Public Health Commons^™

Perceptions Of Private Medical Practitioners Towards The Nigerian National Tuberculosis Treatment Guidelines, Chijioke Pius Osakwe

Walden Dissertations and Doctoral Studies

Tuberculosis (TB) is a major public health problem in many parts of the world. Nigeria is one of the 30 countries in the world that has the highest burden of TB. Private medical practitioners in Nigeria play an important role in health care delivery. Motivating them to adhere to TB treatment guidelines in managing persons suspected of having TB or diagnosed with the disease is one of the strategies employed by the National Tuberculosis Program to Reduce the Burden of TB. Few studies were identified which used qualitative study approaches to study the perceptions of these practitioners towards the TB …

Providers' Treatment For Overweight Navy Members And The Effect On Motivating Lifestyle Changes, Misty Scheel

Walden Dissertations and Doctoral Studies

In the military, excessive weight could put members at risk for training injuries, loss of potential career opportunities, and possible discharge from military service. This could increase cost to United States' national defense through increased injuries, decreased retention due to early discharge, cost of retraining, and lifelong chronic health conditions. The purpose of the study was to determine if there was a correlation or predictive value between active duty Navy members' perception of care provided for weight management and the active duty Navy member's motivation for weight management interventions. The social capital theory served as the theoretical framework for this …

Effects Of Social Support On Health-Seeking Behaviors Among African-American Men Who Have Sex With Men, Chan Moore

Walden Dissertations and Doctoral Studies

The rate of HIV/AIDS infections among African American men who have sex with men (MSM) is alarming. There has been a challenge in reducing HIV/AIDS among the African American MSM population due to internal and external factors that affect their decision making. The theory of social support and reasoned action were applied to gain knowledge on the lived experiences and perceptions of African American MSM as related to social support and seeking health care, which can help fight the heavy impact HIV/AIDS has placed on this population. Data was collected from 14 African American men who openly identified as MSM. …

Low Health Literacy And Hpv Vaccine Uptake Of African American And Hispanic American Women, Peter Ntiamoah

Walden Dissertations and Doctoral Studies

Cervical cancer incidence in the United States has declined for the past 40 years, yet the odds of developing cervical cancer is much higher among marginalized women, particularly African American and Hispanic American women. Although preventable through vaccination against the human papillomavirus (HPV) prior to infection, uptake and completion rates of the vaccine among African American and Hispanic American women are low. The purpose of the study was to determine if a significant relationship existed between the health literacy levels of African American and Hispanic American women, ages 18-26, and the low HPV vaccination uptake. The integrated behavioral model, which …

Effects Of Patient Protection And Affordable Care Act On Behavioral Health Access, Godwin Oshegbo

Walden Dissertations and Doctoral Studies

About 50% of adults in the United States suffer from at least 1 mental health challenge in their lifetime. Annually, mental health and substance use disorders cost the United States about $800 billion, leaving individuals with unaffordable cost of care and the nation with diminished productivity and revenue. With the Essential Health Benefits and Medicaid expansion under the Patient Protection and Affordable Care Act (PPACA), healthcare resources were created to address gaps in behavioral healthcare. There is a need to understand how the healthcare law has influenced the availability of behavioral health services and access to needed care. This study …

Health Disparities Among Hispanic Americans With Type 2 Diabetes, Nelson Sitton

Walden Dissertations and Doctoral Studies

The ongoing increase in Type 2 diabetes among Hispanic Americans challenges the American public health system, particularly with health issues arising from not following appropriate health directives for the disease. This quantitative, cross-sectional, correlational study used primary data to assess the relationship between diabetes knowledge (as measured by the Diabetes Knowledge Questionnaire), health literacy level (as measured by the Short Assessment of Health Literacy-Spanish and English), education level, self-efficacy (as measured by the Diabetes Self-efficacy questionnaire), and self-reported diabetes self-care behaviors (as measured by the Summary of Diabetes Self-care Activities) among a sample of Hispanic Americans with Type 2 diabetes. …

Perceptions Of Healthcare Workers Toward Influenza Vaccination, Amos Adedokun

Walden Dissertations and Doctoral Studies

Even though influenza vaccinations were provided free to all healthcare workers in the United States, healthcare workers were not 100% compliant. The non-compliance with influenza vaccinations may expose their patients, their families, and the public at large to a high-risk source of influenza infection. This study's research questions included how registered nurses perceived influenza and influenza vaccination; registered nurses' self-reported incidents with influenza vaccination; and factors that contributed to registered nurses' non-compliance with influenza vaccination. Guided by the theory of reasoned action and the theory of planned behavior, the purpose of this qualitative study was to determine the factors that …

Using Calcaneal Heel Ultrasounds To Screen For Osteoporosis At Alaska Health Fairs, Heather Guess

Walden Dissertations and Doctoral Studies

Osteoporosis is a major health problem. The Alaska Department of Health and Social Services reports national rates of osteoporosis at 13-18% of women and 3-6% of men over age 50, but current evidence suggests that osteoporosis rates in Alaska are more equal between sexes. Known risk factors for osteoporosis that are very common among Alaskans include arthritis and low vitamin D and calcium levels. The U.S. Preventive Services Task Force (USPSTF) recommends dual-energy x-ray absorptiometry (DXA) scans of the hip and lumbar spine as the gold standard of screening for osteoporosis; however, DXA scans are expensive, not portable, and not …

Cultural And Environmental Determinants Of Dental Discoloration Among School-Aged Children In Nigeria, Ogbudu Gabriel Ada

Walden Dissertations and Doctoral Studies

Dental discoloration from fluorosis is a global public health problem. In Nigeria, 11.4% of the population is impacted by this disorder. Dental discoloration is caused by successive exposures to high fluoride concentrations during tooth development in utero and it is linked to the development of a variety of psychological and physiological problems, from dental aesthetics to a reduction in intelligence and skeletal changes. The purpose of this quantitative, cross-sectional study was to examine the cultural and environmental determinants of dental fluorosis in children in a rural community in Nigeria. A multilevel theoretical model was used to develop possible fluoride exposure …

Perceptions Of Preconception Health And Prenatal Care By Young Adult Women And Men At Risk For Unintended Pregnancies, Broderick Crawford

Walden Dissertations and Doctoral Studies

Among young adults at risk for unintended pregnancies, preconception health and prenatal care programs aimed at positive birth outcomes remain unaddressed. The purpose of this phenomenological study was to explore the lived experiences of young adults in terms of their willingness to use preconception health and prenatal care as a means for increasing both positive birth outcomes and overall health. All study participants met the following criteria: (a) young adult man or woman, (b) age 18 to 25, (c) at risk for unintended pregnancies, (d) sexually active, (e) single or in cohabiting partnerships, and (f) living in the greater Los …

Effects Of Micronutrients On The Status Of Hiv-Infected African American Women, Veronica Alicia Graham

Walden Dissertations and Doctoral Studies

Weight loss among HIV-infected African American women (AAW), results in the fall of the cluster of differentiation (CD4) cell count and an increase in the viral load. There are 48,126 HIV-infected AAW who reported weight loss within the first year. AAW who report more than 10% weight loss within the first year progress to AIDS due to a deficiency in micronutrients and poor linkage to care. The phenomenon that occurs with individuals living with HIV does not necessarily occur among individuals who have cancer, heart disease, or some other life-threatening illness, and this phenomenon indicates a direct threat to the …

Immunoglobulin Therapy And Primary Immunodeficient Patients' Health-Related Quality Of Life And Well-Being, Niedre Heckman

Walden Dissertations and Doctoral Studies

Individuals born with primary immune deficiency diseases (PIDD) have a dysfunctional immune system, and many are treated by lifelong injections of immunoglobulin therapy. Studies have shown that these patients have low health-related quality of life (HRQOL) and well-being (WB) and that these outcomes might be improved by the availability of therapy innovated according to preferences for fewer needle sticks or a shorter infusion time. Regulators at the U.S. Food and Drug Administration (FDA) have approved therapies innovated per these preferences. However, there is limited data demonstrating how these innovations impact HRQOL and WB. Using the biopsychosocial model, the purpose of …

Diabetic Adult Access To Medical Care And Race And Ethnicity In Connecticut, Natacha Bertine Jerome

Walden Dissertations and Doctoral Studies

Diabetes is among the leading causes of death in Connecticut. An approximate of 330,000 adults in Connecticut have diabetes (diagnosed and undiagnosed). Those with diabetes have almost twice the risk of premature death throughout various age groups. The purpose of this cross-sectional study was to investigate whether disparities exist in access to medical care due to race and ethnicity; among adults with diabetes in the state of Connecticut. Furthermore, this study used the Andersen's behavioral model framework. Survey data from the behavioral risk factor surveillance system (BRFSS) were also analyzed. The research study covered 3 years (2013 to 2015) of …

Community Public-Private Partnership Leadership Synergy In Tanzania, Hawa Yatera Mshana

Walden Dissertations and Doctoral Studies

Although the public-private partnership (PPP) concept in health and social health has been politically accepted as the best pathway to improving health outcomes in many developing nations, implementation lacks leadership synergy. Lack of awareness and engagement of community leaders about PPP interventions and their benefits affect accountability and ownership of health and social care interventions. The purpose of this study was to better understand factors that could promote partnership leadership synergy to enhance ownership and accountability for community health and social welfare initiatives in Tanzania. A qualitative empirical case study design was used; diffusion of innovation and the public-private integrated …

Relationships Among Vitamin D Deficiency, Metabolic Syndrome, Smoking Behavior, And Physical Activity, Ethan Pham

Walden Dissertations and Doctoral Studies

Aging increases the risk of both vitamin D deficiency and metabolic syndrome. Vitamin D deficiency and metabolic syndrome may be related, although there are mixed findings. Furthermore, literature suggests other factors such as physical fitness activity and smoking behavior are associated with Vitamin D deficiency and the development of metabolic syndrome. A number of studies have documented associations between Vitamin D levels and physical fitness activities, while other studies found correlations between Vitamin D levels, metabolic syndrome, and smoking behavior. However, no previous study has examined the links between physical fitness activity, smoking behavior, Vitamin D levels, and the risks …

Adherence To Antiretroviral Medicines Among Adolescents And Young Adults In Benue State, Nigeria, Amom Tor-Anyiin

Walden Dissertations and Doctoral Studies

Adherence to ARV medicines is essential to halt HIV progression, increase CD4 counts, decrease virologic impact, and improve quality of life for the infected people. However, sustaining good adherence among adolescents and young adults (AYA) has been a challenge caused by various problems such as distance to clinic, improved CD4 count which lead to complacency in adherence, and the nature of the environment. This was a quantitative, retrospective, correlational, cross-sectional study anchored by the transtheoretical model, which was used to understand how adherence rate among the study population was impacted by the predictive factors. Secondary data was collected from patient's …

Association Between Work-Related Safety And Work-Related Injuries Among Home Health Care Providers, Sania Mohammed Saleh Abdulkhaleq

Walden Dissertations and Doctoral Studies

Home care nurses (HCNs) have reported a high rate of exposure to work-related injuries (WRIs). Nurses are challenged by the multidimensional problems associated with home care safety. These contextual risk factors increase the physical and social health problems of health care workers and of community suffering as a whole. This quantitative, cross-sectional study was designed to examine the relationship between the organization-related factors (ORFs) and the environment-related factors (ERFs) and their influences on safety behaviors (SBs) and the WRIs of HCNs. The PRECEDE framework was used to guide the study. Self-reported data were obtained from 74 home health care (HHC) …

The Impact Of Parental Education Level, Wealth Status, And Location On Female Genital Mutilation Prevalence In Northwestern Liberia, Sando Adetunji

Walden Dissertations and Doctoral Studies

Walden University

College of Health Sciences

This is to certify that the doctoral dissertation by

Sando Adetunji

has been found to be complete and satisfactory in all respects,

and that any and all revisions required by

the review committee have been made.

Review Committee

Dr. Chinaro Kennedy, Committee Chairperson, Public Health Faculty

Dr. Adebowale Awosika-Olumo, Committee Member, Public Health Faculty

Dr. James Rohrer, University Reviewer, Public Health Faculty

Chief Academic Officer

Eric Riedel, Ph.D.

Walden University

2018

Female genital mutilation has been a public health issue in many countries. As a result, researchers across the globe have conducted numerous studies …

Knowledge, Beliefs, And Perceptions About Tuberculosis Among Haitian Immigrants And Haitian Americans Living In Miami-Dade County, Florida, Leslie Barbour

Walden Dissertations and Doctoral Studies

Tuberculosis (TB) kills 1.7 million people each year, and 1/3rd of the world's population is estimated to have latent TB. It was once the deadliest disease in the United States but is now relatively rare and, if treated properly, it is curable. Migrants from TB-endemic countries, such as Haiti, are one source of TB transmission to the US, and the prevalence of TB remains high and is increasing in Little Haiti, Florida. Data on the knowledge and perceptions of Haitian immigrants and Haitian Americans about TB is inadequate. The purpose of this qualitative research was to study the TB-related knowledge, …

Health Promoting Behaviors Of Young Adults With Chronic Lyme Disease, Patricia D. Bolivar

Walden Dissertations and Doctoral Studies

Lyme disease is the most prevalent arthropod-borne (tick) disease in North America. The disease is more prevalent in some Eastern and Central states than in Western states. The general problem is that, in southern California especially in Los Angeles County, both patients and practitioners fail to recognize the disease, resulting in misdiagnosis and delayed treatment. Consequently, the patient may develop the long-term, chronic Lyme disease (CLD). The purpose of this phenomenological study was to explore the impact of CLD on the health-promoting behaviors of ethnically diverse young adults from similar educational and socioeconomic backgrounds based on their lived experiences. The …

Factors Influencing Alzheimer's Disease Healthcare Utilization Patterns In Puerto Rico, Carlamarie Noboa

Walden Dissertations and Doctoral Studies

Alzheimer's disease (AD) is associated with substantial healthcare utilization costs, resulting in a public health priority. In this study, the relationship between the demographic characteristics of age, gender, and type of health insurance; the presence of comorbidities of older Puerto Rican residents diagnosed with AD; and their healthcare utilization patterns (i.e., medical office and emergency room visits and hospital admissions) was examined using Andersen's behavioral model. Data from the 2013 Puerto Rico Health Study was used in this retrospective cohort design study. All AD cases aged -?¥ 60 years were extracted using systematic random sampling. One-way ANOVA-WELCH, Mann-Whitney U test, …

The Impact Of Transmission Mode On Hiv/Aids Medication Adherence, Lindsey Wilde

Walden Dissertations and Doctoral Studies

Medication adherence amongst HIV/AIDS infected individuals can be challenging for many reasons. I examined whether there was an association between mode of HIV transmission, such as sexual intercourse, mother to child, or IV drug use, and medication adherence among HIV+ individuals 18 years and older living in New York City. The theoretical base for this study was the Social Ecological Systems Theory. Logistic regression analyses were conducted on field data obtained from the New York State Medicaid Agency from 2015. Results indicated that transmission mode, age, race, and poverty level all have statistically significant associations with the dependent variable of …

Association Between Genetic Ancestry And Body Mass Index Among A Cohort Of Hispanic American Children, Sahel Hazrati

Walden Dissertations and Doctoral Studies

Childhood obesity is disproportionately higher among children from Hispanic backgrounds. Ethnicity is a social and cultural construct and does not capture true ancestral heterogeneity. Hispanic Americans have a wide variety of genetic admixture proportions of European (EUR), Native American (AMR), and African (AFR) ancestry. The objective of this cross-sectional study was to assess the contribution of ancestral genetic composition to body mass index (BMI), and to evaluate the relationship of obesity risk factors to BMI among 154 2-year-old Hispanic American children. The theory of Evolutionary Developmental Biology was utilized to investigate the relationship between children's growth process and ancestral background. …

Racial And Cultural Etiology Of Body Satisfaction Among Obese, Young Adult Women, Deirdre Lynnett Moyer

Walden Dissertations and Doctoral Studies

Obesity, a public health issue in the United States, has been linked to numerous chronic diseases. A gap exists in the literature related to racial and cultural etiology of body satisfaction for obese women. The purpose of this qualitative phenomenological study was to describe the racial and cultural etiology of body satisfaction for obese Black women and White women residing in a rural area of the state of North Carolina. Social comparison theory provided the theoretical underpinning for this examination. The central research question was how do obese, young adult Black women and White women describe their perceptions about and …

Quality Of Nutrition Services For Children And Pregnant Women In Ntungamo District, Uganda, Church Tophill

Walden Dissertations and Doctoral Studies

Inadequate nutrition during infancy and early childhood seriously interferes with brain development, leading to neurological and behavioral disorders. Such effects are detrimental to children under 2 years of age. The purpose of this cross-sectional study was to better understand the quality of nutrition services offered to children and pregnant women in Ntungamo District in southwestern Uganda. The cross-sectional design facilitated comparison of different variables, using a research-question-driven approach, assessing existing secondary data from SPRING Uganda database. Stepwise, backward multiple logistic regression was used to identify the independent variables that influenced the provision of quality nutrition assessment, counseling, and support (NACS) …

Financial Strategies And Initiatives For Preventing Rural Hospital Closure, Chinue Uecker

Walden Dissertations and Doctoral Studies

In the United States, rural hospital closures increased 34% since 2015 due to financial reasons, affecting access to healthcare services in rural communities. For rural hospital leaders, improving the hospital's financial performance is a valuable strategic goal. This multiple case study was designed to explore strategies that rural hospital leaders implement to improve their hospital's financial performance in Arizona, Georgia, Illinois, Oklahoma, Pennsylvania, and the United States Virgin Islands. The strategic decision-making framework supported the study because top leaders make decisions that affect the organization's health and survival. Fifteen rural hospital leaders who maintain their hospital's financial stability provided hospital …

Parental Influence On Hiv Vertical Transmission In Kenya, Hussein Abdi Nunow

Walden Dissertations and Doctoral Studies

Mother-to-infant vertical transmission of HIV usually occurs during pregnancy, labor, delivery or breastfeeding. It is the third leading cause of transmission of HIV after sexual intercourse and blood transfusions. In 2008, 12 million women aged 15 years and above were anticipated to be living with HIV in countries within Sub-Saharan Africa. In this study, the association between parental HIV knowledge, attitudes and risk reduction practices, and HIV vertical transmission in Kenya were explored. The health belief model was used to help understand and interpret the findings. For this quantitative study, data were collected via surveys from 212 participants in 3 …

A Limited Rational Choice Theory In Local Public Health Decision Making, Lona Bryan

Walden Dissertations and Doctoral Studies

The threat and occurrence of terrorist attacks have increased in the United States since September 2011, heightening concerns for weaponized anthrax, other biological pathogens, and epidemics and pandemics. Early decisions and funding levels in local public health agencies can be the first line of defense or first point of failure; yet little is understood about how decisions are made when there are budget cuts before a biological event happens. Using Lindblom's conceptualization of limited rational choice theory, the purpose of this single case study was to understand how a local public health official made decisions after budget cuts in a …

Determinants Of Low Birth Weight In A Population-Based Sample Of Zimbabwe, Paul Nesara

Walden Dissertations and Doctoral Studies

Low birth weight (LBW) is a major public health concern globally. Despite its negative social and economic impact on the family and community at large, it has remained relatively unexplored at population level in Zimbabwe. The purpose of the study was to establish determinants of LBW using data from the 2015 Zimbabwe Demographic and Health Survey. The socioecological model was the conceptual framework for the study. A secondary analysis was conducted on 4,227 mother-infant dyads. Independent variables were duration of pregnancy, number of births within the past 5-year period, exposure to mass media, type of fuel used for cooking in …

Waterborne Disease Reduction Using Evidence-Based Microbiology Verification In Lower Nyakach, Kenya, Richard R. Blodgett

Walden Dissertations and Doctoral Studies

Waterborne diseases continue to plague the poorest people in low-income countries and are estimated to cause 4,600,000 acute incidents of diarrhea resulting in over 2,000 deaths daily. A major challenge is performing microbiology tests to monitor drinking water quality. Friends of the Old (FOTO) implemented a novel strategy using evidence-based microbiology to educate communities about the relationship between contaminated water and disease. Two commercially available tests for E.coli, adapted for fieldwork, provided easily interpreted results of contamination that correlate with WHO's disease risk categories. Simple and effective household water treatment options 'solar pasteurization and/or chlorination' were provided to all 14,400 …