Medicine and Health Sciences Commons^™

Development Of Reimbursement Model Forhome-Based Chemotherapy In Thailand, Nattanichcha Kulthanachairojana

Chulalongkorn University Theses and Dissertations (Chula ETD)

The objectives of the study were (1) to review on HC reimbursement model in other countries (2) to conduct economic evaluation comparing HC with inpatient chemotherapy and hospital-based chemotherapy treatment (IP) from a societal perspective (3) to develop national models and financing and reimbursing of HC services in Thailand. Literature review and semi-structured interviews as the mixed methods had been applied for data collection. The characteristic of HC and reimbursement policies for public payer and service delivery were obtained from eight countries: Australia, Canada (Ontario), England, France, Japan, Korea, Singapore and the United States (US) (Medicare Part B). A cost-utility …

Mixture Of Medium Chain Fatty Acids For Protein Precipitation In Purification Process Of Equine Anti-Rabies Immunoglobulin As F(Ab′)2, Sirisak Sathorn

Chulalongkorn University Theses and Dissertations (Chula ETD)

Besides the widely used caprylic acid (C8) as protein precipitating agent, capric acid (C10) and lauric acid (C12) were investigated as alternative medium chain fatty acids (MCFAs) for their capabilities on protein purification. The optimization process conducted with normal bovine plasma as a model antibody demonstrated the essential effect of temperature during filtration to significantly reduce the content of albumin, a contaminant marker, compared with filtration at room temperature (p<0.05). From SDS-PAGE analysis, the optimal concentrations of 3% C8 and 5% C10 increased IgG purity from 30.2% to 94.6% and 80.4%, respectively. Interestingly, precipitation by C10 provided the lowest turbidity of filtrates. Purification by C12 showed unsatisfied results that albumin content was minutely decreased when increasing C12 concentration. C8 and C10 were then variously combined into 2 levels of 3% and 5% binary mixture for plasma purification. The synergist effect of C8 and C10 mixtures was clearly demonstrated in albumin elimination that the purity of fractionates were increased to 95%. Moreover, binary mixtures with higher concentration of C10 improved the filtration velocity in plasma model. Selected C8:C10 mixtures were then applied for both ERIG-IgG and ERIG-F(ab′)2 purification. SDS-PAGE analysis confirmed the absence of albumin protein in all purified samples. For ERIG-IgG purification, C8:C10 mixture at ratio 1.5:3.5 demonstrated the best in homogeneity with high recovery rate of bioactive antibody, while the mixtures at 2.25:0.75 showed the best purification capabilities to obtain highly purified ERIG-F(ab′)2. Furthermore, the purification by C8:C10 mixtures displayed superior process characteristic than the commercially non-chromatographic technique for ERIGF(ab′)2 purification in terms of antibody recovery, purity and lower in aggregate formation. The novelty on beneficial use of MCFA mixture as protein precipitating agent for antibody purification has been demonstrated.

Best Practice Suicide Screening/Assessment Tools For The Emergency Department, Katheryn M. Spirito

Walden Dissertations and Doctoral Studies

Patients presenting to the emergency department (ED) often suffer from more than physical ailments when seeking care and treatment. Some of these patients have emotional ailments and suicidal ideation when they come to the local ED. The lack of recognition of at-risk patients by health care providers can lead to poor patient outcomes and death. The focus of this project was to understand which valid and reliable suicide assessment tools described in the literature were considered the best evidence-based instruments to identify ED patients who were at risk for suicide. Peplau's theory of interpersonal relations guided this project. A systematic …

A Constructivist Grounded Theory Study Of Counselors' Preparedness To Counsel Refugees, Shadin Riem Atiyeh

Walden Dissertations and Doctoral Studies

A gap exists in the current literature on the training needs of professional counselors so they can meet the increasing demand for counseling services among refugee populations. The purpose of this constructivist, grounded theory study was to explore the perceptions of professional counselors related to their preparedness to demonstrate multicultural competence when counseling refugees. A constructivist grounded theory approach following Charmaz's principles guided the investigation into perceptions of professional counselors towards counseling with refugee clients. The author conducted a qualitative demographic form, individual interviews, and a focus group with professional counselors who had experience working with refugees. Sample included 21 …

Implementing A Self-Scheduling Model To Decrease Nurse Turnover In Medical-Surgical Nursing, Rebecca Fuentes

Walden Dissertations and Doctoral Studies

Nurses may experience job stress and burnout due to the amount of hours worked and demanding schedules. At one hospital, nurse turnover rates were high in medical-surgical units. Surveys and interviews conducted by hospital administration found that the bedside nurses were dissatisfied with scheduling practices and that this dissatisfaction could lead to heightened turnover. The purpose of this project was to determine if the implementation of a self-scheduling model would decrease nurse turnover on a medical-surgical nursing unit. This quality improvement project focused on facilitating the empowerment of nurses through a self-scheduling model; it followed the quality improvement steps of …

The Relationship Of Nurse Manager’S Leadership Styles In Maintaining A Just Culture, Aida Solomon

Walden Dissertations and Doctoral Studies

Healthcare leaders must establish a just culture to mitigate preventable medical deaths that occur at 250,000 per year, making medical errors the 3rd leading cause of death in the United States. However, there is a gap in knowledge regarding the attributes of nurse manager leadership styles that contribute to promoting a just culture at the unit level. Guided by the full range leadership theory and the just culture model, the purpose of this descriptive correlational study was to determine the relationship between nurse manager transformational, transactional, and laissez-faire leadership styles and unit level just culture perceptions and the differences between …

Religious Coping And Ptsd Symptom Management Among African Americans: A Clergy Perspective, Barbra Talley

Walden Dissertations and Doctoral Studies

Data indicated that although African Americans reported fewer occurrences of traumatic events than that of their racial/ethnic counterparts, however, the degree of traumatic events experienced by African Americans tends to be more serious and violent in nature. More so, lower recovery outcomes associated with PTSD among African Americans have been attributed to varying factors, such as financial restrictions, strained health care access, ineffective coping strategies as well as a mistrust of medical and clinical approaches, thus leading African Americans to seek faith-based approaches. This phenomenological study investigated clergy perspectives on religious coping constructs relative to the management of PTSD symptoms. …

Evaluation Of A Postpartum Hemorrhage Protocol, Lori M. Davies

Walden Dissertations and Doctoral Studies

Postpartum hemorrhage is a leading cause of maternal death, yet many deaths related to hemorrhage might be prevented with early recognition and intervention. The birthing unit of a U.S. community hospital formed an interprofessional task force to plan and implement a postpartum hemorrhage protocol that would provide the obstetric team with the knowledge, skills, and tools needed for early identification and quick action when hemorrhage occurred. Lewin's model of change provided a framework for protocol implementation. The purpose of this doctoral project was to evaluate this quality improvement project. Secondary data internal to the organization were collected and analyzed to …

Art Adherence And Viral Suppression Are High Among Most Non-Pregnant Individuals With Early-Stage, Asymptomatic Hiv Infection: An Observational Study From Uganda And South Africa, Jessica E. Haberer, Bosco M. Bwana, Catherine Orrell, Stephen Asiimwe, Gideon Amanyire, Nicholas Musinguzi, Mark J. Siedner, Lynn T. Matthews, Alexander Tsai, Ingrid T. Katz, Kathleen Bell, Annet Kembabazi, Stephen Mugisha, Victoria Kibirige, Anna Cross, Nicola Kelly, Bethany Hedt-Gauthie, David R. Bangsberg

OHSU-PSU School of Public Health Faculty Publications and Presentations

Introduction

The success of universal antiretroviral therapy (ART) access and aspirations for an AIDS‐free generation depend on high adherence in individuals initiating ART during early‐stage HIV infection; however, adherence may be difficult in the absence of illness and associated support.

Methods

From March 2015 to October 2017, we prospectively observed three groups initiating ART in routine care in Uganda and South Africa: men and non‐pregnant women with early‐stage HIV infection (CD4 > 350 cells/μL), pregnant women with early‐stage HIV infection and men and non‐pregnant women with late‐stage HIV infection (CD4 < 200 cells/μL). Socio‐behavioural questionnaires were administered and viral loads were performed at 0, 6 and 12 months. Adherence was monitored electronically.

Results

Adherence data were available for 869 participants: 322 (37%) early/non‐pregnant, …

Case–Control Research Study Of Auto-Brewery Syndrome, Barbara Jean Cordell, Anup Kanodia, Gregory K. Miller

Faculty Publications

Background: Auto-brewery syndrome (ABS), also known as Gut Fermentation Syndrome and Endogenous Ethanol Fermentation, is afflicting people worldwide, but little is known about ABS patients’ demographics, health history, lifestyle factors, and diet.

Method: We conducted a broad-based case–control survey study on 52 patients known to have a diagnosis of ABS and their household members. The research compares the symptomatic group (N ¼ 28) to the asymptomatic group (N ¼ 18) regarding lifestyle and health, diet, and medical history.

Results: With a response rate of 88% and using rank-sum tests, the data demonstrate that patients with ABS have …

Breaking The Paradigm: Dr Insight Empowers Signature-Free, Enhanced Drug Repurposing, Jinyan Chan, Xuan Wang, Jacob A. Turner, Nicole E. Baldwin, Jinghua Gu

Faculty Publications

Motivation: Transcriptome-based computational drug repurposing has attracted considerable interest by bringing about faster and more cost-effective drug discovery. Nevertheless, key limitations of the current drug connectivity-mapping paradigm have been long overlooked, including the lack of effective means to determine optimal query gene signatures. Results: The novel approach Dr Insight implements a frame-breaking statistical model for the ‘hand-shake’ between disease and drug data. The genome-wide screening of concordantly expressed genes (CEGs) eliminates the need for subjective selection of query signatures, added to eliciting better proxy for potential disease-specific drug targets. Extensive comparisons on simulated and real cancer datasets have validated the …

Social Norms, Misperceptions, And Mosquito Net Use: A Population‑Based, Cross‑Sectional Study In Rural Uganda, Jessica M. Perkins, Paul J. Krezanoski, Sae Takada, Bernard Kakuhikire, Vincent Batwala, Alexander Tsai, Nicholas A. Christakis, David R. Bangsberg

OHSU-PSU School of Public Health Faculty Publications and Presentations

Background: Mosquito net use is an essential part of malaria prevention. Although previous research has shown that many people sleep under a mosquito net in endemic areas, it is unknown whether people underestimate how common it is to sleep under a net every night. Furthermore, perceived social norms about whether most others sleep under a mosquito net every night may contribute to personally sleeping under a net, given decades of research showing that people often mimic others’ behaviours.

Methods: Population-based data were collected from 1669 adults across eight villages in one rural parish in southwestern Uganda. Individuals’ perception about whether …

Words Matter: Putting An End To “Unsafe” And “Risky” Sex, Julia L. Marcus, Jonathan Snowden

OHSU-PSU School of Public Health Faculty Publications and Presentations

Change is constant in sexual health, as in health care more broadly. Novel pathogens are identified, epidemics emerge and reemerge, and new preventive and therapeutic agents are introduced and taken up by populations. On the other hand, some care strategies and practices fall by the wayside among clinicians and populations. Just as health and health care evolve, so too should the language that we use to describe them.

In this commentary, we express our concerns about the use of ambiguous and stigmatizing language when describing sexual behavior. A search on PubMed in September 2019 yielded over four thousand articles with …

The Effect Of Six-Month Aerobic Exercise And Health Education Program Intervention On Body Composition To Reduce Visceral Fat And Waist Circumference Among Army Male Officers At Support Office Armed Forces Development Command: Quasi-Experimental Study, Patchamol Masakul

Chulalongkorn University Theses and Dissertations (Chula ETD)

Overweight and obesity are global pandemics consistent to the annual checkup of the army in support units from 2016 to 2018 found that the problem of continuously increasing BMI over the standard values. The six-month aerobic exercise and health education program intervention on body composition to reduce Visceral Fat and Waist Circumference among army male officer might have positive effects to help resolve this problem. To evaluate the effects of six-month aerobic exercise and health education program intervention on body composition to reduce Visceral Fat and Waist Circumference among army male officers at Support Office Armed Forces Development Command. Total …

Factors Associated With Food Choice Among High School Students In Depok, Indonesia, Syarifah Aqilah

Chulalongkorn University Theses and Dissertations (Chula ETD)

Background: Well-being in adulthood are originated from diet behaviour during adolescence. Recently, hurry-up lifestyle of adolescents leads to unusual food choice and results in overnutrition issues. So, the food choice is studied in order to improve the nutritional status of adolescents. Objectives: To explore food choice among high school students in Depok, Indonesia and identify its associated factors. Methods: A cross-sectional study, using online questionnaires through instant messaging, is conducted from April to May 2020. Food choice is observed through Food Choice Questionnaire (FCQ) and analysed using exploratory factor analysis (EFA). The questionnaires in this study were tested for validity …

Microscopic, Molecular Authentications, And Flavonoid Contents In Selected Bauhinia Species And Pharmacognostic Specifications Of Bauhinia Malabarica Leaves, Paphitchaya Thetsana

Chulalongkorn University Theses and Dissertations (Chula ETD)

There are more than 40 Bauhinia species throughout Thailand. Many pharmacologically active compounds have been reported, particularly flavonoids such as quercetin and its glycoside (quercitrin). This study aimed to characterize 20 Bauhinia species throughout Thailand using microscopic, molecular analysis as well as quercetin and quercitrin quantification. The pharmacognostic specification of B. malabarica leaf which has been used in Thai’s remedies was established. Twenty Bauhinia species leaves were collected from 3 places throughout Thailand. The lamina of fresh mature leaves were microscopically evaluated for the stomatal number, stomatal index, palisade ratio, trichome number, trichome index, and epidermal cell area. The anatomy …

Determination Of Feline Ab Blood Types In Bangkok And Vicinities By The Tube Test, Teerawee Sangkaew

Chulalongkorn University Theses and Dissertations (Chula ETD)

The most important blood group system in cats is the AB system, which is identified by the presence and absence of antibodies and the antigen on the surface of red blood cells. Blood type A, B and AB are recognized in cats worldwide. The presence of strong alloantibodies against type A in all type B cats, and those with high titer against type B in some type A cats can cause significant transfusion reactions when cats are transfused with mismatched blood. Frequencies of blood types in a cat population is essential for estimating risks of transfusion reactions. The objectives of …

The Links Between Motivational Techniques, Successful Physical Therapists, And Successful Rehab Clinics, Abigail Alyse Richmond

Senior Honors Theses

There is a strong positive correlation between a successful physical therapist (PT), their clinic, and the motivational techniques used during therapy. The PT should be prepared to sit down with each patient and set short- and long-term goals to help them accomplish what they desire through therapy. Effective communication skills, practical skills and technique, individualized care, and organizational and environmental factors are the four major aspects that define patient-therapist relationships. Patient adherence to their home exercise program (HEP) is vital to a successful rehabilitation, and therefore the PT’s goal should be to help the patient understand the importance of the …

The Motivations And Perceived Benefits Of Student Participation In Dance Marathon, Emily Nettesheim

Undergraduate Honors Thesis Collection

The Children’s Miracle Network Dance Marathon movement has attracted over one million college students nationwide and fundraised over $38 million in 2017. The objective of this study was to determine student motivations and perceptions of the benefits of participation in Dance Marathon. This was a quantitative and qualitative cross-sectional study administered using an online survey software. Undergraduate students from three different Indiana programs were invited to participate. The survey consisted of 20 questions divided into four categories: demographics, what is Dance Marathon participation, motivations, and perceived benefits from DM involvement. There were 161 respondents out of 1492 recipients for an …

Multi-Antigen Vaccination With Simultaneous Engagement Of The Ox40 Receptor Delays Malignant Mesothelioma Growth And Increases Survival In Animal Models., Peter R Hoffmann, Fukun W Hoffmann, Thomas A Premeaux, Tsuyoshi Fujita, Elisa Soprana, Maddalena Panigada, Glen M Chew, Guilhem Richard, Pooja Hindocha, Mark Menor, Vedbar S Khadka, Youping Deng, Lenny Moise, Lishomwa C Ndhlovu, Antonio Siccardi, Andrew D Weinberg, Anne S De Groot, Pietro Bertino

Articles, Abstracts, and Reports

Malignant Mesothelioma (MM) is a rare and highly aggressive cancer that develops from mesothelial cells lining the pleura and other internal cavities, and is often associated with asbestos exposure. To date, no effective treatments have been made available for this pathology. Herein, we propose a novel immunotherapeutic approach based on a unique vaccine targeting a series of antigens that we found expressed in different MM tumors, but largely undetectable in normal tissues. This vaccine, that we term p-Tvax, is comprised of a series of immunogenic peptides presented by both MHC-I and -II to generate robust immune responses. The peptides were …

Multistate Survey Of American Dog Ticks (Dermacentor Variabilis) For Rickettsia Species, Joy A. Hecht, Michelle E.J. Allerdice, Elizabeth A. Dykstra, Laura Mastel, Rebecca J. Eisen, Tammi L. Johnson, Holly D. Gaff, Andrea S. Varela-Stokes, Jerome Goddard, Benedict B. Pagac, Christopher D. Paddock, Sandor E. Karpathy

Biological Sciences Faculty Publications

Dermacentor variabilis, a common human-biting tick found throughout the eastern half and along the west coast of the United States, is a vector of multiple bacterial pathogens. Historically, D. variabilis has been considered a primary vector of Rickettsia rickettsii, the causative agent of Rocky Mountain spotted fever. A total of 883 adult D. variabilis, collected between 2012 and 2017 from various locations in 12 states across the United States, were screened for rickettsial DNA. Tick extracts were evaluated using three real-time PCR assays; an R. rickettsii-specific assay, a Rickettsia bellii-specific assay, and a Rickettsia genus-specific …

Tofacitinib Or Adalimumab Versus Placebo: Patient-Reported Outcomes From Opal Broaden-A Phase Iii Study Of Active Psoriatic Arthritis In Patients With An Inadequate Response To Conventional Synthetic Disease-Modifying Antirheumatic Drugs., Vibeke Strand, Kurt De Vlam, Jose A Covarrubias-Cobos, Philip Mease, Dafna D Gladman, Daniela Graham, Cunshan Wang, Joseph C Cappelleri, Thijs Hendrikx, Ming-Ann Hsu

Articles, Abstracts, and Reports

Objectives: Tofacitinib is an oral Janus kinase inhibitor for treatment of psoriatic arthritis (PsA). We evaluated patient-reported outcomes (PROs) in patients with PsA refractory to ≥1 conventional synthetic disease-modifying antirheumatic drug (csDMARD-IR) and tumour necrosis factor inhibitor-naïve in a 12-month, phase III randomised controlled trial (OPAL Broaden [NCT01877668]).

Methods: Patients (N=422) received tofacitinib 5 mg or 10 mg twice daily, adalimumab 40 mg subcutaneously every 2 weeks or placebo advancing to tofacitinib 5 mg or 10 mg twice daily at month 3. Least squares mean changes from baseline and percentages of patients reporting improvements ≥minimum clinically important differences (MCID); and …

Blockade Of Fibroblast Activation Protein In Combination With Radiation Treatment In Murine Models Of Pancreatic Adenocarcinoma., Andrew J Gunderson, Tomoko Yamazaki, Kayla Mccarty, Michaela Phillips, Alejandro F Alice, Shelly Bambina, Lauren Zebertavage, David Friedman, Benjamin Cottam, Pippa Newell, Michael J. Gough, Marka R Crittenden, Pieter Van Der Veken, Kristina H Young

Articles, Abstracts, and Reports

Pancreatic ductal adenocarcinoma (PDAC) is characterized by a fibrotic stroma with a poor lymphocyte infiltrate, in part driven by cancer-associated fibroblasts (CAFs). CAFs, which express fibroblast activation protein (FAP), contribute to immune escape via exclusion of anti-tumor CD8+ T cells from cancer cells, upregulation of immune checkpoint ligand expression, immunosuppressive cytokine production, and polarization of tumor infiltrating inflammatory cells. FAP is a post-proline peptidase selectively expressed during tissue remodeling and repair, such as with wound healing, and in the tumor microenvironment by cancer-associated fibroblasts. We targeted FAP function using a novel small molecule inhibitor, UAMC-1110, and mice with germline knockout …

Measurement Properties Of The Minimal Disease Activity Criteria For Psoriatic Arthritis., Laura C Coates, Vibeke Strand, Hilary Wilson, Dennis Revicki, Brad Stolshek, Ahmed Samad, James B Chung, Dafna Gladman, Philip Mease

Articles, Abstracts, and Reports

Objective: To comprehensively assess evidence on the measurement properties of the minimal disease activity (MDA) criteria, a composite measure of the state of disease activity in psoriatic arthritis (PsA).

Methods: A targeted literature review was conducted to identify studies that informed the validity and/or ability of the MDA to detect change among patients known to have experienced a change in clinical status. The search was conducted using MEDLINE and Embase databases (published as of October 2017). Pertinent articles provided by investigators and identified from select conference proceedings were also evaluated.

Results: A total of 20 publications met the inclusion criteria. …

Dnmt3a In The Hippocampal Ca1 Is Crucial In The Acquisition Of Morphine Self‐Administration In Rats, Jian-Jun Zhang, Feng-Ze Jiang, Wei Zheng, Ying Duan, Su-Bo Jin, Fang Shen, Jing Liang, Ming Li, Nan Sui

Department of Psychology: Faculty Publications

Drug‐reinforced excessive operant responding is one fundamental feature of long-lasting addiction‐like behaviors and relapse in animals. However, the transcriptional regulatory mechanisms responsible for the persistent drug‐specific (not natural rewards) operant behavior are not entirely clear. In this study, we demonstrate a key role for one of the de novo DNA methyltransferase, DNMT3a, in the acquisition of morphine self‐administration (SA) in rats. The expression of DNMT3a in the hippocampal CA1 region but not in the nucleus accumbens shell was significantly up‐regulated after 1‐ and 7‐day morphine SA (0.3 mg/kg/infusion) but not after the yoked morphine injection. On the other hand, saccharin …

Improving Lesbian, Gay, Bisexual, And Transgender Health Care Outcomes, David Agosto

Walden Dissertations and Doctoral Studies

Many lesbian, gay, bisexual, and transgender (LGBT) individuals report experiencing discrimination in their health care that leads to avoidance of regular appointments with providers. Lack of regular primary care can delay diagnoses of preventable conditions and increase patient risks for chronic disease complications. A systematic review of the literature was conducted to understand LGBT cultural competencies for nursing and other health care providers. The Cochrane Handbook for Systematic Reviews and Melnyk's levels of evidence framed this systematic literature review. Articles for inclusion were limited to those published in English between 2008 and 2018. Keywords used in the literature search included …

Culture And The Development Of Traditional Medicine In Africa, Rowland Edet, Oyedolapo Isaac Bello, Julianah Babajide

Department of Sociology: Faculty Publications

Traditional medicine has been the dominant healthcare system in Africa before westernization, civilization and colonialism. For people living in the rural areas, traditional medicine is easily available, accessible and affordable. The purpose of this paper is to examine how the cultural way of the life of Africans has contributed to the emergence and development of traditional therapeutic systems in the continent. By explaining the way Africans perceive illness and disease, this paper argues that various forms of healing were predicated on the sociocultural environment of the people. The paper therefore opts for concerted efforts in the development of traditional medicine …

An Instructional Module For Nurses To Teach Patients With Gestational Diabetes Mellitus, Josephine Onyekachi Ollawa

Walden Dissertations and Doctoral Studies

Gestational diabetes mellitus (GDM) is a carbohydrate metabolism issue during pregnancy that is dangerous for mother and the baby. GDM occurs in 1 out of 3 diabetic women in 16.2% of live births. GDM knowledge and treatment practices among nurses were found inadequate when nurses’ effectiveness in treating a disease they have a shallow knowledge about (GDM) was investigated in the local medical facility. A GDM instructional module was applied and its effectiveness in promoting nurse’s use of GDM education as a treatment strategy tested. The total concept for knowledge and care, empowerment and the social cognitive theories grounded this …

Wellness Paradigms In Predicting Stress And Burnout Among Beginning Expatriate Teachers, Kimala Proctor

Walden Dissertations and Doctoral Studies

Research indicates that the current teacher shortage is in part due to stress and burnout. A topic that has not been examined is beginning expatriate English medium teachers (EMTs) with 5 years or less of teaching experience in the United Arab Emirates and the relationship between using individualized, self-initiated wellness paradigms and stress, job burnout, and intent to leave the teaching profession. The transactional model of stress and coping, Maslach's multidimensional theory of burnout, and the health promotion model were used to evaluate the moderating effects of the EMTs' burnout and stress levels on their wellness and intent to leave. …

Meanings Of Preconception Health To Overweight Women In An Economically Depressed County, Valeria Ninette Balogh

Walden Dissertations and Doctoral Studies

The intention-behavior gap between receiving professional health information and transitioning to improved health behaviors prior to conception is not well understood. In order to improve preconception health across the board, a more integrative understanding of the problem must present itself. This study combined elements from the theory of planned behavior, self-determination theory, and the bioecological model of human development as it's foundation. Qualitative phenomenology and semistructured face-to-face interviews were used to gain a deeper understanding of the ways in which nine overweight and obese women described preconception intentions and beliefs and the bioecological experiences leading to those beliefs. Interpretation of …