Public Health Commons^™

Association Between Self-Reported Fatigue And Sarcopenia Measures Among Elderly In Selangor, Malaysia, Maria Justine, Aliff Latir, Nadhirah Noor, Angelbeth Joanny, Izzaty Iskandar, Maisarah Sakinah Amirul Faizi, Dzulhelmi Edinan

Kesmas

The association between fatigue and sarcopenia is not well understood, therefore, this study aimed to compare the sarcopenia measures among elderly with mild and severe fatigue and to determine whether fatigue severity is associated with sarcopenia measures. This was a cross-sectional study conducted on201 elderly (age = 68.45±6.30 years). The elderly was classified into either mild or severe fatigue based on the Fatigue Severity Scale (FSS), meanwhile, sarcopenia measures include SARC-F score, muscle mass (ASM/height2), calf circumference (CC), upper (handgrip) and lower limb muscle strength, as well as physical performance (gait speed). Data were analyzed using independent t-tests and logistic …

Accelerating The Provision Of Safe Water Supply In Urban And Rural Areas Of Indonesia, Sumengen Sutomo, Salord Sagala, Bebi Sutomo, Sri Winarti, Gelant Sanjaya

Kesmas

Over the past 100 years, the provision of a safe water supply to drink in Indonesia has been slowly progressed with low coverage. The majority of the population does not have access to safe water. Morbidity and mortality of water-related diseases, including diarrhea, are very high. The provision of safe water is not a technological issue but good water management that comprises content, institutional, and communication layer. This paper provided information for strategic and operational decisions to accelerate the provision of safe water services in urban and rural areas. Benchmarking good water management with the characteristics of the water supply …

A Convergent Parallel Study On Knowledge, Perceptions, And Attitudes Of Mainstream Workers During Covid-19, Farhan Alshammari, Romeo Mostoles Jr, Eddieson Pasay-An, Sultan Alshammari

Makara Journal of Health Research

Background: This study explores and assesses the knowledge, perceptions, and attitudes of mainstream workers during the COVID-19 pandemic in the Ha’il Region, Kingdom of Saudi Arabia.

Methods: Using convergent parallel mixed-methods design, 502 frontline workers were enlisted via snowball and purposive sampling. Descriptive statistics and thematic analysis were used to analyze the quantitative and qualitative data, respectively.

Results: There is a well-prepared response to COVID-19, namely, a commendable knowledge, attitude, and practices (KAP) gap documented in reliable information concerning the virus, specifically, awareness that COVID-19 can be a potentially fatal disease (100%); that droplets from infected people …

Alveolar Bone Loss Analysis On Dental Digital Radiography Image, Aulia Karina Fitriananda, Bramma Kiswanjaya, Hanna H. Bachtiar-Iskandar

Makara Journal of Health Research

Background: Periodontal disease is the second most common tooth and mouth disease in Indonesia. Moreover, radiographic examination is the most useful tool to evaluate alveolar bone loss and diagnose periodontal diseases. This study aimed to analyze radiographically the relationship between alveolar bone loss and age among patients with chronic periodontitis.

Methods: A total of 192 digital periapical images of patients aged 25–40 years were collected. Four regions were selected, including the maxillary and mandibular central incisors and maxillary and mandibular first molars. Alveolar bone loss was measured in the mesial and distal surfaces.

Results: The mean and …

Preventive Behaviors, Barriers, And Drivers Of The Covid-19 Pandemic In Malaysia: A Cross-Sectional Survey, Normaliza Ab Malik, Rusyda Helma Mohd, Nor Ba'yah Abdul Kadir

Makara Journal of Health Research

Background: Coronavirus disease 2019 (COVID-19) is a public health concern worldwide. This study aimed to assess the preventive behaviors, barriers, and drivers, including the knowledge and self-efficacy of COVID-19 in Malaysia.

Methods: A cross-sectional study was conducted during the COVID-19 outbreak by using a self-administered questionnaire. The instrument used was adopted from the World Health Organization resources. Descriptive statistics were used to describe the categorical data. Chi-square and independent t-test were performed to evaluate the associations between the variables and preventive behaviors.

Results: A total of 465 (97.3%) respondents were recorded. The mean age was 34.3 ± …

Determination Of The Nutritional Habits And Anxiety Levels In Individuals With Covid-19 In Turkey, Hatice Iskender, Eda Dokumacioglu, Osman Yalap

Makara Journal of Health Research

Background: Coronavirus disease 2019 (COVID-19), which has spread worldwide since December 2019, has infected and claimed the lives of millions of people. This study aimed to investigate the relationship between anxiety levels and nutritional habits of patients with COVID-19.

Methods: This cross-sectional study enrolled patients diagnosed with COVID-19 between February 1, 2021 and May 1, 2021. The study population included a total of 108 individuals with COVID-19 residing in Artvin, Turkey. This study used a self-administered online questionnaire, containing 40 questions from the State and Trait Anxiety Scale.

Results: The state anxiety score was 37.26, and the …

Loneliness And Health Outcomes Among Malaysian Older Adults, Siti Zuhaida Hussein, Azera Hasra Ismail, Suraya Hanim Abu Bakar

Makara Journal of Health Research

Background: Loneliness is a major social problem among the elderly all over the world.

Methods: A community-based survey was conducted among 380 community-dwelling older adults residing in Malaysia. A proportional stratified random sampling method was used to examine the relationship between health factors and loneliness. Data were collected using the short-form Social and Emotional Loneliness Scale for Adults, Geriatric Depression Scale-15, and RAND SF-20. p < 0.05 was considered to be statistically significant, and data analysis was performed using Statistical Package for the Social Sciences Statistics 26.0 for Windows.

Results: Results revealed that 32.6% of the respondents had social loneliness, 39.9% had emotional loneliness, and 9.2% had family loneliness. Bivariate analyses showed that social and emotional loneliness are significantly related to …

Prevalence And Correlates Of Frequent And Infrequent Bullying Victimization Among School Adolescents From Five Southeast Asian Countries, Karl Peltzer, Supa Pengpid

Makara Journal of Health Research

Background: Little is known about the frequency of bullying victimization (BV) among adolescents in Association of Southeast Asian Nations (ASEAN) member states. This study aims to assess the prevalence and correlates of frequent and infrequent BV among school-going adolescents in five ASEAN member states.

Methods: The cross-sectional sample of the Global School-based Student Health Survey (GSHS) of 2015 comprised 33,184 school adolescents (14.6 years mean age) from five ASEAN countries. Students completed a paper-based, self-administered questionnaire on BV in their own languages during classroom periods. Multinomial logistic regression was used to predict frequent and infrequent BV, with no …

“It’S Like 1998 Again”: Why Parents Still Refuse And Delay Vaccines, Jiana L. Ugale, Heather Spielvogle, Christine Spina, Cathryn Perreira, Ben Katz, Barbara Pahud, Phd Amanda F. Dempsey Md, Jeffrey D. Robinson Phd, Kathleen Garrett Ma, Mph Sean T. O’Leary Md, Mph Douglas J. Opel Md

Communication Faculty Publications and Presentations

We conducted a qualitative study from 2018 to 2019 to update the reasons why US parents’ refuse or delay vaccines. Four focus groups and 4 semi-structured interviews involving 33 primary care pediatric providers were conducted in Washington and Colorado. A thematic analysis was conducted to identify themes related to reasons for parental refusal or delay. Five predominant themes were identified: (1) vaccine safety, (2) relative influence of information sources, decision-makers, and timing, (3) low perceived risk of contracting vaccine-preventable disease, (4) lack of trust, and (5) religious objection. Vaccine safety was the theme mentioned most frequently by providers (N = …

A 10-Year Post-Analysis Of The Maya Health Toolkit For Medical Providers, Lorenna Garcia-Bochas

Master of Science in Integrative Biology Theses

Researchers have often overlooked America's Indigenous community when conducting health disparities research. In Central and South America, The World Bank 2015 report identifies 774 indigenous groups living today (Davis-Castro, n.d.). One of the oldest known is the Maya people. The Maya have been through various cultural struggles, from the Spanish conquistadors of the past to current anti-indigenous discrimination, violence, and rhetoric. The historical conflict and prejudice have contributed to why many Maya migrate north to the United States for a better opportunity and a more peaceful life for their families. In doing so, they face many health risks to their …

Disparities In Covid-19 Rates Among Various Demographics And Lack Of Racial Representation In Medical Texts, Diangelo Gonzalez

Celebration of Learning

The 2019 novel coronavirus (COVID-19) outbreak, which originated in Wuhan, China in December of 2019, has impacted nations all over the globe. Given the health disparities which existed within the United States prior to the COVID-19 pandemic, this pandemic continued to pose a significant challenge to the health of the public. The aims of this research study were twofold: (1) to analyze the incidence rates of COVID-19 among different racial and ethnic groups within the United States and (2) to describe the occurrence of diversity within medical texts. Overall, the COVID-19 pandemic exacerbated health disparities within the United States. Understanding …

Great (Soft) Power Competition: Us And Chinese Efforts In Global Health Engagement, Michael W. Wissemann

The US Army War College Quarterly: Parameters

Global health engagement, an underutilized strategy rooted in the strengths of soft power persuasion, can lead to more military-to-military cooperation training, help establish relationships that can be relied on when crises develop, stabilize fragile states, and deny violent extremist organizations space for recruiting and operations. Examining Chinese efforts worldwide to curry favor and influence and the challenges posed by the COVID-19 pandemic, this article shows health as a medium is a very compelling and advantageous whole-of-government approach to national security policy concerns.

Skilled Maneuvering: Evaluation Of A Young Driver Advanced Training Program, Samantha A. Slinkard-Barnum, Laura K. Gryder-Culver, Kavita Batra, Paul J. Chestovich, Deborah A. Kuhls

Department of Surgery Faculty Research

BACKGROUND: Young drivers (YDs) are disproportionately injured and killed in motor vehicle crashes throughout the United States. Nationally, YDs aged 16 to 20 years constituted nearly 9% of all traffic-related fatalities in 2018. A Nevada Advanced Driver Training (ADT) program for YDs aims to reduce YD traffic injuries and fatalities through four modules taught by professional drivers. The program modules include classroom-based didactic lessons and hands-on driving exercises intended to improve safe driving knowledge and behaviors. The overarching purpose of this study was to determine if theNevada ADT programachieved its objectives for improving safe driving knowledge and behaviors based on …

Suicide Attempts In Us Veterans With Chronic Headache Disorders: A 10-Year Retrospective Cohort Study, X. Michelle Androulakis, Siyuan Guo, Jiajia Zhang Ph.D., Jason Sico, Peter Warren, Alec Giakas, Xiaoming Li Ph.D., B Lee Peterlin, Roy Mathew, Deborah Reyes

Faculty Publications

Objectives: A large-scale retrospective analysis of veterans with chronic pain was con-ducted to examine (1) the annual incidence of suicide attempts (SA) in veterans with chronic headache and other chronic pain conditions, and (2) the risk of SA in men and women with chronic headache and chronic headache concurrent with traumatic brain injury (TBI) as compared to non-headache chronic pain.

Methods: This retrospective study (N=3,247,621) analyzed National Veterans Affair Health Administrative data of patients diagnosed with chronic head, neck, back and other chronic pain from 2000 to 2010. Multivariable Poisson regression was used to explore the relative risks of SA …

Drivers Of Food Choice Among Children And Caregivers In Post-Earthquake Nepal, Pepijn Schreinemachers, Rachana Manadhar Sherestha, Bishal Gole, Dhruba Raj Bhattarai, Puspa Lal Ghimire, Bhishm P. Subedi, Tilman Brück, Ghassan Baliki, Ishwori P. Gautam, Christine E. Blake

Faculty Publications

Food systems in many countries are experiencing a shift from traditional foods toward processed foods high in sugar, fat and salt, but low in dietary fiber and micronutrients. There is an urgent need to better understand drivers of changing food behavior, particularly for lower-income countries. This study analyzes drivers of food choice among children and parents in rural Nepal. It uses qualitative data collected through key informant interviews and focus group discussions with school children, parents and teachers. The study reveals substantial changes in food behavior during the past decade with increased consumption of rice, meat, and highly processed snack …

Focused Ethnography: Storytelling For Hispanics With Low Health Literacy And Diabetes, Virginia H. Cadenhead

Nursing Theses and Dissertations

Background: Storytelling is an intervention for health communication that has many forms, addresses varied health issues, and is suitable for low health-literate populations. Storytelling can impact knowledge, behaviors, attitudes, and health outcomes. Population Focus: Fictional storytelling has not been researched as an educational adaption in diabetes self-management for Hispanics with low health literacy. Forty-one percent of Hispanics in the United States have low health literacy, a contributing factor to poor health outcomes in chronic disease management. The Hispanic population has disproportional rates of diabetes complications. Research Question: How can short, fictional, orally presented stories be developed as culturally-adapted educational tools …

Why Do Graphic Health Warnings Fail: An Explanatory Case Study On The Persistence Of Smoking Behavior Among Male Adult Smokers In A Rural And Low-Income Setting In The Philippines, John Rafael Arda, Ashley Gabrielle Jeanjaquet, Navin John Pasia, John Dominic Mari Rafael, Danyz Samantha Rita, Kaye Bernice Siao, Jecelyn Grace Yparraguirre, Genejane Adarlo

Health Sciences Faculty Publications

Background: The Philippines enacted in 2014 Republic Act No. 10643 that mandated the printing of Graphic Health Warnings on tobacco packages. However, smoking behavior among male smokers in the country, particularly in rural and low-income areas, persists even if the Graphic Health Warnings are according to the guidelines set by the World Health Organization. Hence, this explanatory case study aims to examine why and how most male adult smokers in a rural and low-income setting in the Philippines fail to quit smoking despite the presence of Graphic Health Warnings on tobacco packages.

Methods: Forty-four male adult smokers from Barangay Urdaneta …

Community-Dwelling Older Adult Fall Prevention Improvement Project, Evan Edminster Bsn, Rn, Cfrn, Tcrn, Cen, Nhdp-Bc

Master's Projects and Capstones

Abstract

Problem: Ground-level falls among community-dwelling adults 60 years and older are significant and contribute to adverse health outcomes such as fractures, functional decline, disability, and death. Additionally, falls among community-dwelling older adults are the number one mechanism of injury seen at a Northern California Level II trauma center. Falls often lead to post-fall fear, activity restriction, and physical deconditioning, further compounding fall risk.

Context: When trauma centers provide targeted outreach and screening for unmanaged health risks such as falls, they reduce unnecessary disability and premature death in the local population. Reducing total fall victim numbers and fall recidivism also …

Guiding Change: A Multidisciplinary Framework For Interventions Addressing Systemic Racism In Healthcare, Lavette D. King

Master's Projects and Capstones

The relationship between systemic and institutional racism in the U.S., and health outcomes in people of the African Diaspora have been well documented (Bailey et al., 2017). Distrust in the healthcare system is the result of generational trauma compounded by an ongoing issue that has yet to be fully addressed (Scharff et al., 2015). For decades people of African descent have expressed concern about negative experiences with the U.S. healthcare system. Often the encounters leave them feeling, mistreated, unheard and or criminalized. These feelings result in trepidation over using the healthcare system which often further compounds health issues (Washington, 2008). …

#Selfcare On Instagram: Proactive Mental Health Has Its Moment, Collin Mullis, Luke Nguyen, Calista Pappas

PANDION: The Osprey Journal of Research and Ideas

While widely used by clinicians, self-care has recently emerged as a trending topic in mainstream and social media. Informal health and support communities have formed on social media sites such as Instagram, which hosts more than one billion monthly users and ranks as the second most popular social networking application in the United States (U.S). This study investigates how the term self-care is portrayed on Instagram. In particular, the researchers were interested in whether or not current portrayals of self-care on Instagram aligned with the health themes previously established in the clinical definitions of self-care. Using the search term #selfcare, …

Apple Cider Vinegar Weight Loss Drinks: Portrayal On Pinterest, Sydney Chamberlain, Jana Mitchell, Davis Major, Lena Elemam, Cassandra Cleland

PANDION: The Osprey Journal of Research and Ideas

Apple cider vinegar has shown great promise for weight loss in controlled lab settings, yet these claims are widely shared on social media and may not yield the same benefits. This study used directed content analysis to examine how apple cider vinegar weight loss drinks were portrayed on Pinterest, a social media website utilized to bookmark online content. Using the search terms “apple cider vinegar weight loss drinks,” researchers sampled every fifth pin to collect 200 relevant pins. A codebook was developed, pilot tested and used to code pins. Of the 200 pins, the majority of pins (66%) positively portrayed …

Adaptation Of The Agency For Healthcare Research And Quality’S ‘Hospital Survey On Patient Safety Culture’ To The Bosnia And Herzegovina Context, Šehad Draganović, Guido Offermanns, Rachel E. Davis

Faculty Publications

OBJECTIVES: Measuring staff perspectives on patient safety culture (PSC) can identify areas of concern that, if addressed, could lead to improvements in healthcare. To date, there is no validated measure to assess PSC that has been tested and adapted for use in Bosnia and Herzegovina (BiH). This research addresses the gap in the evidence through the psychometric assessment of the Agency for Healthcare Research and Quality's: 'Hospital Survey on Patient Safety Culture' (HSOPSC), to determine its suitability for the health system in BiH. SETTING: Nine hospitals. PARTICIPANTS: Healthcare professionals (n=1429); nurse (n=823), doctors (n=328), other clinical personnel (n=111), non-clinical personnel …

Water Insecurity Is Associated With Lack Of Viral Suppression And Greater Odds Of Aids-Defining Illnesses Among Adults With Hiv In Western Kenya, Jason M. Nagata, Joshua D. Miller, Craig R. Cohen, Edward A. Frongillo Jr., Elly Weke, Rachel Burger, Pauline Wekesa, Lila A. Sheira, A Rain Mocello, Phelgona Otieno, Lisa M. Butler, Elizabeth A. Bukusi, Sheri D. Weiser, Sera L. Young

Faculty Publications

Reliable access to safe and acceptable water in sufficient quantities (i.e., water security) is important for medication adherence and limiting pathogen exposure, yet prior studies have only considered the role of food security as a social determinant of HIV-related health. Therefore, the objective of this analysis was to assess the relationships between household water insecurity and HIV-related outcomes among adults living with HIV in western Kenya (N = 716). We conducted a cross-sectional analysis of baseline data from Shamba Maisha (NCT02815579), a cluster randomized controlled trial of a multisectoral agricultural and asset loan intervention. Baseline data were collected from June …

The Development And Implementation Of A Culturally Safe Survey For Measuring Knowledge, Attitudes And Values Around Fasd And Alcohol Use During Pregnancy In A Remote Australian Aboriginal Community Setting, Martyn Symons, David Tucker, Kaashifah Bruce, Annalee Stearne, Annette Kogolo, Maureen Carter, June Oscar, Glenn Pearson, James P. Fitzpatrick

Australian Indigenous HealthBulletin

Fetal Alcohol Spectrum Disorder (FASD) describes a lifelong neurodevelopmental disability caused by prenatal alcohol exposure that has a devastating impact on individuals, families and communities. The prevalence of FASD is high in some Indigenous communities around the World and the only active case ascertainment prevalence study conducted in Australia found a rate of 19.44 per 100 children in the remote Fitzroy Valley region of Western Australia. Following this study community led FASD prevention activities were implemented under the Marulu (“Worth Nurturing”) Strategy in the Fitzroy Valley.

A Knowledge, Attitudes and Practices survey was designed to assess the impact of the …

Covid-19 Disrupted Provision And Utilization Of Health And Nutrition Services In Uttar Pradesh, India: Insights From Service Providers, Household Phone Surveys, And Administrative Data, Phuong H. Nguyen, Shivani Kachwaha, Anjali Pant, Lan M. Tran, Monika Walia, Sebanti Ghosh, Praveen K. Sharma, Jessica Escobar-Alegria, Edward A. Frongillo Jr., Purnima Menon, Rasmi Avula

Faculty Publications

BACKGROUND: The coronavirus (COVID-19) pandemic may substantially affect health systems, but little primary evidence is available on disruption of health and nutrition services. OBJECTIVES: This study aimed to 1) determine the extent of disruption in provision and utilization of health and nutrition services induced by the pandemic in Uttar Pradesh, India; and 2) identify how adaptations were made to restore service provision in response to the pandemic. METHODS: We conducted longitudinal surveys with frontline workers (FLWs, n = 313) and mothers of children < 2 y old (n = 659) in December 2019 (in-person) and July 2020 (by phone). We also interviewed block-level managers and obtained administrative data. We examined changes in service provision and utilization using Wilcoxon matched-pairs signed-rank tests. RESULTS: Compared with prepandemic, service provision reduced substantially during lockdown (83-98 percentage points, pp), except for home visits and take-home rations (∼ 30%). Most FLWs (68%-90%) restored service provision in July 2020, except for immunization and hot cooked meals (< 10%). Administrative data showed similar patterns of disruption and restoration. FLW fears, increased workload, inadequate personal protective equipment (PPE), and manpower shortages challenged service provision. Key adaptations made to provide services were delivering services to beneficiary homes (∼ 40%-90%), social distancing (80%), and using PPE (40%-50%) and telephones for communication (∼ 20%). On the demand side, service utilization reduced substantially (40-80 pp) during the lockdown, but about half of mothers received home visits and food supplementation. Utilization for most services did not improve after the lockdown, bearing the challenges of limited travel (30%), nonavailability of services (26%), and fear of catching the virus when leaving the house (22%) or meeting service providers (14%). CONCLUSIONS: COVID-19 disrupted the provision and use of health and nutrition services in Uttar Pradesh, India, despite adaptations to restore services. Strengthening logistical support, capacity enhancement, performance management, and demand creation are needed to improve service provision and utilization during and post-COVID-19.

The Importance Of Explicit And Timely Knowledge Exchange Practices Stemming From Research With Indigenous Families, Elizabeth J. Cooper, S Michelle Driedger

The Qualitative Report

Ethical research practice within community-based research involves many dimensions, including a commitment to return results to participants in a timely and accessible fashion. Often, current Indigenous community-based research is driven by a partnership model; however, dissemination of findings may not always follow this approach. As a result, products may not be as useful to participants who were motivated to be involved in the research process. We conducted a seven-week workshop on three occasions with different First Nations and Metis women and girls (age 8-12) in Winnipeg, Manitoba. The workshop explored participants’ perspectives around health, safety, and family wellbeing using a …

Development Of Personas To Communicate Narrative-Based Information About The Hpv Vaccine On Twitter, Philip M Massey, Shawn C Chiang, Meredith Rose, Regan M Murray, Madeline Rockett, Elikem Togo, Ann C Klassen, Jennifer A Manganello, Amy Leader

Department of Medical Oncology Faculty Papers

Introduction: Personas are based on real-life typologies of people that can be used to create characters and messages to communicate important health information through relatable narrative storylines. Persona development is data-driven and can involve multiple phases of formative research and evaluation; however, personas are largely underutilized in digital health research. The purpose of this study was to create and document persona development to deliver narrative-focused health education for parents on Twitter with the goal of increasing uptake of HPV vaccination among adolescents. Methods: Leveraging data from a mixed-method study conducted in the U.S. with a diverse population of parents with …

Supporting Health Literacy In Adolescent Populations: Distinguishing Pedagogies For Sun Safety Education In Schools, Donna Barwood

Research outputs 2014 to 2021

Purpose: The aim of this paper is to distinguish pedagogies supporting critical health literacy development in adolescent populations. Specifically, for sun safety education in schools.

Design/methodology/approach: The paper draws on an exploratory intrinsic case study design to qualitatively examine the learning conditions that Pre-Service Teachers' (PsTs) mobilise to advance Health Literary (HL) in learning activities.

Findings: This paper presents data that shows the different ways thirty Pre-Service Teachers (PsTs) in Western Australia conceptualise HL in sun safety education for Year 7 students (12–13 years old). Examination of three consecutive lesson plans categorised learning activities (n = 444) according to HL …

Barriers To Voting And Access To Health Insurance Among Us Adults: A Cross-Sectional Study, Roman Pabayo, Sze Yan Liu, Erin Grinshteyn, Daniel M. Cook, Peter Muennig

Department of Public Health Scholarship and Creative Works

Background: Many states in the United States (US) have introduced barriers to impede voting among individuals from socio-economically disadvantaged groups. This may reduce representation thereby decreasing access to lifesaving goods, such as health insurance. Methods: We used cross-sectional data from 242,727 adults in the 50 states and District of Columbia participating in the US 2017 Behavioral Risk Factor Surveillance System (BRFSS). To quantify access to voting, the Cost of Voting Index (COVI), a global measure of barriers to voting within a state during a US election was used. Multilevel modeling was used to determine whether barriers to voting were associated …

Use Of Smartphone Technology To Promote Knowledge Of Home Safety, Bonnie L. Rogulj

Physical Therapy Collection

This brief article describes the use of smartphone panoramic 360-degree imaging technology to educate patients on home safety. By positioning "hot spots" on images of the home environment, a visual tool for patient education was created to illustrate safety hazards in the home.