussein Abdi Nunow

Walden Dissertations and Doctoral Studies

Mother-to-infant vertical transmission of HIV usually occurs during pregnancy, labor, delivery or breastfeeding. It is the third leading cause of transmission of HIV after sexual intercourse and blood transfusions. In 2008, 12 million women aged 15 years and above were anticipated to be living with HIV in countries within Sub-Saharan Africa. In this study, the association between parental HIV knowledge, attitudes and risk reduction practices, and HIV vertical transmission in Kenya were explored. The health belief model was used to help understand and interpret the findings. For this quantitative study, data were collected via surveys from 212 participants in 3 …

A Limited Rational Choice Theory In Local Public Health Decision Making, Lona Bryan

Walden Dissertations and Doctoral Studies

The threat and occurrence of terrorist attacks have increased in the United States since September 2011, heightening concerns for weaponized anthrax, other biological pathogens, and epidemics and pandemics. Early decisions and funding levels in local public health agencies can be the first line of defense or first point of failure; yet little is understood about how decisions are made when there are budget cuts before a biological event happens. Using Lindblom's conceptualization of limited rational choice theory, the purpose of this single case study was to understand how a local public health official made decisions after budget cuts in a …

Determinants Of Low Birth Weight In A Population-Based Sample Of Zimbabwe, Paul Nesara

Walden Dissertations and Doctoral Studies

Low birth weight (LBW) is a major public health concern globally. Despite its negative social and economic impact on the family and community at large, it has remained relatively unexplored at population level in Zimbabwe. The purpose of the study was to establish determinants of LBW using data from the 2015 Zimbabwe Demographic and Health Survey. The socioecological model was the conceptual framework for the study. A secondary analysis was conducted on 4,227 mother-infant dyads. Independent variables were duration of pregnancy, number of births within the past 5-year period, exposure to mass media, type of fuel used for cooking in …

Waterborne Disease Reduction Using Evidence-Based Microbiology Verification In Lower Nyakach, Kenya, Richard R. Blodgett

Walden Dissertations and Doctoral Studies

Waterborne diseases continue to plague the poorest people in low-income countries and are estimated to cause 4,600,000 acute incidents of diarrhea resulting in over 2,000 deaths daily. A major challenge is performing microbiology tests to monitor drinking water quality. Friends of the Old (FOTO) implemented a novel strategy using evidence-based microbiology to educate communities about the relationship between contaminated water and disease. Two commercially available tests for E.coli, adapted for fieldwork, provided easily interpreted results of contamination that correlate with WHO's disease risk categories. Simple and effective household water treatment options 'solar pasteurization and/or chlorination' were provided to all 14,400 …

Women's Perceptions Of Malaria In The Western Rural Areas Of Sierra Leone, Marcella Davies

Walden Dissertations and Doctoral Studies

Malaria is one of the leading causes of death for children and women in Sierra Leone. The purpose of this qualitative study was to explore and understand the lived experiences of women from the rural areas of Sierra Leone regarding malaria. A purposive sample of Krio women from the western rural area, aged 21-55 years, spoke English, and had taken care of someone with malaria described their perceptions and lived experiences with the disease in face-to-face interviews. The research questions were based on the health belief model and focused on knowledge, beliefs, and perceptions about malaria prevention and treatment. Interpretative …

Human Immunodeficiency Virus Disparity In Black Men Who Have Sex With Men, Valencia L. Beckley Hildreth

Walden Dissertations and Doctoral Studies

The HIV/AIDS epidemic continues to be a challenge in the men who have sex with men (MSM) population. Initiatives to decrease rates of new HIV infections have proven less than optimal. Despite evidence-based interventions to curtail the prevalence and incidence rates of HIV infection, Black MSM have been most impacted with increased HIV incidence. The purpose of this quantitative correlational study was to explore the relationship, if any, between age, online and physical venues attended by participants within the last thirty days, neighborhood's perceived social environment, and HIV incidence in the non-Hispanic Black MSM population in a metropolitan statistical area …

Illegal Drug Use, Suicidal Ideation, And Attempted Suicide Among New York Adolescents, Jacqueline Taylor

Walden Dissertations and Doctoral Studies

Suicide, ranked as one of the top five causes of death among adolescents, aged 15 to 19, claims numerous lives within the state of New York. Driven by the social cognitive theory, the objective of this quantitative cross-sectional study was to investigate the association among being offered, sold, or given illegal drugs, illegal drug use, being bullied, age, gender, ethnicity, suicidal ideation, and attempted suicide among adolescents in New York. The Centers for Disease Control 2015 Youth Risk Behavior Surveillance data for 89,068 New York adolescents, Grades 9-12, were utilized in this study. There was increased risk of suicide ideation …

Using Social Cognitive Theory To Predict Obesity Behaviors In Hispanic American Children, Augustina Anyikwa

Walden Dissertations and Doctoral Studies

Childhood obesity is a growing challenge in the U.S. Hispanic American population. There is a need for evidence-based approaches to combat this problem. Social Cognitive Theory (SCT) is one such approach. The purpose of this study was to examine the extent to which selected constructs of SCT (expectations, self-efficacy, self-efficacy in overcoming barriers and self-control) could predict five childhood obesity prevention behaviors, namely time spent on television watching, time spent on physical activities, water consumption, consumption of fruits and vegetables, and meal portion size among Hispanic American children. A quantitative cross-sectional research design was employed for this study. Data were …

Special Educators' Perceptions On Effective Preparation And Practice For Student Success, Anne Brackney Liese

Walden Dissertations and Doctoral Studies

Alternative school settings are success prospects for students at risk of school failure. However, research on the daily experiences of the special educators in alternate school settings tasked with educating the at-risk population, is limited. The purpose of this phenomenological study was (a) to recognize the perceptions of special educators concerning their preparation to advance the success of SEN students who are at risk of school failure; (b) to determine how to improve special educator preparation programs in alternative school settings. Deci and Ryan's self-determination theory, focused on student success provided the study's framework. Twelve semistructured interviews were conducted to …

Perceptions Of Stress: Employee Participation In A Yoga Class, Rosemarie Lee

Walden Dissertations and Doctoral Studies

Abstract

Employees experience workplace stress that can affect their health resulting in chronic diseases such as diabetes, stress, hypertension, and cardiovascular diseases. Stress also contributes to staff presentism, absenteeism, and high turnover rate. The employee wellness program (EWP) yoga class at a metropolitan teaching hospital has not been evaluated for its effectiveness in employee stress reduction and improvement in employee health. The practice focus question for this project explored employees' perception of the impact of a metropolitan teaching hospital's EWP yoga class on their stress reduction and health promotion activities. The theoretical framework for this project is Lazarus' transactional model …

Postpartum Hemorrhage Evidenced-Based Registered Nurse Staff Education Project, Jessica Powell

Walden Dissertations and Doctoral Studies

Despite medical technology and research advances postpartum hemorrhages (PPH) continue to be a leading cause of morbidity and mortality for pregnant women, even in developed countries. One possible explanation for PPHs continuing to be a leading cause of maternal death is inconsistent recognition and timely treatment of women experiencing a PPH. This doctor of nursing practice project attempts to improve labor and delivery nurse knowledge through an educational intervention which will contribute to rapid identification and treatment of PPH. Knowledge change was demonstrated though change in pretest and posttest scores. The educational information and process was guided by adult learning …

Implementing A Smoking Cessation Educational Module For Clinical Staff Members Who Care For Mentally Ill Outpatients, Anthonia Okeani

Walden Dissertations and Doctoral Studies

In the United States, cigarette smoking is the main contributor to preventable death in all populations; and, among the mentally ill, the prevalence of smoking is a clinical practice concern. Nearly half of all smokers also have a diagnosis of mental illness compared with 23% of the general population. In an effort to reduce the problem of tobacco use within mentally ill populations, this project sought to create an educational module on smoking cessation for staff in a mental health clinic. The theory of planned behavior was used to guide the project that focused on implementation of a behavior change …

Hand Expression With Lactation Support: Effect On Self-Efficacy And Breastfeeding Duration, Florence Omekara

Walden Dissertations and Doctoral Studies

Breastfeeding is the best infant feeding method, and breastmilk has many immunological and anti-inflammatory properties that protect babies against illnesses and diseases. It protects the health of the mother and saves society substantial economic costs, as demonstrated in many studies. Studies show that if 90% of U.S mothers breastfed for 6 months, up to $13 billion in healthcare costs could be saved. Despite the health and economic benefits of breastfeeding, most women stop breastfeeding before 6 months postpartum, which falls short of the recommendations of the World Health Organization, U.S. Surgeon General, and American Academy of Pediatrics. This study explored …

A Story To Tell Among Minority Alzheimer's Patient Caregivers: A Phenomenological Study, Albertina Lashonda Walker

Walden Dissertations and Doctoral Studies

The level of burden experienced by caregivers of patients diagnosed with Alzheimer's disease is high. Studies that examine this burden by taking into account cultural and spiritual differences are limited, particularly with regard to minority populations. The purpose of this study was to investigate the burden and challenges faced by minority caregivers providing in-home care to Alzheimer's patients. Guided by social support theory, a phenomenological study design was used with semi-structured interviews of 12 caregivers to examine their perspectives on the burden and challenges they face, including their lived experiences, cultural and spiritual values, and interaction with health professionals. Thematic …

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 …

Mindfulness Meditation: A Self-Awareness Approach To Weight Management, Michelle Brown

Walden Dissertations and Doctoral Studies

Obesity is a crucial health care issue that has a global effect on the health care industry. Not only does obesity decrease the patients' quality of life, it also places an astronomical burden on health care delivery systems. The purpose of this quality improvement project was to establish a weight management program derived from evidence-based research. The research question is can the utilization of mindfulness meditations and practices with traditional weight loss methodologies produce sustainable weight loss? Pender's health belief model was the conceptual framework utilized to guide and provides structure for this project. The health belief model has been …