Medicine and Health Sciences Commons^™

A Technology-Based, Mixed Methods Approach To Examining The Psychosocial Determinants Of Maternal Health Disparities, Hannah M. Ming

Theses and Dissertations

Background: Exposure to racism and discrimination in the U.S. increases Black women’s risk for experiencing maternal health disparities. Additionally, racism and discrimination affect maternal psychosocial well-being, creating evidence for a biopsychosocial relationship between racism and maternal health outcomes. However, current research does not define the psychosocial Black maternal self well. Given the dynamic relationship between racism, psychosocial well-being, and Black maternal health outcomes, research must comprehensively examine the Black maternal self. The operationalization of a comprehensive construct for Black maternal psychosocial well-being can improve understanding of the relationship between racism, psychosocial well-being, and Black maternal health outcomes.

Purpose: …

Social And Biological Determinants Of Pregnancy-Related Mortality And Morbidity In A Rural, Underserved Population, Anna Hansen

Theses and Dissertations--Sociology

Cases of severe maternal morbidity (SMM) and pregnancy-related mortality (PRM) are increasing in the US. Research concerning SMM and PRM has neglected women in Central Appalachia; a largely rural, health-disparate population. The aims of this study are two-fold: (1) Examine patient-level and place-based predictors of SMM/PRM via hierarchical logistic regression modeling, and (2) Elucidate Appalachian healthcare patients’ and providers’ experiences with SMM/PRM, perceptions of contributing factors, and insights on points of intervention.

This study uses a mixed methods approach guided by the WHO’s conceptual framework for action on social determinants of health to identify determinants of SMM and PRM among …

Coaching, Capacity, And Change: Youth Sport Providers' Perceptions On Creating A Health-Promoting Environment, Jennifer Papenfuse

Occupational Therapy Doctorate Capstone Projects

Background: Rising youth public health disparities can be attributed to the social determinants of health that influence health and wellness. Youth sport providers can be influential in creating healthier environments that facilitate positive youth development, positively impacting life-long healthy behaviors.

Purpose: The purpose of this Capstone Project was to explore youth sport provider’s perceptions, after completing an educational module, of their capacity to implement positive youth development and to create a health-promoting environment. Theoretical Framework. The Model of Human Occupation and the Transtheoretical Model of Behavioral Change guided this project’s assumption that the multicontextual environment’s influence on the process of …

Academic Health Science Centers And Health Disparities: A Qualitative Review Of The Intervening Role Of The Electronic Health Record And Social Determinants Of Health, Wies Rafi

Theses and Dissertations

Literature on the magnitude of negative health outcomes from health disparities is voluminous. Defined as the health effects of racism, environmental injustice, forms of discrimination, biases in science, and sociological or socioeconomic predictors across populations, health disparities are part of an ongoing and complicated national problem that health equity programs are specifically designed to address. Academic Health Science Centers (AHC) institutions are a complex and unique educational-healthcare ecosystem that often serves as a safety net for patients in vulnerable and lower-income communities. These institutions are often viewed as one of the most uniquely positioned entities in the U.S. with an …

Black Hearts Matter: A Comparative Study Of Sociodemographic, Clinical, And Psychosocial Characteristics In Black And White Persons With Heart Failure, Hannah M Anderson Hughes

Theses and Dissertations

Heart failure (HF) is a chronic, progressive, debilitating illness that disproportionately affects Black individuals, often leading to poor quality of life (QOL). Various sociodemographic, clinical, and psychological characteristics are related to QOL in patients with HF. Because most studies do not include representative Black samples or report findings from racial subgroup analyses, these relationships and any existing racial differences are not well understood. The purpose of this descriptive, comparative study was to explore the relationships among sociodemographic, clinical, and psychological characteristics and QOL in patients with HF and to determine if there were racial differences between Black and White individuals. …

The Value Of An Educational Curriculum For Community Health Workers To Decrease Health Disparities, Mandeep K. Gill

DNP Qualifying Manuscripts

Abstract:

Introduction: Community health workers (CHWs) are a group of health care workers that work with underserved populations in rural areas. Community health workers seldom require any formal education for their role, which may cause disparities in the information they present to the populations they serve.

Problem: Underserved communities contain many low-income and marginalized populations that do not have access to adequate healthcare. Healthcare provider shortages can be particularly severe, leaving residents without access to primary care and emergency services from physicians, nurses, and allied health professionals.

Aim/Objective: The purpose of the article is to propose a framework for developing …

Resilience And Health Outcomes Of Sexual Minority Middle-Aged And Older Adults, Christi L. Nelson

USF Tampa Graduate Theses and Dissertations

While research on lesbian, gay, and bisexual (hereafter referred to as sexual minority) middle-aged and older adults has increased over the past decade, there is still a critical need for more research on the health and resilience in this growing subpopulation. Research has provided evidence that sexual minority adults have an increased risk of negative health outcomes when compared to heterosexual adults. Research has also demonstrated possible resilience in sexual minority middle-aged and older adults; however, few studies have measured resilience in middle-aged and older adults. Gaining a better understanding of resilience in sexual minority adults may help identify modifiable …

Mental Health And Adiposity: The Effects Of Racial Discrimination And Social Relationships, Nicole D. Fields

Doctoral Dissertations

Excess adiposity is associated with increased risk of cardiovascular disease, type 2 diabetes, and premature mortality. It is well-documented that Black women are disproportionately affected by excess adiposity. Research has focused on lifestyle factors, such as diet and physical activity, to explain the higher prevalence of obesity among Black women compared to white women; however, there is much less research on the association between psychological distress and adiposity, which may be important for understanding racial disparities. To date, no studies have examined the social context by which mental health and physical health are related. Black women in U.S. society live …

Perinatal Periods Of Risk: Examination Of Data Quality & Inclusion Criteria, New Unbiased Reference Groups, And A Nationwide County-Level Analysis, Carol S. Gilbert

Theses & Dissertations

Records of births, infant deaths, and fetal deaths are compiled by the US Vital Records System and used to monitor population health and guide health policy. The Perinatal Periods of Risk Approach (PPOR) relies on vital records data to address fetal and infant mortality in US cities. It uses reference groups to estimate preventable mortality by risk period. To avoid biased analyses due to poor data quality for small and early infant and fetal deaths, an expert committee recommended that PPOR analyses exclude fetal deaths delivered at gestational age (GA) <24 >weeks, and infant deaths and live births with birthweights (BW) …

Strategies For Addressing Vaccination Disparities And Rates In The U.S Among Racial/Ethnic Minority Adults, Harpreet Kaur

Master's Projects and Capstones

As new and emerging infectious diseases surface, public health officials are working harder to close the immunization gap. Every year, thousands of adults in the U.S suffer adverse health outcomes and die from vaccine-preventable diseases. The COVID-19 pandemic has reminded us of the power of vaccines as they have been able to eradicate diseases, save lives, and create healthier communities. A literature review was conducted to identify the gaps in research as it relates to vaccine disparities among racial/ethnic adult populations.

The literature indicates that ethnic/racial minorities are at disproportionate risk for vaccine-preventable diseases and data has shown increasingly high …

Feasibility And Acceptability Of Using Mobile Health Apps In Underserved Patients With Diabetes, Jieyu Luo

Theses and Dissertations (ETD)

Introduction. Diabetes mellitus is a condition with a growing morbidity and mortality burden. An estimated 30 million adults currently live with diabetes, with each individual spending over $9500 annually on medical care. The successful management of diabetes is a lifelong endeavor. This involves balancing a variety of factors including diet, medications, and glucose monitoring. It has been well established that successful control of diabetes depends largely upon patients’ daily lifestyle habits and activities. Not all patients, however, have the resources necessary for effective diabetes management. Health disparities lead to a higher rate of diabetes development in minority and poor populations. …

Rural Hospital Closures And Perceived Access To Care: A Qualitative Descriptive Study In An Appalachian County Of Tennessee, Amanda M. Letheren

Doctoral Dissertations

Background: Tennessee has suffered more hospital closures per capita than anywhere else in the nation. The impact of hospital closures on access to care in rural and economically distressed Appalachian counties of Tennessee is of particular concern because these communities experience great health disparities. Hospital closures may exacerbate these disparities and create additional barriers when accessing care.

Objectives: The aim of this study was to describe community residents’ perceptions of health and access to care following a hospital closure in a rural and economically distressed Appalachian county of Tennessee.

Methods: This study used a qualitative descriptive approach to present community …

In With A Runny Nose, Out In A Body Bag: Why Is It So Difficult For Black Women To Leave The Hospital Alive?, Chelsea Carter

Liberal Arts Capstones

In the Black community, there is an unspoken understanding about going to the doctor with a runny nose, and leaving in a body bag. A recent article published by The Oprah Magazine demonstrates that racism is rampant in the United States healthcare system, and it is taking the lives of Black women at an alarmingly disproportionate rate (Stallings, 2018). When seeking medical treatment, many Black women are at the mercy of doctors who hold an implicit bias against Black women. Simply put, implicit bias describes when people behave and treat others based on negative preconceptions they have about other people, …

Healthy Food Accessibility In Rural Mississippi And Potential For A Corner Store Intervention, Anna Conner

Honors Theses

Some areas of the United States have poorer food environments than others. The Mississippi Delta has limited access to nutritious food, often relying on corner stores for sustenance. The impact of a poor diet can increase chronic disease prevalence, creating additional barriers to health and nutrition for Mississippians. The purpose of this study was to document and explore the rural food environment and discuss urban intervention studies in light of the current state of stores in the Delta. An adapted version of the Baltimore Healthy Kids survey and store impact questionnaire was used to record owner perceptions and food availability. …

Examining Health Disparities Among Lesbian, Gay, Bisexual, Transgender, And Queer/Questioning Adults In Davidson County, Tennessee, Samantha Anticuar

DNP Scholarly Projects

Background: Lesbian, gay, bisexual, transgender, queer, and questioning (LGBTQ) individuals experience increased risks for health disparities and discrimination compared to non-LGBTQ individuals, yet there is limited research in southern populations. Purpose: The purpose of this scholarly project was to examine if LGBTQ individuals had increased health disparities compared to non-LGBTQ individuals in Davidson County, Tennessee (TN). Methods: A quasi-experimental design (N = 1,704) used the 2019 Nashville Community Health and Well-being Survey for analysis. Results: Findings suggested LGBTQ individuals had increased odds of not having health insurance (p = .009, adjusted odds: 6.84), poor mental health (p …

The Impact Of The Hospital Value-Based Purchasing Program On Healthy Days, Health Inequity, And Hospital Community Benefit Spending, Samhita Kadiyala

Scripps Senior Theses

The Hospital Value-Based Purchasing Program (HVBP) is a Centers for Medicare and Medicaid Services (CMS) program implemented in 2012 to reward acute-care hospitals with incentive payments for the quality of care provided to Medicare patients in inpatient settings. Under this policy, payment adjustments are made based on a variety of factors including clinical quality, patient experience, and cost reductions. This paper uses state-level variation in the implementation of HVBP to ascertain whether the policy led to improvements in Healthy Days (a CDC-designed composite measure of individuals’ self-reported number of physically and mentally “healthy” days per month), health disparities, and community …

Addressing Hidden Barriers To Follow Up Healthcare: A Community Referral Pilot Project, Amber Williams

Doctor of Nursing Practice Projects

Objective: The project was aimed to reduce the number of participants lost to primary care follow-up following a mobile health unit screening event.

Design: A pilot study program screening tool implementation was utilized to address the hidden barriers of the Social Determinants of Health (SDoH) during a Winter 2021 event.

Sample: A group of 12 participants were screened during a mobile health unit event. Eight of the participants opted to be a part of the pilot study.

Measurements: A comparison ratio of Primary Care follow up was compared from the Winter of 2020 with Winter of 2021, where the screening …

The Association Of Demographic Characteristics And Social Vulnerability With Covid-19 Outcomes, Gloria D. Boone

Electronic Theses and Dissertations

The Association of Demographic Characteristics and Social Vulnerability With COVID-19 Outcomes

by

Gloria Boone

(Under the Direction of Gulzar Shah)

ABSTRACT

This research explored 102 Illinois counties' COVID-19 data to determine whether demographic characteristics and social vulnerability are associated with increased vulnerability to COVID-19 infections and deaths. COVID-19 is disproportionately impacting vulnerable groups and has been deadlier for African American and Hispanic people. The findings of this research will contribute to the knowledge base regarding social vulnerability and assist public health officials in targeting resources and designing interventions. This study used a retrospective cross-sectional design to assess demographic characteristics of …

Quantifying The Impact Of Chronic Stress On Racial Disparities In Cardiovascular Disease, Nnadozie Emechebe

USF Tampa Graduate Theses and Dissertations

Background: Despite declining mortality in cardiovascular diseases (CVD), racial disparities between non-Hispanic Blacks (NHB) and to non-Hispanic Whites (NHW) persist. Although the prevalence of traditional risk factors of CVD such as hypertension, is higher in NHB compared to NHW, adjusting for this difference does not eliminate the disparity completely. This suggests other factors might explain the persisting disparities. Thus, the purpose of this dissertation is to quantify the impact of chronic stress in explaining the racial disparities in cardiovascular diseases (CVD). This dissertation contains three studies that addressed the following Specific Aims: Specific aims: 1) To create and assess the …

Knowledge, Attitudes, Behaviors And Environmental Health Needs Of Latinas In Cleaning Occupations, Erin Ihde

Seton Hall University Dissertations and Theses (ETDs)

Background: Population health, including research and educational outreach, are quickly becoming mainstays at large tertiary care medical centers around the U.S. In fulfilling this mission, it is essential to understand underserved and underrepresented communities, including any unique health challenges faced.

In New Jersey, the Latino population ranks seventh largest in the country with 1,730,000 Hispanics, or 19 percent of the population throughout the state. Yet there may be underrepresentation in health research and a lack of understanding of key health needs faced by this population. This underrepresentation is impacted by several factors, including lack of health insurance and poverty. …

Patients' Disclosure Of Sexual And Gender Minority Status: A Comparative, Multiple Case Study, Damon B. Cottrell

Nursing Theses and Dissertations

This work explores the healthcare and related experiences of sexual and gender minority (SGM) people. This population faces unique challenges in addressing their health needs. In the context of these challenges, the health outcomes are often poorer than those of heterosexuals. SGM subpopulations experience unique disparities making healthcare needs more complex and necessitating an understanding of SGMs’ being. Essential to addressing SGMs’ healthcare needs is the healthcare provider’s (HCP’s) knowledge of sexual and gender minority status. The first manuscript in this portfolio dissertation, Fostering Sexual and Gender Minority Status in Patients, provides an overview of the issues surrounding disclosure to …

Barriers To Integrated Primary Care And Specialty Mental Health Services: Perspectives From Latinx And Non-Latinx White Primary Care Patients, Elizabeth A. Anastasia

Graduate Theses and Dissertations

High need, low access, and rising health care costs reveal the inadequacies of the current mental health system in the U.S. Racial/ethnic minorities, including Latinxs, face substantial disparities in accessing mental health treatment compared with non-Latinx Whites. Integrated primary care (IPC) offers an alternate model for meeting mental health needs by providing care in a way that is accessible to the general population. Though it has been suggested that IPC may reduce health disparities by decreasing barriers to mental health treatment, empirical data relevant to this question are limited. A series of three studies were conducted using a mixed methodology …

Examining The History Of Racial Groups To Understand Health Disparities In Monterey County, Virginia Murillo

Capstone Projects and Master's Theses

The Monterey County Health Department’s Health Equity Scholars Academy aspires to train health workforce leaders to prioritize equity into services. Health inequities occur when there are systematic differences in the health statuses of different populations. These disparities perpetuate negative health outcomes for minority groups. In Monterey County, too few public employees are aware of the types and pervasiveness of health inequities experienced by a significant proportion of the population. A timeline was developed to provide a more accessible way to educate public employees about significant events and policies affecting Monterey County resident’s health. Content from the timeline has been incorporated …

Increasing Accessibility To Key Social Determinants Of Health In Monterey County, Tabitha Vargas

Capstone Projects and Master's Theses

Monterey County Health Department’s Planning, Evaluation, and Policy Unit provides agency-wide support in promoting health equity. Obesity and diabetes rates in Monterey County are too high and there needs to be an increase of accessible data, which may help increase targeted prevention services. A health brief was developed for the purpose of increasing access to county-wide obesity and diabetes data and increasing knowledge of the role of how social determinants of health may affect health outcomes. A survey was conducted to measure the effectiveness of the health brief with results demonstrating that 100% of respondents agreed that the brief was …

Process Improvement To Improve Quality Measures In A Rural Primary Care Clinic, Lucille Yurko Vanderwoude

Doctoral Projects

Health disparities are differences in health that increase the amount of sickness in certain parts of the population, these inequalities in health are directly influenced by social, economic and environmental status (Healthy People 2020, 2008). Individuals living in poverty, violence, or disability have less opportunity for good healthcare and often have higher rates of chronic disease. Rural geographic locations additionally fall under this category (Healthy People 2020, 2008). These disparities can result from decreased exercise, violence in living situations, and unhealthy diet choices or options (CDC, 2018). Research has shown that health disparities increase with a reduction of individual’s income …

Identification Of A Novel Single Amino Acid Substitution (V666g) Of Jak1 From A Patient With Acute Lymphoblastic Leukemia Impairs Jak3 Mediated Il-2 Signaling, Alice Hernandez Grant

Open Access Theses & Dissertations

The Janus kinase (JAK) family, notably JAK1, JAK2 and JAK3 are recognized as oncogenic drivers in high risk Acute Lymphoblastic Leukemia (ALL). The bulk of activating JAK mutations are thought to occur within functional hot-spots across Janus Homology (JH) domains. The most frequently mutated regions is the JH2 pseudo-kinase, which provides a negative regulatory role to the adjacent catalytically active JH1 kinase domain. Despite the prevalence of JAK activating mutations and a need for new therapeutic inhibitors, there is a lack of understanding in the allosteric regulation of JAK kinases. Here we sought to identify mutations involved in driving ALL …

Severe Maternal Morbidity In Michigan: An Investigation Of Health Disparities, Laura Houdeshell-Putt

Walden Dissertations and Doctoral Studies

Severe maternal morbidity (SMM) rates in Michigan have increased over the past 20 years and continue to affect racial and ethnic women disproportionately. Women experiencing health conditions that complicate pregnancy outcomes have a greater risk of having poor obstetric outcomes that result in a SMM event. To evaluate the distribution of women experiencing health conditions that complicate pregnancy and a SMM event, geographic information systems were utilized in this study. The purpose of this study was to depict trends in the prevalence of 4 health conditions and SMM among women hospitalized for obstetric delivery in Michigan from 2016–2017. The 4 …

Contaminants Of Emerging Concern: Reconsidering Our Paradigm Of Water Pollution, Jonathan Gunasti

Pomona Senior Theses

In this senior thesis, I explore contaminants of emerging concern (CECs) and endocrine disrupting compounds (EDCs) and discuss the ways in which these novel contaminants defy traditional notions of pollution. I discuss the history and “emergence” of CECs and EDCs in scientific and public spheres and outline ongoing challenges to recognizing, prioritizing, and understanding the action of these contaminants. I position EDCs within the framework of environmental injustice and health disparities and suggest that these compounds could reinforce multigenerational health inequities. Finally, I perform a pilot analysis of the EDC bisphenol A (BPA) in Mt. Baldy Creek, the Los Angeles …

Consider The Person, Thao Vu

Regis University Student Publications (comprehensive collection)

Being culturally competent means being able to understand your own personal biases to avoid behaviors that may be considered discriminatory. In healthcare, it also means treating patients with respect and providing optimal care regardless of their background. If patients lack the care that they need or are provided with less than optimal care, then health care disparities arise, increasing the inequalities that are already present within the health care system. At the center of this care are the nurses who interact with patients the most during their clinical session. Thus, it is vital for nurses to be culturally competent and …

Primary Care Physicians’ Knowledge And Perception Of The Impact Of Health Literacy On Patient Care, Lutrisha S. King

Walden Dissertations and Doctoral Studies

Until recently, many health literacy studies were completed from the patient and nurse perspective, while few focused on the physician perspective, specifically the primary care physician. The purpose of this study was to provide insight into the health literacy knowledge and education of primary care physicians and determine the association, if any, between physicians’ perceptions of patients’ limited health literacy and physicians’ use of health literacy communication techniques. The knowledge, attitudes, and practice (KAP) framework directed this study. This framework posits that knowledge informs or influences attitudes, which leads to practices. The KAP framework was employed to answer the research …