Promoting Maternal And Infant Health In Franklin County, Ky: A Community-Based Physical Activity And Education Intervention, Subin Kim

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

Maternal and infant health outcomes are key indicators of population health, yet persistent disparities exist in rural communities across the United States. In Kentucky, Franklin County reflects this pattern, with concerning maternal and infant health indicators despite relatively favorable socioeconomic conditions. Identified challenges include elevated rates of poor physical and mental health days, high drug overdose mortality, provider shortages, and ongoing reproductive health concerns such as tobacco use during pregnancy and increased infant mortality associated with elevated maternal body mass index.

To address these gaps, a three-pronged, community-based prenatal and postpartum physical activity and education program is proposed. The program …

A Program To Increase Prenatal And Postnatal Care Access In A Rural Kentucky County, Alyssa Thomas

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

Prenatal and postpartum health care access is necessary for positive pregnancy and postpartum outcomes. Many rural areas in the United States are facing maternity care deserts, where there are no obstetric services available in their county. Maternity care deserts typically have higher rates in maternal mortality, low-birth weight, and pre-term births. Fleming County, Kentucky is a small rural community with a population of about 15,000 that is a maternity care desert. To improve prenatal and postpartum care access in this county, this program will use a mobile health clinic and community health workers (CHWs). The mobile health clinic will operate …

Momentum For Healthy Births-Hardin County, Ky, Brittany R. Jackson

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

Maternal and infant health disparities in Hardin County, Kentucky, reflect persistent gaps in timely access to care, particularly among rural and underserved populations. Structural barriers, including transportation limitations and unmet social needs, contribute to delayed prenatal care initiation and low postpartum follow-up, increasing the risk of adverse outcomes. This capstone project proposes the MOMentum (Maternal Outreach and Monitoring for Mothers) Program, an integrated care model designed to strengthen access, improve care coordination, and enhance continuity across the prenatal and postpartum period.

The program combines a Community Health Worker (CHW)-led navigation model with enhanced postpartum care supported by telehealth services and …

Improving Prenatal And Postpartum Care Gaps In Breathitt County, Megan Deaton

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

Maternal and infant health remain a major public health issue across the United States, particularly in rural communities. Barriers such as shortages of obstetric providers, transportation challenges, and limited access to prenatal and postpartum care contribute to delayed care, low follow-up rates, and an increased risk of poor outcomes, including preterm birth and low birth weight. In response, the proposed Maternal and Infant Health Program aims to address gaps in care access through a home visiting model that provides in-home support, maternal health education, care coordination, and referrals to healthcare services, with a direct focus on Breathitt County. Expected outcomes …

Implementation Of A Reminder/Recall Messaging Program In Kentucky, Laura Schwarz

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

Childhood vaccination remains a critical public health priority, yet measles, mumps, and rubella (MMR) vaccination rates in several rural Kentucky counties fall below the 95% threshold required for herd immunity. Recent declines in coverage, compounded by socioeconomic disparities and barriers to healthcare access, place children at increased risk for vaccine-preventable diseases and outbreaks. This capstone project proposes the implementation of an evidence-based reminder/recall (R/R) text messaging intervention utilizing the Kentucky Immunization Registry (KYIR) to improve timely MMR vaccination among children aged 4–6 years before kindergarten entry.

The proposed program targets thirteen Kentucky counties with vaccination rates below 70% and documented …

Strengthening Rural Mental Health Crisis Response: Integrating Broadband Telehealth Care Across Counties Served By Kentucky River District Health Department, Mary K. Mcnabb

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

Rural communities in Eastern Kentucky face persistent barriers to timely and effective mental health crisis care, including provider shortages, transportation challenges, and limited broadband infrastructure. Counties served by the Kentucky River Health Department Wolfe, Lee, Owsley, Perry, Knott, Leslie, and Letcher experience disproportionately high behavioral health needs while relying on shared regional resources. The Broadband-Enabled Rural Crisis Stabilization Initiative (BERCSI) is a proposed public health program designed to strengthen rural mental health crisis response through integrated, technology-enabled care. Grounded in evidence-based practices, including tele-mental health and crisis stabilization models, BERCSI leverages broadband expansion to facilitate rapid assessment, coordinated care, and …

Culturally Responsive Dialectical Behavior Therapy With Chinese Sexual And Gender Minority Individuals: A Qualitative Study, Weiyi Liao M.S.

Selected Full Text Dissertations, 2011-

Professional guidelines emphasize the importance of adapting evidence-based treatments to the cultural and contextual needs of minoritized populations. Although substantial research has examined lesbian, gay, bisexual, transgender, and queer (LGBTQ+) mental health, comparatively little is known about the psychotherapy experiences of Chinese sexual and gender minority individuals or how dialectical behavior therapy (DBT) may be delivered responsively with this population. DBT is an evidence-based treatment for emotion dysregulation, self-harm, and suicidal behavior that explicitly addresses the effects of invalidating environments. Because Chinese cultural contexts and LGBTQ-related minority stress may both shape emotional expression, help-seeking, and treatment experiences, this qualitative study …

Left In The (Road) Dust: Analyzing Advanced Clean Cars Ii In California’S Disadvantaged Communities, Jj Hoffman

Pomona Senior Theses

Across the United States, air pollution disproportionately impacts minority groups. California’s Advanced Clean Cars II (ACC II) waiver was positioned to lead to significant environmental justice impacts, such as reductions in emissions and adverse health outcomes, by establishing stricter regulations for vehicle emissions and ensuring that 100 percent of new passenger vehicle sales are zero-emission by 2035. As the federal government recently nullified ACC II, pollution, and by extension health, could worsen, especially in disadvantaged communities. The thesis established several important relationships, including how disadvantaged communities experienced higher traffic, pollution, and worse health outcomes than non-disadvantaged communities. Though the results …

Integrating Perspectives Of People With Aphasia: A Holistic Approach To Community Aphasia Groups Within An Intensive Comprehensive Aphasia Program, Mckinlee A. Mihelish

Graduate Student Theses, Dissertations, & Professional Papers

Introduction: People with aphasia (PWA) experience chronic communication deficits that impact daily life. Community Aphasia Groups (CAGs) are commonly used to address these challenges and have demonstrated psychosocial and communicative benefits; however, they lack standardized structure and are implemented with variability across settings. Additionally, much of the existing research focuses on group-level outcomes rather than participant-driven priorities, limiting clinicians’ ability to tailor interventions. This study examined what PWA want from CAG participation and how these priorities may change over time.

Methods: This quantitative study investigated priority changes among PWA participating in a CAG within a summer 2025 Intensive Comprehensive Aphasia …

Initial Qualitative Inquiry Into Social Proverb Use And Acceptability, Emma K. Hinds

Graduate Student Theses, Dissertations, & Professional Papers

Currently,  1 in 36 individuals are diagnosed with autism spectrum disorder (ASD), which is characterized by social communication differences and restricted and/or repetitive behaviors. Many children with ASD also present with sensory, behavioral, and emotional differences, underscoring the need for specialized, evidence-based interventions. Social proverb is a novel intervention approach developed by Dr. Schoffer Closson that provides in-the-moment guidance by explicitly stating expected social behaviors and the rationale behind them (e.g., “We cover our coughs, so we don’t spread germs”). To date, no research has examined the use of social proverbs as an intervention strategy. The purpose of this qualitative …

The Effect Of The Affordable Care Act Medicaid Expansion On The Risk Of Hospital Closure And Adolescent Hpv Immunization In Rural Counties, Juliette Des Rosiers

Scripps Senior Theses

From 2005 to 2025, over 200 rural hospitals shut their doors, often citing increased operational costs, staffing shortages, low patient volume, regulatory barriers, financial challenges exacerbated by the COVID-19 pandemic, and uncompensated care as common contributors to the closures. Rural patients are often referred by their primary care physician to a hospital for regular immunizations, since smaller clinics have less capacity to provide immunizations due to a shortage of pediatricians and limited vaccine stock. A crucial vaccine that is not required by schools and underutilized in rural areas is that against human papillomavirus (HPV), a virus that infects cutaneous and …

Improving Maternal Health: Investigating The Early Impacts Of Medicaid Coverage Of Doulas In Oregon, Miriam Akhmetshin

Scripps Senior Theses

While the U.S. spends more per-capita than any country on healthcare, we experience the worst maternal health outcomes of high-income nations. In addition to hefty healthcare bills, an overwhelming majority of mothers experience pregnancy-related health issues that decrease productivity and utility. Thus, it is critical to research cost-effective solutions that can improve maternal health and promote equitable outcomes. Doulas are trained non-medical professionals who support mothers and families before, during and after birth. As a growing body of medical literature points to the role of doulas in decreasing costly medical interventions, insurance companies have begun covering their services. In 2014, …

Food Stamp Participation And Health Outcomes In Ca Immigrants, Esther Kang

Scripps Senior Theses

The U.S. social welfare system includes programs aiming to increase access to nutritious food to reduce nutrition insecurity. However, studies suggest that immigrants continue to face disproportionate risks of nutrition insecurity and may face barriers to enrollment due to legal status. This study, using secondary data from the 2023 California Health Interview Survey, examines the associations between food stamp participation, food insecurity, and clinical diagnosis of diabetes among adult U.S.-born, naturalized, and non-citizen adults in California. The findings suggest that those enrolled in food stamps are more likely to report food insecurity than those who are not enrolled, and that …

Effect Of Jet Lag And Nighttime Shifts On The Circadian Rhythm Of Humans, Mahd Adrees

Williams Honors College, Honors Research Projects

This project reviews the circadian rhythm and its disruption by jet lag and nighttime shifts. It discusses the effects on melatonin, sleep quality, and physiological symptoms using articles from Google Scholar. Key studies, mechanisms, and statistics will support these points. A discussion follows, comparing and contrasting the various literature sources. This review aims to raise awareness and summarize strategies to reduce jet lag and nighttime shift effects, improving wellbeing.

Ethanol And Iron Absorption Interactions Within Crayfish Invertebrate Models, James Rollman, Andrew Wissmar

Williams Honors College, Honors Research Projects

Analysis of the effects of alcohol consumption (ethyl-alcohol) on iron absorption within crayfish model. The use of tube-feeding provides a novel, more precise output, and less invasive procedure compared to the traditional approach of dissolving the target substance in tank water and measuring hemolymph changes. The project aims to determine the extent to which alcohol influences iron absorption. Ultimately, the choice of iron reflect the future potential to aid in research with genetic hemochromatosis and or Iron overload.

The Connection Between Medicaid And Obesity In Northeast Ohio, Emmie Kelley, Sophie Kheder

Williams Honors College, Honors Research Projects

Obesity is a major public health concern in the United States that is projected to increase exponentially over the next few years. Obesity is commonly associated with a lower socioeconomic status. Lower-income individuals tend to be supported by Medicaid, a federal insurance program for low-income Americans. Prior studies have shown a positive correlation between income status and obesity prevalence. Our goal was to find if there was a correlation between Medicaid patients and obesity in Northeast Ohio, to provide physicians with a set of characteristics to better combat obesity, since preventative and treatment guidelines are tailored to national trends. We …

The Effects Of Habitual Temperature And Diet On Crayfish Physiological Processes, Tyler D. Deramo, Sunny Rana, Victor Popoviciu

Williams Honors College, Honors Research Projects

We will use crayfish to test the individual and combined effects of temperature and diet to see how they impact physiological processes such as metabolism, growth rate, molting patterns, and behavioral analysis. A total of forty-eight crayfish will be used throughout the experiment, and they will be housed in separate containers. A plant-based diet (consisting of fresh kale) and an animal-based diet (consisting of dried bloodworms) will be tested alongside room temperature (~18 degrees Celsius) and a warmer habitual temperature (~24 degrees Celsius). Metabolism will be measured via O2 consumption, and growth will be measured by weighing and measuring the …

Advancing Safe Medication Administration During Pediatric Emergency Care Through Nurse Education: A Quality Improvement Project, Ciera Hunter

Master's Theses and Capstones

Background: Due to the increased complexities of pediatric medication administration, preventable errors occur at a higher rate than in general adult populations. Rural emergency departments (EDs) often see fewer pediatric patients and have less specialized support available on-site. Nurse continuing education is an evidence-based intervention to reduce medication administration errors making it vital to supporting patient safety and maintaining pediatric readiness.

Local Problem: The microsystem is a rural, critical access hospital in northern New England. In 2021, the microsystem scored 66/81 on the National Pediatric Readiness Project’s (NPRP’s) ED Assessment. In 2026, the score dropped 11 points to 55/81. Contributing …

Addressing Perception Of Nurse Burnout Through Educational Interventions On An Inpatient Hematology And Oncology Unit: A Quality Improvement Project, Kendra Flint

Master's Theses and Capstones

Introduction Nurse burnout is a growing concern in healthcare due to its negative effects on nurse well-being, staff retention, patient safety and quality of care. This quality improvement project evaluated whether a brief educational intervention could improve nurses’ confidence in recognizing and managing early signs of burnout within an inpatient hematology and oncology unit.

Methods This QI project utilized the Plan-Do-Study-Act (PDSA) framework to guide implementation and evaluation. Registered nurses completed anonymous pre- and post- intervention electronic surveys and descriptive statistics were used to compare change in self-reported confidence and burnout perception.

Intervention Participants were directed through a brief electronic …

Promoting Safe And Effective Ciwa-Ar Protocol Adherence On An Inpatient Psychiatric Unit Through An Educational Reference Poster: A Quality Improvement Project, Kenan J. Gray

Master's Theses and Capstones

Abstract

Background: Alcohol withdrawal syndrome (AWS) can progress to seizures, delirium tremens, and autonomic instability. The Clinical Institute Withdrawal Assessment for Alcohol–Revised (CIWA-Ar) supports symptom-triggered AWS management, but safe use depends on timely nursing assessment, reassessment, and documentation.

Local Problem: On an adult inpatient psychiatric unit, chart audits identified CIWA-Ar protocol adherence gaps, including missed four-hour assessments and one-hour reassessments after lorazepam.

Methods: This quality improvement project used the Plan-Do-Study-Act model. Three educational reference posters were placed in high-visibility staff areas with QR-linked access to the facility’s AWS protocol and CIWA-Ar scoring guidelines. Outcomes were evaluated using pre- and post-intervention …

Evaluating The Relationship Between Motor Symptoms And Levodopa Dosage In Parkinson’S Disease, Frank Ferrari

Master's Theses and Doctoral Dissertations

Parkinson’s disease (PD) has a clear lack of dosing guidelines or standard treatment protocols, leaving physicians to develop individualized treatment plans to handle the needs of PD patients. The long-term progressive nature of Parkinson’s requires consistent care and updates to medication regimens. This puts significant strain on the healthcare systems tasked with treating them. With an increasing number of Parkinson’s patients and a plateau of professionals to care for them, patients may soon experience decreased physician availability, longer wait times, and worse quality of life outcomes. This study evaluated the relationship between PD motor symptoms, measured through the MDS-UPDRS Part …

Improving Timely Pain Reassessments And Documentation Using Nurse Education And Visual Reminders: A Quality Improvement Project, Madison Grace

Master's Theses and Capstones

Background: Effective pain management requires nurses to complete and document an entire pain assessment cycle, including the initial assessment, intervention, and reassessment (Wolters Kluwer, paragraph 5, 2020). Timely reassessments are essential for determining whether interventions were effective or if additional actions need to be taken to improve patient pain and comfort. Despite established hospital policies and guidelines, inconsistencies in timeliness of pain reassessments and associated documentation are a common challenge faced.

Local Problem: Baseline chart audits on a 22-bed combined pediatric and adult medical-surgical unit identified opportunities to improve adherence to timely pain assessments and documentation. With only 65% percent …

Improving Staff Knowledge And Consistency In Sat And Sbt Practices In The Critical Care Unit: A Quality Improvement Initiative, Morgan Crapo

Master's Theses and Capstones

Abstract

Background: Spontaneous Awakening Trails (SATs) and Spontaneous Breathing Trials (SBTs) are key components of the ICU Liberation Bundle and have been associated with shorter durations of mechanical ventilation, reduced intensive care unit (ICU) length of stay (LOS), and improvement in patient outcomes. Despite having strong evidence supporting their use, implementation remains inconsistent due to knowledge gaps, workflow barriers and interdisciplinary communication challenges.

Local Problem: This quality improvement (QI) project aimed to improve critical care nurses’ knowledge and confidence regarding the implementation of SATs and SBTs through an evidence-based educational intervention.

Methods: Guided by the Plan-Do-Study-Act (PDSA) framework, this QI …

A Quality Improvement Project: Enhancing Nursing Knowledge And Patient Safety In The Prevention Of Hospital-Acquired Pressure Injuries (Hapis) In A Medical-Surgical Unit, Kristen Vartabedian

Master's Theses and Capstones

Background: Hospital-acquired pressure injuries (HAPIs) are a significant quality indicator within the hospital system. HAPIs increase hospitalization, morbidity, and associated healthcare costs. The current evidence suggests that ongoing nursing education can improve pressure injury prevention and help in the early identification.

Local Problem: Nurses within a medical-surgical unit demonstrated a gap in knowledge in the identification of hospital acquired pressure injuries and lack of accuracy when charting skin findings. Thus, contributing to a delay in recognition and treatment of HAPIs.

Methods: This quality improvement project utilized the Plan-Do-Study-Act (PDSA) framework to guide implementation of educational flipbooks. Materials contained standardized wound …

Implementing A Nurse Re-Education Program To Promote Timely Use Of The Jada® System In The Postpartum Hemorrhage Cascade: A Quality Improvement Project, Maegan E. Doody

Master's Theses and Capstones

Background: Postpartum hemorrhage (PPH), defined as blood loss greater than 1,000 mL after delivery, is a leading cause of maternal morbidity in the United States. Identification of risk factors and timely intervention are critical to improving maternal outcomes after delivery. First-line interventions include manual uterine massage, uterotonic medications, and antifibrinolytic medications; however, when bleeding is not well controlled, the Jada® System (Jada) is a newer vacuum-induced hemorrhage control device with a high efficacy and safety profile, particularly when implemented earlier in the hemorrhage cascade.

Local Problem: In 2025, the annual rate of PPH within the microsystem was 7.29%, …

Reducing Readmissions For Copd Through Improved Education: A Gap Analysis, Raphael Gaughan

Master's Theses and Capstones

No abstract provided.

Promoting Equitable Access To Postpartum Hemorrhage Education: A Quality Improvement Project Using Educational Interventions For Night Shift Nurses, Michelle Stella

Master's Theses and Capstones

Abstract

Background: Postpartum hemorrhage (PPH) is a serious condition that can lead to maternal morbidity or mortality following the birth of their child. It is important for nurses to be properly educated to manage this condition quickly and efficiently. Night shift nurses often face barriers to accessing educational opportunities during their shift because most education is tailored to daytime hours.

Local Problem: At the project site facility, night shift nurses perceived inconsistent access to education compared to day shift nurses. This gap highlighted the need for more flexible educational modalities to meet the needs of night shift nurses.

Methods: This …

Enhancing Patient Safety And Team Communication Via Standardized Unit Handoff Tools In Inpatient Rehabilitation, Julia Rae Before

Master's Theses and Capstones

Abstract

Background: Interdisciplinary safety huddles in healthcare are used to facilitate staff communication, voice patient safety concerns and identify high acuity patients, as well as identify current unit issues that need resolution. Using characteristics of safety huddles, revising patient report sheets to include pertinent safety information often shared during huddles may lead to an increase in staff perception of communication as well as awareness to patient safety concerns. Within an in-patient rehabilitation hospital, anonymous staff reports indicated dissatisfaction with interprofessional communication and microsystem data revealed increased events of adverse patient outcomes and safety concerns. Baseline data indicated inconsistent patient handoff …

A Patient-Centered Approach To Improving Patient And Family Education On Perioperative Processes To Reduce Anxiety: A Quality Improvement Initiative, Ashley Lauren Doherty

Master's Theses and Capstones

Background: Perioperative anxiety is common among surgical patients and their family members. Anxiety may be increased by uncertainty and limited understanding of the surgical experience. Improving perioperative education may enhance understanding, reduce anxiety, and support a more patient and family centered surgical experience.

Local Problem: A Post-Anesthesia Care Unit (PACU) identified knowledge gaps in patient and family education about the perioperative process. The existing waiting room bulletin board was outdated and provided limited information. PACU nurses observed anxiety-related behaviors and confusion among patients and family members about the perioperative process. Patient satisfaction surveys routinely collected by the hospital also demonstrated …

Enhancing Safety And Efficiency In Cardiac Admission Handoffs Through Implementation Of An I-Pass Checklist: A Quality Improvement Project, Soraia D. Barros

Master's Theses and Capstones

Abstract

Background: Effective care handoff is a necessary step for maintaining patient safety during hospitalizations. The goal of this quality improvement project was to improve the completeness of information, particularly cardiac-related, provided by the ED staff to the CSSU nurses. The implementation involved the creation of a cardiac checklist and applying it to the pre-existing I-PASS forms used during asynchronous handoff.

Local Problem: The macrosystem implemented an updated system for handoffs between the ED and CSSU by substituting an over-the-phone report with a faxed I-PASS sheet. The result, as identified by the CSSU staff, is that reports contain undetailed patient …