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Community Health and Preventive Medicine Commons™
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Articles 421 - 450 of 622
Full-Text Articles in Community Health and Preventive Medicine
Paediatric Tuberculosis In Bhopal, Madhya Pradesh, India: Dots, Diagnosis, And Determinants, Emma Klein
Paediatric Tuberculosis In Bhopal, Madhya Pradesh, India: Dots, Diagnosis, And Determinants, Emma Klein
Independent Study Project (ISP) Collection
Tuberculosis (TB) is one of the world’s largest public health challenges, and it has a disproportionate impact on India. In children, TB is a serious but understudied illness due to the complexity of case-notification and relative lack of public health importance. This study took place over the course of one month in Bhopal, Madhya Pradesh, India. In a mixed method study consisting of 53 quantitative patient interviews and qualitative interviews with healthcare providers, social determinants of TB in this setting were investigated as well as challenges faced at all stages of healthcare delivery. Malnutrition and housing were the most severe …
Colorectal Cancer Prevention: Perspectives Of Key Players From Social Networks In A Low-Income Rural Us Region, Nancy E. Schoenberg, Kathryn Eddens, Adam Jonas, Claire Snell-Rood, Christina R. Studts, Benjamin Broder-Oldach, Mira L. Katz
Colorectal Cancer Prevention: Perspectives Of Key Players From Social Networks In A Low-Income Rural Us Region, Nancy E. Schoenberg, Kathryn Eddens, Adam Jonas, Claire Snell-Rood, Christina R. Studts, Benjamin Broder-Oldach, Mira L. Katz
Behavioral Science Faculty Publications
Social networks influence health behavior and health status. Within social networks, “key players” often influence those around them, particularly in traditionally underserved areas like the Appalachian region in the USA. From a total sample of 787 Appalachian residents, we identified and interviewed 10 key players in complex networks, asking them what comprises a key player, their role in their network and community, and ideas to overcome and increase colorectal cancer (CRC) screening. Key players emphasized their communication skills, resourcefulness, and special occupational and educational status in the community. Barriers to CRC screening included negative perceptions of the colonoscopy screening procedure, …
Evidence For The Role Of Resource-Sharing Networks In Coalition Development, Margaret Mcgladrey, Angela Carman Drph
Evidence For The Role Of Resource-Sharing Networks In Coalition Development, Margaret Mcgladrey, Angela Carman Drph
Frontiers in Public Health Services and Systems Research
Background: Accreditation bodies and sponsors of community health projects increasingly require the use of health coalitions in community health planning efforts to ensure buy-in, leverage resources, and distribute health information. Despite a substantive body of research documenting the characteristics of successful health coalitions, little is known about how team dynamics in these coalitions evolve.
Purpose: The goal of this study was to employ social network analysis techniques to evaluate whether coalitions’ relative stages in Tuckman’s stages of team development model were associated with specific patterns of advice-, information-, and resource-sharing among the eight coalitions participating in a region-wide …
We Have The Tools To End Hiv: Benefits, Barriers, And Solutions To Expanded Utilization Of Pre-Exposure Prophylaxis (Prep) In The Us Deep South, Jason Ervin, Allison Weller Tikare, Carolyn Mcallaster
We Have The Tools To End Hiv: Benefits, Barriers, And Solutions To Expanded Utilization Of Pre-Exposure Prophylaxis (Prep) In The Us Deep South, Jason Ervin, Allison Weller Tikare, Carolyn Mcallaster
Faculty Scholarship
No abstract provided.
Experiences Of Victimization And Health Care Access Among Non-Metropolitan Lgbtq+ Individuals, Ashley-Ann Marcotte
Experiences Of Victimization And Health Care Access Among Non-Metropolitan Lgbtq+ Individuals, Ashley-Ann Marcotte
Theses and Dissertations (Comprehensive)
Lesbian, gay, bisexual, trans, and queer (LGBTQ+) individuals report substantial rates of violence, discrimination, and negative life events due to homophobia and transphobia and these experiences impact access to health care services and programs (Bauer et al, 2009; Grant, Mottet, Tanis, Harrison, & Keisling, 2010) These experiences result in LGBTQ+ communities needing services, programs, and social supports to provide safer spaces. Although it is well recognized that health care services are not a major determinant of health outcomes and yet use more than 60% of health spending (Canadian Institute for Health Information, 2014; Muzyka, Hodgson, & Prada, 2012). As such, …
Creating A Community Of Practice To Prevent Suicide Through Multiple Channels: Describing The Theoretical Foundations And Structured Learning Of Pc Cares, Lisa Wexler, Diane Mceachern, Gloria Difulvio, Cristine Smith, Louis F. Graham, Kirk Dombrowski
Creating A Community Of Practice To Prevent Suicide Through Multiple Channels: Describing The Theoretical Foundations And Structured Learning Of Pc Cares, Lisa Wexler, Diane Mceachern, Gloria Difulvio, Cristine Smith, Louis F. Graham, Kirk Dombrowski
Department of Sociology: Faculty Publications
It is critical to develop practical, effective, ecological, and decolonizing approaches to indigenous suicide prevention and health promotion for the North American communities. The youth suicide rates in predominantly indigenous small, rural, and remote Northern communities are unacceptably high. This health disparity, however, is fairly recent, occurring over the last 50 to 100 years as communities experienced forced social, economic, and political change and intergenerational trauma. These conditions increase suicide risk and can reduce people’s access to shared protective factors and processes. In this context, it is imperative that suicide prevention includes—at its heart— decolonization, while also utilizing the “best …
The Disease Burden And The Extent Of Drug Therapy Problems In An Underserved Minority Population Receiving Medication Therapy Management At An Ambulatory Care Free Clinic, D. N. Ombengi, F. A. Ndemo, Ayman M. Noreddin, W. T. Harris
The Disease Burden And The Extent Of Drug Therapy Problems In An Underserved Minority Population Receiving Medication Therapy Management At An Ambulatory Care Free Clinic, D. N. Ombengi, F. A. Ndemo, Ayman M. Noreddin, W. T. Harris
Pharmacy Faculty Articles and Research
Objective: To determine the common medical conditions, medications, and associated drug therapy problems in an underserved minority population receiving medication therapy management services at a large Community Free Clinic compared to the findings of the Minnesota Pharmaceutical Care Project.
Methods: Retrospective cohort study of a random sample of 60 minority patients referred for medication therapy management service at a Community Free Clinic from January 2012 to January 2014. Patient data including demographics, medication experience, past medical and medication history, medical conditions, active medications, allergies, immunization history and drug therapy was systematically evaluated to determine the most common conditions, …
Using A New Evidence-Based Health Workforce Innovation Research Framework To Compare Innovations In Community Health Center And Other Ambulatory Care Settings, Leah E. Masselink, Patricia Pittman, Claire Houterman
Using A New Evidence-Based Health Workforce Innovation Research Framework To Compare Innovations In Community Health Center And Other Ambulatory Care Settings, Leah E. Masselink, Patricia Pittman, Claire Houterman
Health Workforce Research Center Publications
In the United States, changing demographics, rising costs, and the impact of new regulations and payment models arising from the Affordable Care Act have placed unprecedented pressures on healthcare providers to increase access to care, improve quality and to control costs. To meet these challenges, some providers are forming accountable care organizations (ACOs) while others are pursuing medical homes or other novel payment and care delivery models designed to help meet these challenges. Within established organizations such as federally funded community health centers (CHCs), healthcare leaders are exercising significant latitude in developing innovative solutions for meeting their patients’ needs more …
Goddesses Versus Gynecologists: An Analysis Of The History Of Women’S Healthcare, Marion A. Mckenzie
Goddesses Versus Gynecologists: An Analysis Of The History Of Women’S Healthcare, Marion A. Mckenzie
Student Publications
Starting from the downfall of Goddess cultures in Europe, women's health care has been negatively impacted for generations. The rise of the white, male Indo-European "dominator model" along with the witch craze, caused the end of widespread wise women traditions and pharmacopeia methods. After women's traditional voice was silenced, medical colleges were established to pronounce new, "professional" knowledge. Only those who attended these universities were allowed to legally practice medicine; however, during this time, medical research and treatments for women primarily included mutilation and painful, nonsensical regimens. The horrifying state of women's healthcare has since improved, but was originally a …
Exploring Community Health Through The Lens Of The Community Unit In Kariobangi North And The Surrounding Areas, Maya Paris-Saper
Exploring Community Health Through The Lens Of The Community Unit In Kariobangi North And The Surrounding Areas, Maya Paris-Saper
Independent Study Project (ISP) Collection
Healthcare is a challenge in countries of the Global South. Not only do climates and trends of rapid urbanization affect the health status of many negatively, but also many health facilities are inaccessible and not of good quality, they lack enough medical personnel and lack the resources to adequately provide for patients who do not have the resources them selves. As the wealth gap increases all over the world and resources continue to be distributed unequally communicable and non-communicable health issues plague those in urban and rural settings at an alarmingly high rate and as health innovation has worked to …
Think Inside The Blocks: Health Literacy Outreach To Disadvantaged People In Their Own Environment, Nancy Patterson
Think Inside The Blocks: Health Literacy Outreach To Disadvantaged People In Their Own Environment, Nancy Patterson
Georgia International Conference on Information Literacy
This bilingual (Spanish/English) poster highlights six creative health literacy outreach projects that have proven to be successful in increasing participation in health-related events in their communities and in boosting health literacy in the process.
For example, in Georgetown, South Carolina, a beauty salon owner, concerned about her clients’ frequent frustration with trying to decipher medical information, partners with her local public library and is grant funded to provide a Wellness Workstation in her salon. Years later, her clients research health information between services using the workstation, evening health literacy classes are regularly conducted for community members and continued funding has …
Socially Constructing Drug Addicts From The Poor: A Critical Discourse Analysis, Kalynn Susan Amundson
Socially Constructing Drug Addicts From The Poor: A Critical Discourse Analysis, Kalynn Susan Amundson
Graduate Theses and Dissertations
Welfare drug testing was authorized by the Personal Responsibility and Work Opportunity Reconciliation Act (PRWORA) of 1996, and has subsequently garnered extensive legislative interest in numerous states. This policy raises several questions, which are the subjects of the two journal articles and one manuscript included in this dissertation.
The first article addresses the question of a possible confluence of War on Drugs and Welfare Reform policies as evidenced through welfare drug testing policy, and indicated by continuity in policymakers’ rhetoric. This study examines federal-level policymakers’ debate discourse in these two policy streams. The analysis finds themes of the Social pathology, …
Associations Between Family Functioning And Adolescent Health Behaviors, Megan S. Fleming
Associations Between Family Functioning And Adolescent Health Behaviors, Megan S. Fleming
Senior Honors Projects
Background: The obesity epidemic has been a concern across the globe, affecting about 20% of adolescents in the U.S. Physical activity and nutrition-related behaviors that develop during adolescence carry through into adulthood. Adolescents’ perceptions of how their family functions may be associated with health behaviors, including physical activity and diet.
Objective: To determine whether there is an association between perceived family functioning and adolescent health behaviors among a national sample of adolescents aged 11 to 16 who participated in the 2009-2010 Health Behaviors of School-Aged Children survey.
Methods: Participants reported on demographics and measures of family function, which included …
Puerto Rican Mother-Child Communication About Sexuality And Sexual Health: Results From An Ethnographic Community Survey In Springfield, Ma, María Idalí Torres, Phillip Granberry, Sarah Rustan
Puerto Rican Mother-Child Communication About Sexuality And Sexual Health: Results From An Ethnographic Community Survey In Springfield, Ma, María Idalí Torres, Phillip Granberry, Sarah Rustan
Gastón Institute Publications
This bilingual report presents data from an ethnographic survey on the experiences of Spanish-speaking Puerto Rican mothers communicating with children ages 10 to 19 regarding sexuality and sexual health. Results of this survey will be used as baseline data to evaluate a media campaign promoting Puerto Rican mother-child communication. This Spanish media campaign was implemented from March to May, 2015 using public service announcements in television, radio, and newspapers and on public transportation.
In this report, we use three main concepts with specific definitions: mother, sexuality, and sexual health protection, defined as follows. Mother is defined as the female adult …
Chronic Physical Health Conditions Among Homeless, Nooshin Nikoo, Marjan Motamed, Mohammad Ali Nikoo, Verena Strehlau, Erika Neilson, Sahoo Saddicha, Michael Krausz
Chronic Physical Health Conditions Among Homeless, Nooshin Nikoo, Marjan Motamed, Mohammad Ali Nikoo, Verena Strehlau, Erika Neilson, Sahoo Saddicha, Michael Krausz
Journal of Health Disparities Research and Practice
ABSTRACT
Objective: Morbidity and mortality among homeless individuals is higher than the general population. This study aims to determine the prevalence of current self-reported, chronic physical health conditions in a large sample of homeless people with sub-samples from shelters and street in British Columbia, Canada. Methods: Cross-sectional survey applying modified version of the ‘National Survey of Homeless Assistance Providers and Clients (NSHAPC)’ questionnaire in multiple sites in Vancouver, Victoria and Prince George, British Columbia, Canada. Sample: Five hundred homeless individuals were surveyed between May and September of 2009. A person was defined as homeless if he/she had a …
The Impact Of Vaccine Hesitancy On The Polio Vaccine In South Asia, Leah Everist
The Impact Of Vaccine Hesitancy On The Polio Vaccine In South Asia, Leah Everist
Independent Study Project (ISP) Collection
A disease that paralyzes hundreds of children each year, polio is incurable but also entirely preventable through vaccination. Though part of the reason some children are not reached for immunization is that they are in areas too volatile for healthcare workers to access, vaccine hesitancy is increasingly being recognized as an important player. The objective of this study is to ascertain the degree to which vaccine hesitancy affects polio vaccine campaigns in Afghanistan and Pakistan, the countries in South Asia where polio continues to be endemic, to assess the drivers behind hesitancy in this region, and to present recommendations for …
Permanence And Picnic Tables Perceptions Of Maji Safi Group’S Disease Prevention Center At Shirati Kmt District Designated Hospital, Sarah Muskin
Independent Study Project (ISP) Collection
This study conducted in Shirati village in the Rorya District of the Mara Region of Tanzania analyzed perspectives on the effectiveness of Maji Safi Group’s Disease Prevention Center at Shirati KMT District Designated Hospital. It took place from April 9th- 24th 2015. The sample frame was those affiliated with or using the Disease Prevention Centers resources. The sample populations were medical professional employed at Shirati Hospital (n = 15), Community Health Workers (n = 11) (CHWs) working for Maji Safi Group, and visitors (n = 113) to the Disease Prevention Center. This study utilized three main methods for data collection: …
Herbs, Home Medicine, And Self-Reliance: A Study On The Current Status Of Traditional Home Medicine In Idukki District, Kerala, Richard Gaunt
Herbs, Home Medicine, And Self-Reliance: A Study On The Current Status Of Traditional Home Medicine In Idukki District, Kerala, Richard Gaunt
Independent Study Project (ISP) Collection
Home medical knowledge, or knowledge of how one’s surroundings can be used to maintain and restore health, can be an important tool for health self-sufficiency in rural places as well as for the ecological conservation of important plants and natural materials. The Indian state of Kerala has a rich heritage of traditional medicine, found in the historically inter-related forms of codified Ayurveda and folk knowledge. In Idukki district, a region of Kerala nestled in the hills of the Western Ghats, rural households engage in small-scale home-gardening and agroforestry, which in addition to providing nutritionally diverse food is a source of …
Are There Gender Differences In Perceived Sexual Self-Efficacy Among African-American Adolescents?, Michelle L. Redmond, Rhonda K. Lewis
Are There Gender Differences In Perceived Sexual Self-Efficacy Among African-American Adolescents?, Michelle L. Redmond, Rhonda K. Lewis
Journal of Health Disparities Research and Practice
Background: African American adolescents accounted for more than half of all HIV/AIDS cases in 2009. Behavioral Strategies are needed to help lessen the incidence of HIV/AIDS among this population.
Purpose: The aim of his study was to examine sexual self-efficacy practices and beliefs among African American adolescents. We also examined gender differences between African American adolescents to better understand their perceptions of sexual self-efficacy, condom use intention, and other safer sex practices and beliefs.
Methods: A cross-sectional study was conducted with 214 African American adolescents using survey instruments to examine their beliefs, perception and intentions on the use of condoms, …
Introducing Antiretroviral (Arv)-Based Prevention Products For Women: A Guide To Strategic Decisionmaking And Planning, Population Council
Introducing Antiretroviral (Arv)-Based Prevention Products For Women: A Guide To Strategic Decisionmaking And Planning, Population Council
HIV and AIDS
As evidence mounts that antiretrovirals (ARVs) are effective for HIV prevention, policymakers and program managers will need to determine whether and how best to introduce specific products into health care systems. Determining the most appropriate users within a particular country will depend on the overall context, the nature of the HIV epidemic within the country, and the opportunities available to reach and serve HIV-negative women with ARV-based prevention products and services. This toolkit was developed by the Population Council for use by governments, organizations, and donors who are in a position to support or add new HIV-prevention products into programs. …
Burundi Program Implementation Workshop, 3–5 June 2014: Link Up Meeting Report, Population Council, Alliance Burundaise Contre Le Sida
Burundi Program Implementation Workshop, 3–5 June 2014: Link Up Meeting Report, Population Council, Alliance Burundaise Contre Le Sida
HIV and AIDS
Link Up is a global consortium of international and local nongovernmental organizations led by the International HIV/AIDS Alliance. Link Up aimed to improve the sexual and reproductive health and rights of young people in Bangladesh, Burundi, Ethiopia, Myanmar, and Uganda who are living with HIV or are affected by the HIV pandemic. At a workshop held in Burundi, 3–5 June 2014, the Population Council, Alliance Burundaise contre le SIDA, and local partners in Burundi identified successful activities, highlighted important challenges and best practices, and found innovative ways to improve Link Up programming. This document contains a selection of the most …
Adhd Versus Ptsd In Preschool-Aged Children: Implications For Misdiagnosis, Klaudette D. Stewart
Adhd Versus Ptsd In Preschool-Aged Children: Implications For Misdiagnosis, Klaudette D. Stewart
PCOM Psychology Dissertations
Attention Deficit Hyperactivity Disorder (ADHD) has been one of the most diagnosed disorders in children since it was included in the Diagnostic and Statistical Manual of Mental Disorders−III (DSM−III) in 1980. The number of children who have been diagnosed since that time has grown significantly, raising concerns about the overwhelming number of young children being diagnosed and prescribed medication. According to the literature, young children are diagnosed at a higher rate by pediatric primary care physicians (PCPs) than clinical child psychologists (CCPs) because they are taken to a PCP’s office by a parent, rather than referred from a school environment, …
Sexual Behaviors And Biomarkers: Baseline Findings, Population Council
Sexual Behaviors And Biomarkers: Baseline Findings, Population Council
Poverty, Gender, and Youth
The Adolescent Girls Empowerment Program (AGEP) is a program for girls ages 10–19 in rural and urban Zambia that aims to find the best ways to improve their social, health, and economic resources. More than 10,000 girls participated in weekly girls’ group meetings, received health vouchers, and opened savings accounts. More than 5,000 girls, unmarried at baseline, were enrolled in a randomized, controlled trial and followed over four years—two years in the program and two years after the program ended. This brief describes the characteristics of enrolled girls at baseline.
Health Literacy Proficiency, Sources Of Health Information, And Perceived Barriers To Health Literacy Among Selected Members Of The Hmong Community In Minnesota, Amanda Vang
All Graduate Theses, Dissertations, and Other Capstone Projects
The purpose of this study was to determine health literacy proficiency, sources of health information, and perceived barriers to health literacy among selected members of the Hmong community in Minnesota. Data for this cross-sectional study were collected using the Short Assessment on Health Literacy-English (SAHL-E) screening tool and a questionnaire. The SAHL-E screening tool and a questionnaire were distributed to 40 Hmong residents in the St. Paul/Minneapolis in Minnesota. When combining the numbers of health literacy scores, a mean of 15.5 was reported. The overall findings of this research assessed that the Hmong community in Minnesota has adequate health literacy …
Falls Among Community-Dwelling Older Adults: Determining The Relationship Between Social Networks And The Risk For Falls, Smita Sikhrakar
Falls Among Community-Dwelling Older Adults: Determining The Relationship Between Social Networks And The Risk For Falls, Smita Sikhrakar
All Graduate Theses, Dissertations, and Other Capstone Projects
Falls among community-dwelling older adults is a big public health problem, which have an effect on older adults' health, independence, and quality of life. The purpose of this study was to determine the relationship between social networks and the risk for falls among community-dwelling older adults. This was a descriptive correlational study, which utilized a cross-sectional survey for the data collection. The dependent and independent variable of this study were the risk for falls among the community-dwelling older adults, and the strength and type of social networks respectively. In this study, 218 community-dwelling older adults were recruited, who were living …
Participatory Research Results From Training With The Mabinti Tushike Hatamu Out-Of-School Girls Program: Tanzania 2015, Kelly Hallman, Ilan Cerna-Turoff, Neema Matee
Participatory Research Results From Training With The Mabinti Tushike Hatamu Out-Of-School Girls Program: Tanzania 2015, Kelly Hallman, Ilan Cerna-Turoff, Neema Matee
Poverty, Gender, and Youth
The Mabinti Tushike Hatamu (Girls let’s be leaders!) program is designed to test and evaluate strategies for reducing the vulnerability of out-of-school adolescent girls in Tanzania aged 10–19 years to HIV/AIDS, pregnancy, and unfavorable life outcomes. MTH is led by the Tanzania AIDS Commission, implemented by Restless Development, and supported by UNICEF. The Population Council developed a strategy for Restless Development to capture the richness of its activities. The Council designed a training session and a companion toolkit in participatory action research for community volunteers, aged 19–23 years, to use within their girl groups. This report describes the findings from …
Invest In Urban Youth Sexual And Reproductive Health To Achieve A Demographic Dividend In Africa, Joyce Mumah, Jessica Brinton, Carol Mukiira, Caroline W. Kabiru, Chimaraoke O. Izugbara
Invest In Urban Youth Sexual And Reproductive Health To Achieve A Demographic Dividend In Africa, Joyce Mumah, Jessica Brinton, Carol Mukiira, Caroline W. Kabiru, Chimaraoke O. Izugbara
Reproductive Health
The future of Africa depends on its ability to harness the potential of its young people. Making the right investments in youth—particularly those in urban areas—can enable the region to experience substantial economic growth and sustainable national development for current and future generations. This policy brief reports on a number of recommendations to help African governments and Ministries of Health and Education realize the demographic dividend; incorporate economic empowerment programs into urban programming and budget allocation; integrate training on the provision of quality and effective youth-friendly services for health workers; and revitalize school health programming.
Promoting Respectful Maternity Care Resource Package—Implementing Respectful Maternity Care In Kenya, Population Council
Promoting Respectful Maternity Care Resource Package—Implementing Respectful Maternity Care In Kenya, Population Council
Reproductive Health
The Respectful Maternity Care (RMC) Resource Package was developed by the Heshima project as part of the USAID Translating Research into Action (TRAction) project. The resource package is designed to be used by program managers, supervisors, trainers, technical advisors, and others who organize or facilitate RMC training workshops on sexual and reproductive health as well as skills training in emergency obstetric and newborn care. The resource package provides experienced facilitators with background information, materials, instructions, and tips for promoting respectful care in reproductive, maternal, and newborn health services in both facilities and communities. The resource package also includes tools for …
Strengthening The Role Of Patent Medicine Vendors In The Provision Of Injectable Contraception In Nigeria, Population Council, The Evidence Project
Strengthening The Role Of Patent Medicine Vendors In The Provision Of Injectable Contraception In Nigeria, Population Council, The Evidence Project
Reproductive Health
The majority of contraceptive services in Nigeria are offered in private settings, including Patent Medicine (PM) shops. PM shops are informal businesses owned by Patent Medicine Vendors (PMVs) licensed to sell patent or proprietary drugs. Injectable contraception is the most popular modern contraceptive method in Nigeria. However PMVs are not regulated to sell or administer injectable contraceptives because the businesses do not receive formal training. Despite this, some PMVs are selling and administering injectable methods in response to high demand. The Evidence Project, in collaboration with the Federal Ministry of Health, conducted implementation research to: demonstrate the feasibility of PMVs …
Domestic Violence In The North Dakota Oil Patch: Barriers To Identifying And Serving Female Victims, Kristi Rendahl
Domestic Violence In The North Dakota Oil Patch: Barriers To Identifying And Serving Female Victims, Kristi Rendahl
School of Business Student Theses and Dissertations
This study explored domestic violence in energy boomtowns to answer the questions: What issues are confronting social service professionals who are in a position to identify and respond to female victims of domestic violence in rural North Dakota? What opportunities do professionals cite in identifying and responding to female victims of domestic violence in rural areas and boomtowns? Further, how has the professionals’ experience of the oil boom changed their methods of identifying and responding to female victims of domestic violence? The study used a qualitative approach through a focus group and interviews with the program directors of rural domestic …