Health Services Research Commons^™

An Assessment Of Accessibility And Affordability Of Inpatient Psychiatric Care In Tennessee, Kailee Havrda

Electronic Theses and Dissertations

Introduction: Access to mental health has seen changes over the past decade, but little research and attention have been given to access to inpatient psychiatric facilities. Inpatient psychiatric care is crucial for patients experiencing mental health emergencies who need immediate access to care. Gaps in spatial accessibility, affordability, and the access and assessment process were identified due to a lack of available information in the field.

Methods: Secondary data from the Tennessee Department of Health were used to assess financial accessibility through payer source charges and patient encounters, as well as through mapping of inpatient psychiatric facilities and conducting drive …

Post-Pandemic Telebehavioral Health: Sustaining And Regulating Remote Mental Health Care As A Core Modality, Weiqiao Dong

Dartmouth College Master’s Theses

The United States continues to face a persistent mental health crisis after the COVID-19 pandemic, raising a policy question about the long-term role and regulation of telebehavioral health as a core modality of care. This thesis examines that question through a case study of New York State, an early center of the pandemic and a leader in telehealth policy reform.

Guided by the Health Policy Triangle framework, this thesis integrates longitudinal data from all 62 New York counties for 2010-2025 with a 2025 cross-sectional dataset covering 61 counties. Seventeen standardized indicators are organized into four dimensions: geographic, economic, demographic, and …

Healthcare Access Challenges Among Asian Americans, Phyo Theingi

University Honors Theses

Asian Americans are the fastest growing racial ethnic group in the U.S. According to the 2023 U.S. Census Bureau population estimate, Asian Americans account for 25.2 million (or 7.4%) of the nation's population. Asian Americans are not a monolith and represent a diversity of rich histories, cultures, languages and ethnicities. According to research conducted by the Pew Research Center, most Asian Americans face discrimination of some kind, including being treated as a foreigner in the U.S and being stereotyped as a model minority. They also experience health care access barriers. Research found that Asian Americans face barriers related to language …

Determinants Of Corporal Punishment And Severe Physical Punishment In Egypt: A Mixed-Methods Analysis For Child Protection Policy, Marwa Moustafa Nassef

Theses and Dissertations

Corporal punishment (CP) and severe physical punishment (SPP) remain a major public health, child rights, and child protection policy concern. In Egypt, despite legislative reforms, survey-weighted analysis of the 2021 Egypt Family Health Survey (EFHS) 2021 (CAPMAS, 2022) reveals prevalence rates of 60.5% for CP and 27.4% for SPP among children aged 1–14 (author’s calculations using EFHS-2021, n=7623), yet evidence distinguishing the determinants of routine corporal punishment from escalation to severe physical punishment remains limited in low- and middle-income contexts. Guided by Bronfenbrenner’s ecological framework, this mixed-methods study identifies key drivers of CP and its escalation to SPP among Egyptian …

Cross-Cultural Differences Among Children And Youth With Special Health Care Needs: A Mixed-Methods Analysis Of Chinese, Spanish, And English-Speaking Families, Kathleen Mcgrath, Miriam Franco, Amy Morales-Lara, Karen Bonuck Phd, Joanne Siegel

Developmental Disabilities Network Journal

One in five U.S. children has a special health care need, with prevalence rates rising each year. Children and youth with special health care needs (CYSHCN) from immigrant and/or non-English speaking families face heightened barriers to care, unmet health needs, and worsened health outcomes. This mixed-methods study explores cross-cultural similarities and differences among English-, Spanish-, and Chinese-speaking families of CYSHCN across four key domains – (1) the diagnostic process, (2) access to essential services, (3) community integration, and (4) social supports. As part of a statewide, New York State Department of Health funded initiative implemented across three University Centers for …

Multiple Interest Holder Perspectives Of The True Grit Sci Residential Program: A Mixed Methods Program Evaluation, Keara Mcnair

Seton Hall University Dissertations and Theses (ETDs)

Young adults with spinal cord injury (SCI) face significant challenges during the transition to adulthood, including barriers to independence, community participation, and psychosocial adjustment (Ingimarsdóttir et al., 2023; Zebracki et al., 2010). Current rehabilitation models in the United States prioritize short-term physical recovery and offer limited support for the developmental and contextual needs that shape long-term outcomes after SCI, particularly during transitions from inpatient rehabilitation to the community (Anderson et al., 2024; Bryden & Gran, 2024). Community-based programs may help address these gaps, though few have been rigorously evaluated using implementation science frameworks that attend to health equity, contextual influences, …

Quantifying Black Carbon Concentrations In Georgia And Analyzing Associated Public Health Risks, Khloe R. Osborne

Honors Theses

Quantifying Black Carbon Concentrations in Georgia and Analyzing Associated Public Health Risks

One of the most daunting challenges of the industrial world is air pollution. Within this broad spectrum, there is an inhalable particle group named PM2.5, which contains black carbon. Black carbon has evidence that supports the generation and worsening of adverse health impacts, which may include birth complications, cognitive deficits in children, pulmonary aggravation, asthma, cardiovascular issues, neurological degenerative patterns, and cancer risk. This is especially seen in vulnerable populations, like children, elderly, and those who already suffer from weakened health, many of which reside in the southern …

Perceived Stigmatization Of Mental Health Problems And Utilization Of Academic Accommodations Among College Students, Sabrina Williams, Robert E. Davis Ph.D., Kristin Bogda Ph.D.

2026 Honors Symposium

Background: Higher education is seeing an increase in students utilizing mental health services. Studies on students with disabilities suggest students often have reservations about accessing these accommodations due to anticipated social stigmatization. Purpose: This study aimed to assess relationships among stigmatization and indicators of psychological distress among a sample of students who qualify for accommodations. Methods: This was a cross-sectional survey of students at a large university in the central United States. Data collection measures included previously validated screening instruments for depression, anxiety, suicidal ideation, and adapted versions of the validated scales to assess specific aspects of stigma related to …

Eating Disorder Prevention And Early Intervention In U.S. Higher Education – A Comparative Benchmarking Study, Jake R. Arcement

Senior Theses

Eating disorders (EDs), including anorexia nervosa, have the highest mortality rate of any psychiatric illness, yet remain underrecognized relative to their severity and treatment burden. Because the period of peak onset aligns with the college years, institutions of higher education are uniquely positioned to play an important role in prevention, early identification, and referral to specialized care. However, limited research has examined how colleges and universities structure ED prevention and treatment resources. This thesis applies a comparative benchmarking framework to assess current institutional practices across U.S. colleges and universities. A national survey of student health and counseling centers examined staffing, …

A Qualitative Analysis Of Progress, Successes, And Challenges Among Indiana Recipients As Part Of A National Initiative To Reduce Covid-19–Related Health Disparities, Marla Winters, Lily Darbishire

Purdue Journal of Service-Learning and International Engagement

In light of the COVID-19 pandemic, the Centers for Disease Control and Prevention (CDC) provided funding to states as part of the CDC Disparities Grant initiative. The aim of the funding was to reduce chronic disease and COVID-19–related health disparities among vulnerable communities through four unique strategies. Funding was awarded to the Indiana Department of Health (IDOH) to begin an Indiana chapter of this initiative, called Indiana Healthy Opportunities for People Everywhere (I-HOPE). From 2021 to 2023, the IDOH provided I-HOPE funding to local communities (subgrantees) to support the design and implementation of programs to improve community health. For example, …

Exploring The Impact Of Adverse Childhood Experiences On Preventive Healthcare Utilization In Rural Georgia, Ryan R. Traylor

College of Graduate Studies: Theses & Dissertations

This study examines the relationship between Adverse Childhood Experiences (ACEs) and preventive healthcare use among adults in Georgia, specifically within rural populations facing structural barriers. Using 2023 Georgia Behavioral Risk Factor Surveillance System (BRFSS) data, the research analyzes associations between ACE exposure, rural residence, and preventive care outcomes, including physical exams and flu vaccinations. Guided by an intersectionally adapted version of Andersen’s Behavioral Model of Health Services Use, the study evaluates how predisposing factors, enabling resources, and perceived barriers relate to healthcare engagement. Logistic regression analyses assess the correlation of ACE exposure, cost barriers, provider access, and sociodemographics with preventive …

Improving The Continuity Of Care For Opioid Use Disorder: Investigating Fentanyl Overdose Outcomes And Pharmacy-Level Buprenorphine Access, Lyn Yuen Choo

Graduate Theses, Dissertations, and Problem Reports (ETD)

Opioid overdose (OD) deaths remain a leading cause of injury-related death in the United States (US) and approximately 76,516 drug OD deaths were predicted in the past year prior to April 2025. While previous research has focused on fatal opioid ODs, less is known about outcomes following non-fatal opioid ODs (NFOO) involving fentanyl. Patients who experienced a fentanyl OD may develop significant morbidity and inpatient mortality due to fentanyl’s high potency, rapid onset of action, and decreased response to naloxone. Research efforts to improve continuity of care for opioid use disorder (OUD) are highly needed to ensure appropriate follow-up care …

Engaging Ukrainian Tf-Cbt Therapists In A Practice Skills Course To Support Their Wellbeing, Elisabeth Pollio, Esther Deblinger, Beth Cooper, Maike Garbade, Julie P Harrison, Elisa Pfeiffer

Rowan-Virtua School of Osteopathic Medicine Departmental Research

Background: Burnout and secondary traumatic stress (STS) are common among therapists working with trauma-exposed clients, which can negatively impact them professionally and personally. The shared trauma of war exposure may put therapists at greater risk. To help support their wellbeing, an eight-session course was offered to Ukrainian therapists following training in Trauma-Focused Cognitive Behavioral Therapy (TF-CBT). This course involves therapists personally utilizing the PRACTICE skills taught to clients in TF-CBT for professional and personal benefit.

Objective: The objective was to gather preliminary evidence on the potential impact of implementing the course with Ukrainian therapists providing TF-CBT during a period of …

A Quantitative Exploration Of Risk And Protective Factors Affecting The Mental Health Of Chitimacha Tribal Youth, Daphnie Vilcan-Tanner

University of New Orleans Theses and Dissertations

This study examines the relationships between demographics, risk factors, and protective factors with mental distress among Chitimacha Tribal adolescents aged 12 to 18. Using a Positive Youth Development framework, the research aimed to identify the prevalence of mental distress, trauma, discrimination, and protective factors, as well as their collective and individual impacts on mental health. Data were collected through online surveys completed by 73 participants residing on or near the Chitimacha Tribal Reservation. Descriptive statistics and multiple linear regression analyses were conducted to analyze the data. Results revealed that while trauma and discrimination collectively predicted mental distress, family and community …

The Science Of Sound: Studying The Cognitive, Emotional, And Physiological Effects Of Frequency, Genre, And Music, Jett Yarborough

Senior Honors Theses

Music influences emotion, physiology, and cognition, yet little is known about how the frequency it is tuned to affects these influences. Prior research has shown that music tuned to 432 Hz can reduce stress, lower blood pressure, and improve sleep. My colleagues and I conducted two studies to investigate this. Our research found that music tuned to 432 Hz promotes a significant increase in memory retention and induces a state of focus and relaxation. These results suggest that shifting from the standard tuning frequency of 440 Hz to 432 Hz could have a profoundly positive impact on our daily lives. …

“Medication Is Only 10% Of Recovery”: A Mixed-Method Analysis Of Facilitators And Barriers To The Equitable Implementation Of Medications For Opioid Use Disorder Treatment, Alexandra Hernandez-Vallant

Psychology ETDs

Medications for opioid use disorder (MOUD), the gold standard treatment for OUD, are underutilized. Yet, research on MOUD clinical encounters is limited. Attention to social determinants of health (SDOH) can help improve engagement and retention in MOUD treatment. This dissertation project describes development of a clinical vignette-based survey using a two phase exploratory sequential design to examine the extent to which SDOH influence clinical decision-making among MOUD providers. Study 1 included interviews with 23 providers to learn their perspectives on facilitators/barriers to MOUD treatment and the clinical and social determinants most influential to their clinical decision-making. Study 2 involved development …

A Cancer Education Needs Assessment: Informing Middle-Aged Female Patients About The Relationships Between Obesity And Women’S Health Concerns In The Reproductive System, Breast, And Endometrial Health, Batul Mirza

MUSC Theses and Dissertations

Obesity significantly impacts women’s health, particularly among middle-aged women, by increasing the risk of hormone-sensitive cancers such as breast, endometrial, and reproductive system cancers. This study examines the educational needs of this demographic group regarding obesity-related cancer risks and explores effective intervention strategies. Obesity-induced mechanisms – hormonal imbalances, chronic inflammation, and insulin resistance – drive cancer susceptibility, emphasizing the need for targeted health education. The study employs a qualitative design, which includes interviews with subject matter experts (SMEs) and surveys of middle-aged women. The goal is to assess awareness, perceived barriers, and preferred learning methods. Findings suggest that with many …

Examination Of Eating Disorder Risks And Body Image Dissatisfaction Among Division Iii Student-Athletes, Maddie Wisener

Masters Theses/Capstone Projects

Eating disorders (ED) and pathogenic behaviors are prevalent concerns among collegiate athletes due to performance pressures and body image expectations. This cross-sectional study examined the risk of ED among 243 student-athletes (Males: 54.9%, Females: 44.3%, Non-Binary: 0.4%) at a private institution in the Midwest. The convenience sample included student-athletes from baseball, basketball, cheerleading, cross country, football, golf, lacrosse, soccer, softball, tennis, track, volleyball, and wrestling teams. The participants were given a demographic survey, the Eating Attitudes Test-26, and Sex-Specific Figural Stimuli Silhouettes to assess eating behaviors and perceived and desired body images. Overall, 22.1% of participants were at risk for …

Understanding The Impact Of Language Barriers And Visit Duration On Caregiver Satisfaction In Pediatric Primary Care, Gavin Miller

Health, Human Performance and Recreation Undergraduate Honors Theses

Background: Children from households that speak languages other than English (LOE) face barriers in accessing healthcare, leading to poorer health outcomes. Language barriers contribute to these disparities, often resulting in diminished communication between providers and families. Visit duration may play a key role in facilitating effective communication and improving patient satisfaction.

Purpose: This study examines how language barriers affect caregiver satisfaction in pediatric primary care, and whether visit duration mediates this relationship. We hypothesized that caregivers from LOE households would have comparable visit durations to English-preferring caregivers but report lower satisfaction due to receiving less information within that time. …

Kansas City Health Department – Childhood Lead Poisoning Prevention Program – Quality Improvement, Hanh Pham

Capstone Experience: Master of Public Health

This capstone manuscript evaluates the Kansas City Health Department's Childhood Lead Poisoning Prevention Program’s effectiveness. Through comprehensive data analysis of grant utilization, return-on-interest (ROI) and participant satisfaction evaluation, the project will provide actionable recommendations for improving sustainable long-term outcomes in lead poisoning prevention.

A Systematic Review Of Weight Loss Interventions Among Black Postpartum Women, Jhelma Velveder Perez

Honors Scholar Theses

Cardiovascular disease is a leading contributor to maternal mortality, which remains disproportionately high among Black women. Obesity and postpartum weight retention exacerbate cardiovascular disease risk and increase the likelihood of complications in future pregnancies. Weight loss during the postpartum period may reduce long-term chronic health risks and mortality for Black women. This systematic review aimed to understand the weight-related health needs of Black postpartum women by evaluating behavioral weight loss interventions within the first year after childbirth. A comprehensive search of the PubMed database identified 3 randomized controlled trials that met inclusion criteria. These studies evaluated home-based programs, mobile health …

Assessing The Impact Of The Covid-19 Pandemic On Mental Health In Patients Presenting To A Student-Run Free Clinic, Sabah Iqbal, Kirsten Carlberg, Emily Reilly, Jessica Ivanov, Victoria Youssef, Lily Roessler, Maikel Monsour, Nils Brolis

Rowan-Virtua Research Day

Background

Mental health is an important part of patient care, therefore it is imperative to understand how it’s recognized and treated. Socioeconomic status and the COVID19 pandemic contribute to disproportionate incidences of mental illness^{1, 2, 10, 11, 12}. This study uses data from a student-run clinic, the Rowan-Virtua Community Health Center (RVCHC), to examine disparities in mental health needs and screenings among the local population.

Hypothesis

It was hypothesized that underserved populations are at a disadvantage when it comes to both mental health screenings and treatment due to restricted access to healthcare and other unmet needs. Additionally, the …

Psychological Treatment Behind The Walls:Insights From The Inside, Rogelio Serrano

Psychology Division Scholarship

Repeated eras of mass incarceration, criminalization of marginalized communities, and substance use policies have created a revolving door of justice involved populations. The ever-increasing prison population has repeatedly become the largest contingency of mental health clientele for an overburdened mental health system. Those who work with formerly incarcerated individuals in the community often don’t know the unique set of challenges faced by practitioners within the system. Increased understanding and coordination of care can offer opportunities for sustained recovery and reduced levels of recidivism. In this presentation participants will learn about the unique insights on mental health treatment that can be …

The Quic-Sp: A Spanish Language Tool Assessing Unpredictability In Early Life Is Linked To Physical And Mental Health, Sabrina R. Liu, Natasha A. Bailey, Sara Romero-González, Amy Moors, Belinda Campos, Elysia P. Davis, Laura M. Glynn

Psychology Faculty Articles and Research

Accumulating evidence indicates that unpredictable signals in early life represent a unique form of adverse childhood experiences (ACEs) associated with disrupted neurodevelopmental trajectories in children and adolescents. The Questionnaire of Unpredictability in Childhood (QUIC) was developed to assess early life unpredictability, encompassing social, emotional, and physical unpredictability in a child’s environment, and has been validated in three independent cohorts. However, the importance of identifying ACEs in diverse populations, including non-English speaking groups, necessitates translation of the QUIC. The current study aims to translate and validate a Spanish language version of the QUIC (QUIC-SP) and assess its associations with mental and …

Resilience And Reality: Exploring The Lived Experiences Of People Living With Hiv In Texas During The Covid-19 Pandemic – A Qualitative Study., Ahmed F. Alanazi

Social Work Dissertations - Archive

This study investigated the lived experiences of individuals living with HIV (PLWH) in the Dallas-Fort Worth (DFW) area of Texas during the COVID-19 pandemic, using an Interpretative Phenomenological Analysis (IPA) framework. The research examined the intersection of health, social dynamics, and psychological resilience among PLWH, who faced compounded vulnerabilities due to systemic inequities and the dual public health crises of HIV and COVID-19. Through semi-structured interviews with ten participants from diverse backgrounds, the study captured the profound impacts of disrupted healthcare systems, heightened stigma, and social isolation on this marginalized population. The findings reveal that the pandemic exacerbated existing inequities …

Inpatient Utilization Among Medicaid Members With Substance Use And Serious Mental Illness In Oregon, Megan Holtorf

Articles, Abstracts, and Reports

No abstract provided.

Researching Dementia Indicators Among Rural Populations, Justin S. Yount

Theses and Dissertations--Community & Leadership Development

The study explored potential dementia indicators and risk factors among older adults residing in rural areas who are actively engaged in farming operations. Data was collected in three components a questionnaire, an audiogram test, and a memory impairment screening. 104 people responded to the questionnaire, 133 participants took the audiogram test, and 94 participated in the memory impairment screening. The findings revealed that 80.9% of participants showed no sign of cognitive impairment while 19.1% showed signs of possible impairment. Participants reported moderate levels of physical and social activity, but common risk factors such as elevated BMI, diabetes, hearing loss, and …

Improving Health Equity: Integrating Mental Health Services Into Mobile Health Clinics For Unhoused And Low-Income Populations In The United States, Tiffany Lynn Wong

Master's Projects and Capstones

Mental health disparities among homeless and low-income populations in the United States highlight significant challenges in access and quality of care. This literature review explores the integration of mental health services into Mobile Health Clinics (MHCs) as a promising recommendation to address these disparities. I used various search engines, extracting 10 articles published from 2013 to 2023 focused on the U.S. MHCs show its effectiveness in improving healthcare access and quality of care, covering different services like mammography, reproductive health, COVID-19 testing, and diabetes care. Building on these successful models, this paper proposes extending MHCs to include mental health screenings, …

Assessing The Reach Of Health Access Resources In Indianapolis For Populations With Low Income, Kyler A. Casbon, Kai J. Gatting, Simran Nadig, Isabella K. Peckinpaugh, Alexandre A. Sauquet, Kourtney A. D. Byrd, Megan E. Conklin, Gicella Garcia, Mitchell L. Struewing, Omolola A. Adeoye-Olatunde

Purdue Journal of Service-Learning and International Engagement

Two public health crises that the United States are contending with are diabetes and the prevalence of opioid overdoses, both of which have a significant impact on communities nationwide. Inequities in social conditions contribute to health disparities amidst these diabetes and opioid overdose public health crises nationally and locally. To address these health inequities in Indianapolis, Indiana, the the Purdue University Center for Health Excellence, Quality and Innovation (CHEQI) shaped relationships through their CHAMP (Community Health Access Model Partnerships) services with local food pantries and homeless shelters, providing Indianapolis residents pre-diabetes screening and resources and convenient access to and education …

Understanding Provider Competency In Gender Affirming Care, Vanessa Castle, Lindsay Gietzen

Pacific Journal of Health

Lesbian, gay, bisexual, transgender, queer/questioning, intersex, and asexual plus (LGBTQ+) individuals, especially transgender patients, face many healthcare disparities. It is extremely important for them to have access to high-quality healthcare, particularly Gender Affirming Care (GAC), to support their well-being and mental health. However, many healthcare providers, including clinical social workers, NPs, PAs, and MDs lack proper training to offer GAC. The current training opportunities available are often basic and lack comprehensive, detailed information. To reduce healthcare barriers for the transgender and gender-diverse community, we must have comprehensive training on GAC available for providers so they can treat their patients with …