Public Health Commons^™

Action Items For Breast Cancer Awareness Month, Deanna J. Attai

Journal of Patient-Centered Research and Reviews

This special issue introduction provides a brief history of Breast Cancer Awareness Month and focuses on patient populations often omitted from annual marketing campaigns. The importance of research is emphasized as a means to improve the outcomes of people with metastatic breast cancer and male breast cancer as well as to address health care inequities related to breast cancer diagnosis and treatment.

Parental Concerns And Uptake Of Childhood Vaccines In Rural Tanzania – A Mixed Methods Study, Lavanya Vasudevan, Joy Noel Baumgartner, Sara Moses, Esther Ngadaya, Sayoki Godfrey Mfinanga, Jan Ostermann

Faculty Publications

Background

Vaccine hesitancy has been recognized as an important barrier to timely vaccinations around the world, including in sub-Saharan Africa. In Tanzania, 1 in 4 children is not fully vaccinated. The objective of this mixed methods study was to describe and contextualize parental concerns towards vaccines in Tanzania.

Methods

Between 2016 and 2017, we conducted a cross-sectional survey (n = 134) and four focus group discussions (FGDs, n = 38) with mothers of children under 2 years of age residing in Mtwara region in Southern Tanzania. The survey and FGDs assessed vaccination knowledge and concerns and barriers to timely vaccinations. …

An Evaluation Of The Coverage Of Theoretically Based Implementation Factors In Disseminated Classroom Physical Activity Programs., Hannah G. Calvert, Hannah G. Lane, Carolina M. Bejarano, Kelli Snow, Kate Hoppe, Nicole Alfonsin, Lindsey Turner, Jordan A. Carlson

Manuscripts, Articles, Book Chapters and Other Papers

Classroom-based physical activity (CBPA) is increasingly recommended as a method to support children's physical activity, health, and academic performance. Many adoption-ready programs exist to aid in the implementation of CBPA in schools; yet, implementation rates remain low. The purpose of this study was to evaluate the extent to which resources provided by adoption-ready CBPA programs addressed theory-based implementation contextual factors to support implementation. Existing CBPA programs (N = 37) were identified through Internet searches and all materials (e.g., implementation guides) provided by each program were coded for their inclusion of 51 implementation factors based on the Consolidated Framework for Implementation …

Supporting Academic Primary Care Teams Serving Refugees: A Qualitative Study, Gabrielle Waclawik Md Mph, Fabiana Kotovicz, Devin Walsh-Felz Md Mph, Savitri Tsering Mssw, Nancy Pandhi Md Mph Phd

Journal of Refugee & Global Health

Introduction: Primary care providers continue to experience significant challenges when caring for refugee patients, yet they are often refugees’ initial point of contact with the U.S. health care system. The purpose of this qualitative study is to expand our understanding of the experiences of academic primary care team members during clinical encounters with refugee patients.

Methods: This multi-perspective, qualitative study included physicians (faculty and residents), nurse practitioners, pharmacists, nurses, and medical assistants (n=10), who have been working with refugee patients for at least one year at two family medicine residency clinics and/or a community health center. Semi-structured in-person interviews were …

Covid-19 Treatment Resource Disparities And Social Disadvantage In New York City, Jason A. Douglas, Andrew M. Subica

Health Sciences and Kinesiology Faculty Articles

Black and Hispanic communities in the U.S. have endured a disproportionate burden of COVID-19-related morbidity and mortality. Racial and ethnic health disparities such as these are frequently aggravated by inequitable access to healthcare resources in disadvantaged communities. Yet, no known studies have investigated disadvantaged communities' access to COVID-19-related healthcare resources. The current study accordingly examined racial and ethnic differences in (1) April 2020 COVID-19 total and positive viral test rates across 177 New York City (NYC) ZIP Code Tabulation Areas (ZCTA); and (2) November 2019–April 2020 licensed and intensive care unit (ICU) hospital bed access across 194 NYC ZCTAs. Pairwise …

Project Soar Research Informs National Policy Change In Tanzania Expanding Access To Hiv Services For Marginalized Populations, Population Council

Research Utilization and Impact Briefs

A recent Project SOAR study evaluated community-based delivery of antiretroviral treatment to female sex workers (FSWs) in Tanzania, demonstrating the value of this approach to improve HIV care. Informed by these findings, the Government of Tanzania changed national guidance to allow for community-based HIV treatment to better meet the needs of marginalized populations, including FSWs.

Measuring Service Quality And Assessing Its Relationship To Contraceptive Discontinuation: A Prospective Cohort Study In Pakistan And Uganda, Karen T. Chang, Nirali M. Chakraborty, Amanda M. Kalamar, Waqas Hameed, Ben Bellows, Karen A. Grépin, Agha Xaher Gul, Sarah E K. Bradley, Lynn M. Atuyambe, Dominic Montagu

Community Health Sciences

Background: The quality of contraceptive counseling that women receive from their provider can influence their future contraceptive continuation. We examined (1) whether the quality of contraceptive service provision could be measured in a consistent way by using existing tools from 2 large-scale social franchises, and (2) whether facility quality measures based on these tools were consistently associated with contraceptive discontinuation.
Methods: We linked existing, routinely collected facility audit data from social franchise clinics in Pakistan and Uganda with client data. Clients were women aged 15-49 who initiated a modern, reversible contraceptive method from a sampled clinic. Consented participants completed an …

Influence Of Incentive Design And Organizational Characteristics On Wellness Participation And Health Outcomes, Jessica Grossmeier, David J. Mangen, David R. Anderson, Stefan B. Gingerich, Rebecca J. Mitchell, Mary T. Imboden, Gordon D. Kaplan, Gregg M. Gascon, Seth A. Serxner, Tony Bodak

Faculty Publications - Department of Kinesiology

Objective: To explore how changing incentive designs influence wellness participation and health outcomes.

Methods: Aggregated retrospective data were evaluated using cluster analysis to group 174 companies into incentive design types. Numerous statistical models assessed between-group differences in wellness participation, earning incentives, and over-time differences in health outcomes.

Results: Four incentive design groups based on requirements for earning incentives were identified. The groups varied in support for and participation in wellness initiatives within each company. All four design types were associated with improved low density lipoprotein (LDL)(P < 0.01), three with improved blood pressure (P < 0.001), and two with improved fasting glucose (P < 0.03). No incentive plan types were associated with improved body mass index (BMI), but designs predominantly focused on health outcomes (eg, Outcomes-Focused) exhibited a significant increase over time in BMI risk.

Conclusion: Incentive design and organizational characteristics impact population-level participation and health outcomes.

Empowering Nurses Of Minority In The Face Of Incivility And Bullying: Through The Lens Of Phenomenology, Corrine Floyd

Dissertations

Abstract

Up to 85% of nurses have reported exposure to incivility in the workplace (Hunt & Marini, 2012). The often-subtle nature of incivility toward nurses in a minority population may partially explain why it remains a problem. Healthcare organizations realize the need for civility to counter the high turnover rate, staff shortages, and low job satisfaction reported by nurses, but lack understanding of how nurses of a minority population perceive incivility and bullying. This study aimed to answer the research question how do nurses with minority representation experience incivility and bullying versus empowerment in the workplace? A descriptive phenomenological design …

The Role Of Paraprofessionals In The Mental Health Structure Of India, Amy Abraham

Senior Theses

The mental health treatment gap in India is part of a growing public health crisis, with over 95% of those in need of services never receiving them. Over 197 million Indians suffer from at least one diagnosable mental health disorder, and this number continues to grow given the treatment gap. The treatment gap is a result of four major factors: lack of government support, stigma, limited treatment facilities, and the dearth of professionals able to provide treatment. The current study aimed to analyze several factors of paraprofessional led mental health interventions including setting, treatments delivered, treatment models, and client outcomes. …

Facing Covid-19: Knowledge, Attitudes, Practices, And Challenges Of Healthcare Providers, Population Council

Reproductive Health

This research brief describes findings from the Population Council study Reproductive Healthcare in the Time of COVID-19: Perspectives of Poor Women and Service Providers from Rahim Yar Khan, Punjab with the support of the United Nations Population Fund (UNFPA). During this study, 60 health care providers that represented 60 unique health facilities in Punjab’s Rahim Yar Khan district were interviewed by telephone, to evaluate how much they know about COVID-19 symptoms, prevention, and treatment, as well as their individual attitudes, practices, and challenges during the ongoing pandemic. To assess how the situation evolved during the critical first three months of …

Poor Women's Reproductive Health And Family Planning Challenges And Needs During The Covid-19 Pandemic, Population Council

Reproductive Health

This research brief describes findings from the Population Council study Reproductive Healthcare in the Time of COVID-19: Perspectives of Poor Women and Service Providers from Rahim Yar Khan, Punjab with the support of the United Nations Population Fund (UNFPA). The study conducted 164 interviews by telephone with beneficiaries of the Benazir Income Support Programme (BISP) in Rahim Yar Khan, Pakistan, previously surveyed in 2019, to determine how much those most vulnerable to the effects of COVID-19 know about the disease and its effects, in addition to understanding the pandemic’s effects on their lives, including their mental health and well-being as …

Household And Personal Air Pollution Exposure Measurements From 120 Communities In Eight Countries: Results From The Pure-Air Study, Matthew Shupler, Perry Hystad, Aaron Birch, Daniel Miller-Lionberg, Matthew Jeronimo, Raphael E. Arku, Yen Li Chu, Rehman Khawaja, Romaina Iqbal, Khawar Kazmi

Community Health Sciences

Background: Approximately 2·8 billion people are exposed to household air pollution from cooking with polluting fuels. Few monitoring studies have systematically measured health-damaging air pollutant (ie, fine particulate matter [PM_2·5] and black carbon) concentrations from a wide range of cooking fuels across diverse populations. This multinational study aimed to assess the magnitude of kitchen concentrations and personal exposures to PM_2·5 and black carbon in rural communities with a wide range of cooking environments.
Methods: As part of the Prospective Urban and Rural Epidemiological (PURE) cohort, the PURE-AIR study was done in 120 rural communities in eight countries …

Regulation, Quality Reporting And Third-Party Certification Of Healthcare Providers, Amir Jahan Khan, Muhammad Ashar Malik

Community Health Sciences

The newly established provincial healthcare commissions in Pakistan have started certification of healthcare providers. The policy-makers perceive that without third-party certification or licencing the healthcare quality will be suboptimal in the country. This paper reviews the current literature on third-party certification and studies objectives and progress of the largest healthcare commission in Pakistan. It analyses the certification role of the Punjab Healthcare Commission and draw lessons for future regulation and strengthening of the quality reporting process. It also documents the short-term and long-term trade-off resulting from the enforcement of quality certification in the absence of appropriate alternative investment in medical …

Policies And Practices Of Shea Research Network Hospitals During The Covid-19 Pandemic., Michael S. Calderwood, Valerie M. Deloney, Deverick J. Anderson, Vincent Chi-Chung Cheng, Shruti Gohil, Jennie H. Kwon, Lona Mody, Elizabeth Monsees, Valerie M. Vaughn, Timothy L. Wiemken, Matthew J. Ziegler, Eric Lofgren

Manuscripts, Articles, Book Chapters and Other Papers

To understand hospital policies and practices as the COVID-19 pandemic accelerated, the Society for Healthcare Epidemiology of America (SHEA) conducted a survey through the SHEA Research Network (SRN). The survey assessed policies and practices around the optimization of personal protection equipment (PPE), testing, healthcare personnel policies, visitors of COVID-19 patients in relation to procedures, and types of patients. Overall, 69 individual healthcare facilities responded in the United States and internationally, for a 73% response rate.

The Correlation Between The Quality Of Work Life Against The Performance Of The Employees Of Ogan Ilir District General Hosiptal, South Sumatera In 2018, Herliyanti Yadi, Dumilah Ayuningtyas

Journal of Indonesian Health Policy and Administration

A favorable work environment will influence the quality of work life, would create quality human resources, and support the improvements in the quality of services. To discover the correlation betweem the quality of work life and the employees’ performance at Ogan Ilir District General Hospital, a study was performed in March-April 2018. The study was a cross sectional quantitative study on 315 civil servants and voluntary staff at the hospital. Univariate, bivariate, and multivariate analysis was performed using the chi-square and the double regression prediction/determinant model. We discovered that the quality of the work life at the hospital was lacking, …

Strategic Plan For The Development Of The Rs Bersalin Grha Mutiara In 2019-2023: Policy Implementation, Melsha Syarahhandi, Mieke Savitri

Journal of Indonesian Health Policy and Administration

This research discusses the Strategic Plan for the Development of the RS Bersalin Grha Mutiara in 2019-2023, using the theory of Strategic Planning to observe and evaluate external environmental opportunities and threats as well as the internal strengths and weaknesses of the hospital, to determine the right strategic plan. This study is a qualitative research using primary data, in-depth interviews with informants, observation and decision making with CDMG (Consensus Decision Making Group), and secondary data obtained from the BPS (Central Bureau of Statistics), Dinas Kesehatan Subang (District Health Office) Profile, Profile and Financial Report of RS Bersalin Grha Mutiara. From …

Economic Burden Bore By Patients And Families Because Of Stroke: Policy Assessment, Honesty Fadhilah, Vetty Yulianty Permanasari

Journal of Indonesian Health Policy and Administration

Stroke to this day is still a disease that causes a high disability. In the future, it will require a prohibitive cost so that it has an impact on the socio-economic consequences for patients and their families. The price is prohibitive so that the impact on socioeconomic implications for patients and their families. Because of that, the purpose of the study is to estimate the cause of the cost that causes an economic burden from a stroke. The method that is used is a content analysis by doing a further literature review from various sources, from journal to textbook from …

Essential Drug Management At Rsu Karsa Husada Batu: Policy Implementation, Setya Haksama

Journal of Indonesian Health Policy and Administration

Coordination in a hospital is a necessary process needed to reach the organization’s goals. One of the processes that need coordination among cross-functional units is the essential drug procurement. The essential drug in Karsa Husada Batu Public Hospital (RSU Karsa Husada Batu) was often out of stock condition in some specific kinds of drugs. The average of the essential drug out of stock between the year of 2017 until the first semester of 2018 reached 33,73%. This number was far from the ideal standard of 0% out of stock condition. This research was aimed to recommend better coordination of essential …

Race, Ethnicity, And Insurance: The Association With Opioid Use In A Pediatric Hospital Setting, Louis Ehwerhemuepha, Candice D. Donaldson, Zeev N. Kain, Vivian Luong, Michelle A. Fortier, William Feaster, Michael Weiss, Daniel Tomaszewski, Sun Yang, Michael Phan, Brooke N. Jenkins

Psychology Faculty Articles and Research

Background

This study examined the association between race/ethnicity and health insurance payer type with pediatric opioid and non-opioid ordering in an inpatient hospital setting.

Methods

Cross-sectional inpatient encounter data from June 2013 to June 2018 was retrieved from a pediatric children’s hospital in Southern California (N = 55,944), and statistical analyses were performed to determine associations with opioid ordering.

Results

There was a significant main effect of race/ethnicity on opioid and non-opioid orders. Physicians ordered significantly fewer opioid medications, but a greater number of non-opioid medications, for non-Hispanic African American children than non-Hispanic Asian, Hispanic/Latinx, and non-Hispanic White pediatric …

Information System Policy Of Web-Based Patient Safety Incident Reporting Information System At Rsj Prof Dr. Soerojo Magelang, Setyo Purnomo, Aris Puji Widodo, Yuliani Setyaningsih

Journal of Indonesian Health Policy and Administration

To provide security to their patients, healthcare providers use a system for patient safety which includes risk reporting and analysis of incidents, identification and management of risks, and the ability to learn about events that have occurred. According to the 2017 patient safety data at Prof. Dr. Soerojo Psychiatric Hospital, 7% of patient safety incidents at the hospital required a Root Cause Analysis. To aid the process, an online information system is necessary. This research was qualitative research that used the waterfall method for the information syntax. This involved planning, analysis, design, implementation, and system. From there, the data was …

Credible Practice Of Modeling And Simulation In Healthcare: Ten Rules From A Multidisciplinary Perspective, Ahmet Erdemir, Lealem Mulugeta, Joy P Ku, Andrew Drach, Marc Horner, Tina M Morrison, Grace C Y Peng, Rajanikanth Vadigepalli, William W Lytton, Jerry G Myers

Department of Pathology, Anatomy, and Cell Biology Faculty Papers

The complexities of modern biomedicine are rapidly increasing. Thus, modeling and simulation have become increasingly important as a strategy to understand and predict the trajectory of pathophysiology, disease genesis, and disease spread in support of clinical and policy decisions. In such cases, inappropriate or ill-placed trust in the model and simulation outcomes may result in negative outcomes, and hence illustrate the need to formalize the execution and communication of modeling and simulation practices. Although verification and validation have been generally accepted as significant components of a model's credibility, they cannot be assumed to equate to a holistic credible practice, which …

Operability, Usefulness, And Task-Technology Fit Of An Mhealth App For Delivering Primary Health Care Services By Community Health Workers In Underserved Areas Of Pakistan And Afghanistan: Qualitative Study, Shehla Zaidi, Abdul Momin Kazi, Atif Riaz, Ammarah Ali, Rabia Najmi Taha, Rawshan Jabeen, Umerdad Khudadad, Saleem Sayani

Community Health Sciences

Background: The recent proliferation of digital health technology in low- and middle-income countries has made it possible for community health workers (CHWs) to use mobile health (mHealth) to perform tasks such as data collection and training. Although most studies focus on the prospect of digital apps to motivate and connect CHW, only a few have captured end-user experiences with mobile-based apps. We examined the experience of frontline health workers with a move towards digitalized real-time data to record maternal and childcare services in remote areas of Afghanistan and Pakistan.
Objective: Our study aimed to explore CHW perceptions on the operability …

Ethics And Economics Of The Covid-19 Pandemic In The United States, Peter Hilsenrath, Tyrone F. Borders

Health Management and Policy Faculty Publications

The Covid-19 experience provides a natural experiment in personal and social ethics. Difficult decisions are routinely made to optimize lives and livelihoods. This commentary provides background and insight into the ethical and economic foundations underpinning dilemmas of this historic pandemic.

Artificial Intelligence–Powered Smartphone App To Facilitate Medication Adherence: Protocol For A Human Factors Design Study, Don Roosan, Jay Chok, Mazharul Karim, Anandi V. Law, Andrius Baskys, Angela Hwang, Moom Roosan

Pharmacy Faculty Articles and Research

Background: Medication Guides consisting of crucial interactions and side effects are extensive and complex. Due to the exhaustive information, patients do not retain the necessary medication information, which can result in hospitalizations and medication nonadherence. A gap exists in understanding patients’ cognition of managing complex medication information. However, advancements in technology and artificial intelligence (AI) allow us to understand patient cognitive processes to design an app to better provide important medication information to patients.

Objective: Our objective is to improve the design of an innovative AI- and human factor–based interface that supports patients’ medication information comprehension that could potentially …

Innovating The Study Of Context: Using A Qualitative Study On Subjugation And Resistance To Explore The Utility Of Foucauldian Governmentality As A Framework For Enriching Situational Analyses, Hannah Kia, Carol Strike, Daniel Grace, Lori E. Ross

The Qualitative Report

Situational analysis has, as an emerging poststructuralist approach to grounded theory, recently grown in use across a diverse range of disciplines and substantive areas. In this paper, we consider the complementarity of Foucauldian governmentality as a theoretical framework for supporting and enriching situational analyses. Our work is based on the findings of a recent study, informed by situational analysis, in which we interviewed 27 HIV-positive (n=16) and HIV-negative (n=11) gay men ages 50 and over about their health care experiences, and used these data to examine processes of subjugation and resistance reflected in their accounts. Drawing on our analytical process, …

Preterm Birth Prevention In Appalachian Kentucky: Understanding Barriers And Facilitators Related To Transvaginal Ultrasound Cervical Length Surveillance Among Prenatal Care Providers, Anna Hansen, Mairead E. Moloney, Cynthia Cockerham-Morris, Jing Li, Niraj R. Chavan

Sociology Faculty Publications

Background: Appalachian Kentucky has higher-than-average rates of preterm birth (PTB)—a health disparity associated with increased maternal and fetal/neonatal morbidity and neonatal mortality. Transvaginal ultrasound (TVU) cervical length measurement is the best predictor of PTB risk, but is underutilized in Appalachia. This study explores prenatal care providers' TVU-related knowledge and practices, and identifies barriers and facilitators, which impact the adoption of this evidence-based technology.

Materials and Methods: This study recruited providers from three Appalachian Kentucky health care sites. Prenatal care providers took part in semistructured interviews and completed brief survey scales. Questions focused on PTB knowledge, TVU-related barriers, and suggestions for …

Beyond Clinical Food Prescriptions And Mobile Markets: Parent Views On The Role Of A Healthcare Institution In Increasing Healthy Eating In Food Insecure Families., Emily Dewit, Emily Meissen-Sebelius, Robin P. Shook, Kimberly Pina, Evelyn Donis De Miranda, Michelle J. Summar, Emily A. Hurley

Manuscripts, Articles, Book Chapters and Other Papers

BACKGROUND: Children in food-insecure families face increased barriers to meeting recommendations for fruit and vegetable consumption. Hospitals and pediatric healthcare institutions have attempted to alleviate food-insecurity through various internal programs like food prescriptions, yet little evidence for these programs exist. Consistent with a patient-centered perspective, we sought to develop a comprehensive understanding of barriers to fruit and vegetable consumption and a parent-driven agenda for healthcare system action.

METHODS: We conducted six qualitative focus group discussions (four in English, two in Spanish) with 29 parents and caregivers of patients who had screened positive for food-insecurity during visits to a large pediatric …

Patient Navigation And Cancer-Related Care: Policy Solutions To Improve Access To Pennsylvania’S Complex System Of Care, Nirmal Ahuja

Harrisburg University Faculty Works

In Pennsylvania, cancer patients experience disparate cancer-related health outcomes. Patient navigation, a patient-centered evidence-based approach effectively addresses barriers to care, and reduces cancer-related disparities and burden. We performed a literature search with specific inclusion and exclusion criteria to identify literature emanating from the United States which potentially described the development, efficacy and cost effectiveness of patient navigation across the United States and in Pennsylvania. The results from this review signified that, over last two decades there has been a rapid growth in the field of patient navigation programs across the United States which includes the state of Pennsylvania. However, despite …

Hs-4100 - Global Health Issues, Jose Nanin

Open Educational Resources

This syllabus includes OER materials and college policies for a fully online course that takes a comprehensive look at global health issues. In this course, the assessment of health issues are analyzed from various perspectives including geographic, ethnic, religious, human rights, socioeconomic, social, cultural, and political influences. Students learn about global environmental causes and consequences of infectious diseases, major diseases, mental illness, natural disasters, malnutrition, drug and alcohol addiction, violence and injuries.