Health Services Research Commons^™

Non-Metropolitan And Metropolitan Trends In Mental Health Treatment Availability In Community Health And Community Mental Health Centers, Tyrone F. Borders, Timothy Williams, Katherine Youngen, Julia Cecil

Rural & Underserved Health Research Center Publications

Key Findings

The supply of community mental health centers (CMHCs) decreased substantially from 2000 to 2019 and became nearly non-existent in non-metropolitan counties.

• The number of CMHCs in non-metropolitan counties declined from 182 to 15.
• The number of CMHCs in metropolitan counties declined from 582 to 104.

The supply of community health centers (CHCs) offering mental health services increased substantially over the same time period, or from 2000 to 2019.

• The number of CHCs in non-metropolitan counties increased from 184 to 573.
• The number of CHCs in metropolitan counties increased from 126 to 797.

Episode Based Payment Models And The Hospital Safety-Net: An Evaluation Of The Center For Medicare And Medicaid Services’ Comprehensive Joint Replacement Bundled Payment Program, John A. Gravina

Dissertations and Theses

Episode Based Payment Models and the Hospital Safety-net: An Evaluation of the Center for Medicare and Medicaid Services’ Comprehensive Joint Replacement Bundled Payment Program

By John Anthony Gravina

Advisor: Alexis Pozen, Ph.D.

Introduction: Payments for Healthcare services are increasingly being tied to clinical quality, patient experience, health outcomes, and efficiency through value-based payment arrangements (VBP). VBP presents a potential opportunity to reduce healthcare expenditures by requiring providers to take on financial risk associated with the cost and quality of care, therefore aligning payment incentives with the goals of providing higher quality and efficient care. As of 2020, 80 percent of …

Utility Of The Motivation To Change Lifestyle And Health Behaviors For Dementia Risk Reduction Scale (Mclhb-Drr) Based On A North American Sample, Angelina E. Witbeck

Dissertations

As the population ages, the prevalence rates of dementia continue to increase. Without a cure or promising treatment for dementia, the best course of lowering the prevalence rates of dementia is through preventative measures. Through an electronic survey, the study utilized the MCLHB-DRR scale to determine whether (1) gender, age, educational background, and socioeconomic status will impact the motivational factors to change lifestyle and health behaviors to reduce the risk of developing dementia and (2) direct experiences with individuals that have a dementia diagnosis are likely to impact one's motivational factors to change lifestyle and health behaviors to reduce the …

Lactating Justice: Constructing A Society Economically Focused On Optimizing Health Through Human Lactation, Shadley Hobour

Dissertations, Theses, and Capstone Projects

This paper uses a qualitative research method to answer if a Universal Base Income would be a good economic policy to adopt to optimize Black chestfeeding. The key idea this thesis aims to clarify is how anti Blackness is killing Black people and how one economic policy could improve health. In this essay, I will break down the significance and importance of human lactation for lifelong better health, and investment in a UBI would especially work as a preventative measure for several health issues Black people experiences.

The Racial And Ethnic Diversity Of The Family Physician Workforce In Non-Metropolitan And Metropolitan Counties, Lars E. Peterson, Zachary J. Morgan

Rural & Underserved Health Research Center Publications

Overview of Key Findings

• The family physician workforce is becoming more racially diverse; however, non-metropolitan family physicians are not.
• Using data from over 24,000 family physicians who either registered to continue their American Board of Family Medicine (ABFM) certification or completed the graduate survey from 2017 to 2019, we found that early career family physicians are more diverse than later career physicians (66.9% vs. 72.8% White; 58.3% vs. 44.0% female) but, in both groups, the percentage of White non-metropolitan family physicians was even higher (82.7% to 90.5%).
• Minority non-metropolitan family physicians, particularly Black and Native American/Alaska Native physicians, are more …

Find Your Flow: A Menstrual Health Social Media Campaign, Sarah Hamp-Adams

Kinesiology and Public Health

In many cultures, menstruation is surrounded by silence and shame instead of being celebrated as a sign of health and vitality. Globally, challenges, including stigma surrounding menstruation, create barriers for menstruators (White, 2013; Crawford, 2014; Garg, 2015). It proves to be difficult for young menstruators to navigate menarche due to the taboos and socio-cultural restrictions surrounding menstruation (Sharma,2015). Encouraging women to have open conversations about their periods is necessary to combat these challenges.

To understand how to address the stigmas around menstruation, the researchers first conducted a literature review, revealing that education messages via the Internet, posters, storytelling, and peer …

Frequency Of Use And Preferences For Information And Communication Technologies In Patients With Sleep Apnea: A Multicenter, Multinational, Observational Cross-Sectional Survey Study, Veronica R. Jaritos, Emanuel Vanegas, Juan Facundo Nogueira, Sebastian Leiva Agüero, Vanina Giovini, Jorge Rey De Castro, Yadira Rodríguez Reyes, José Luis Carrillo Alduenda, Pammela Torres Gittaim, Zaira Romero, Azza Sarfraz

Department of Paediatrics and Child Health

Background: Obstructive sleep apnea (OSA) is a condition characterized by repeated episodes of partial or complete obstruction of the upper airway during sleep. An accessible method to facilitate self-management education is through information and communication technologies (ICTs).
Purpose: To assess the frequency of and preferences for ICT use in patients with sleep apnea.
Methods: A multicenter, multinational, observational cross-sectional survey study was conducted between 2018 and 2019 in sleep units in different countries of Latin America, including patients of both genders older than 18 years with a diagnosis of sleep apnea. Participants were asked to complete 20 questions in a …

Risk For Post-Colonoscopy Irritable Bowel Syndrome In Patients With And Without Antibiotic Exposure: A Retrospective Cohort Study, Ravy K Vajravelu, Jordan M Shapiro, Josephine Ni, Shivani U Thanawala, James D Lewis, Hashem B El-Serag

Faculty, Staff and Students Publications

BACKGROUND & AIMS: Laboratory studies have demonstrated that antibiotic use in conjunction with bowel purgatives causes alterations to the gut microbiota. Because gut microbiota changes may be a trigger for the development of irritable bowel syndrome (IBS), we sought to assess whether individuals who undergo bowel cleansing for colonoscopy and have concurrent antibiotic exposure develop IBS at higher rates than individuals who undergo colonoscopy without antibiotic exposure.

METHODS: We used data from Optum's de-identified Clinformatics Data Mart Database in the United States to study a cohort of 50- to 55-year-olds who underwent screening colonoscopy. Individuals exposed to antibiotics within 14 …

Knowledge, Attitudes, And Covid-19 Prevention Practices Of Healthcare Workers In Indonesia: A Mobile-Based Cross-Sectional Survey, Besral Besral, Zulvi Wiyanti, Dion Zein Nurizin, Milla Herdayati, R Sutiawan, Martya Rahmaniati, Popy Yuniar

Kesmas

Knowledge of disease can affect attitudes and prevention practices, and wrong attitudes and practices can directly increase the risk of disease infection. This study aimed to describe the knowledge, attitudes, and COVID-19 prevention practice of healthcare workers in Indonesia and factors associated with prevention practices. A mobile-based cross-sectional survey was conducted in August 2020 with 254 healthcare workers in Indonesia. The self-administered questionnaire consisted of four parts: 1) sociodemographic information, 2) knowledge of COVID-19, 3) attitudes and anxiety toward COVID-19, and 4) COVID-19 prevention practices. The results indicated that healthcare workers in Indonesia had excellent knowledge and positive attitudes about …

Infarct Diameter For Predicting Cognitive Dysfunction In Ischemic Stroke Survivors In West Nusa Tenggara, Indonesia, Herpan Syafii Harahap, Setyawati Asih Putri, Yanna Indrayana, Hasan Amin, Fransisca Ika Mahardika

Kesmas

Cognitive dysfunction is an important consequence of ischemic stroke, which can progress in the first few years and is primarily determined by clinical factors. This study aimed to investigate the clinical determinants of cognitive dysfunction in stroke survivors in West Nusa Tenggara Province, Indonesia. This cross-sectional study assessed 255 ischemic stroke survivors with a mean age of 57.1±9.3 years old and 29–79 years old, recruited consecutively in three main hospitals in West Nusa Tenggara Province between March 2019 and October 2021. Categorical data collected included age, sex, education level, clinical determinants of ischemic stroke, and cognitive status of the patients. …

Interprofessional Collaborative Practice And Health Workers Retention At Remote Primary Health Care: Case Study From Nusantara Sehat Team-Based Program, Prastuti Soewondo, Retno Pujisubekti, Ade Widyati Prastyani, Nurul Maretia Rahmayanti

Kesmas

The Nusantara Sehat Team (NST), established in 2015 and consist of multi-professional health workers, implemented to provide comprehensive services at remote primary health cares (PHCs) for two years. This study aimed to explore how the NST leverages the Interprofessional Collaboration (IPC) and its impact on the future career prospects of health workers. Using a qualitative approach, the information was gathered from 48 informants drawn from the current 30 NST recruits and 18 alumni through semi-structured interviews. Of these 48, 20 were clinical practitioners, while the rest were non-clinical health workers. The findings revealed several challenges in promoting collaborative practice, including …

Benign Prostatic Hyperplasia (Bph): A Comprehensive Analysis Of The Malaise And Summarizing Possible Management Options Through Phytotherapeutic Agents, Shan Sasidharan, Kumarapillai Parameswaran Srinivasakumar, Sandeep Poddar, Amiya Bhaumik, Sreemoy Kanti Das, Hareendran Nair J

Kesmas

Benign prostatic hyperplasia (BPH) is a severe illness affecting middle-aged and geriatric male patients. This disease normally occurs at the age of 40 or above and is also associated with sexual dysfunction. Alpha-blockers and 5α-reductase inhibitors are the preferred drugs practiced to treat BPH. However, invasive surgical therapy remains the gold standard for managing the condition in the case of refractory and intricate BPH conditions. Due to the fear of sexual dysfunction and the detrimental influence on their quality of life, most patients seek to avoid synthetic drugs and surgery. For this reason, several patients turn to phytotherapy and other …

Treatment Adherence And Incidence Of Coronary Heart Disease In Type 2 Diabetes Mellitus Patients, Ahmad Sahlan Baniu, Rani Sauriasari, Woro Riyadina, Pradana Soewondo

Kesmas

Previous studies showed that uncontrolled blood sugar and long-term use of several types of antidiabetic could increase the risk of coronary heart disease (CHD). This study aimed to compare the incidence of CHD in type 2 diabetes mellitus (T2DM) patients showing treatment adherence and non-adherence behavior over four years. This was a retrospective cohort study with data sets obtained from the Bogor Cohort Study of Non-Communicable Disease Risk Factors. All study subjects were not diagnosed with CHD at the beginning of the study. The sample was divided into two groups; one had adhered to treatment from health centers and followed …

Local Wisdom Enriching Complementary Feeding Practices During Disaster Situations In Indonesia, Astuti Astuti, Happy Hayati, Fajar Tri Waluyanti, Dessie Wanda

Kesmas

This study aimed to analyze complementary food fulfillment during disaster situations in Indonesia since it frequently experiences natural disasters and young children face unique challenges related to their feeding needs in disaster situations. This qualitative case study based on the Mount Merapi eruption and Sumedang landslide in 2021 collected data using observations, forum group discussions, and in-depth interviews; then, a thematic analysis was conducted. This study involved 17 participants, including Non-governmental Organizations (NGO) activists, health workers, residents involved in making complementary foods, and primary caregivers of children aged 6–24 months. This study found that there were five themes generated from …

Muscle Dysmorphia In Fitness Center Members: Its Affecting Factors And Impacts, Deny Yudi Fitranti, Nurmasari Widyastuti, Etika Ratna Noer, Ayu Rahadiyanti, Fillah Fithra Dieny, Rachma Purwanti, Dewi Kurnia Sandi, Widya Destikasari

Kesmas

Muscle dysmorphia (MD) has several impacts on the decline in social and health functions. This study aimed to determine the correlation between MD with eating behaviors and exercise loading among fitness center members and analyze the factors affecting it. This study used a cross-sectional design with 100 subjects chosen by a consecutive sampling method at three fitness centers in Semarang City. The subjects were all male members of an active fitness center between 17 and 45 years. The data of MD were obtained using the Drive Muscular Scale (DMS), while eating behavior data were obtained using the Eating Attitude Test-40 …

Determinants Of The Coexistence Dual Form Of Malnutrition In Pairs Of Mother And Child Aged 6 – 59 Months In Bogor District 2019, Maulina Dwi Krismanita, Triyanti Triyanti, Ahmad Syafiq, Trini Sudiarti

Kesmas

The dual form of malnutrition (DFM) is defined as multiple nutritional problems in the same household and time. This study aimed to determine the related factor to DFM incidence in pairs of mothers and children aged 6–59 months in Bogor District in 2019. This cross-sectional study used secondary data on the Nutrition and Health of Babakan Madang Subdistrict Toddlers in 2019 and Nutrition Intake and Stunting of Children Under-Five in Bogor District, West Java Province, involving a total sample of 274 households. The dependent variable in this study was DFM, while the independent variables were maternal age during pregnancy, maternal …

The Influence Of Intrapersonal Constraints On Travel Intention Of People At High Risk From Covid-19 During The New Normal, Dyah Widiyastuti, Ikasari Kusuma Wardhani

Kesmas

Due to the COVID-19 pandemic, tourism constraints have created a challenge for inclusive tourism, especially for older people and people with comorbidities. This study examined intrapersonal constraints’ effect on the travel intentions of people facing fewer opportunities for tourism due to the COVID-19 pandemic, which could disrupt their well-being fulfillment. The data were collected through an online survey of Jakarta citizens aged 46 years and older from the end of June to September 2021, and a total of 337 responses were accumulated. This study applied partial least square structural equation modeling to test the moderating effect of intrapersonal constraints toward …

Zoom Fatigue During The Covid-19 Pandemic: Is It Real?, Putri Winda Lestari, Adhila Fayasari

Kesmas

The coronavirus disease 2019 (COVID-19) pandemic has caused drastic changes to social lives moreover the activities done outside, such as work and school. The policy of large-scale social restrictions (LSRR)/Pembatasan Sosial Berskala Besar (PSBB), which makes people stay at home, also plays an important role in changing the face-to-face activity online. As a solution to the major change, people use video conferencing to keep in touch and still feel like doing "offline" activities. The increasing use of video conferencing has raised concerns about the resulting fatigue, termed "Zoom fatigue." This study aimed to describe Zoom fatigue during the COVID-19 pandemic …

Diabetes Mellitus And Mortality Among Covid-19 Patients In Jakarta, March-August 2020, Endang Widuri Wulandari, Sudarto Rotnoatmodjo, Ngabila Salama

Kesmas

Diabetes mellitus (DM) comorbidity is one of the risk factors for coronavirus disease 2019 (COVID-19) mortality. This study aimed to determine the association of comorbid DM and mortality among COVID-19 confirmed cases in DKI Jakarta Province, controlled with confounding variables from March to August 2020. The study design was a retrospective cohort using cox proportional hazard regression, with a total sample of 1,480. The data consisted of 740 COVID-19 cases with and 740 without comorbid DM. The inclusion criteria were COVID-19 confirmed cases with polymerase chain reaction (PCR) laboratory testing reported to the DKI Jakarta Provincial Department of Health, and …

Policy Implementation Of Halal Product Assurance For Pharmaceutical Products In Indonesia, Hilyatul Fadliyah, Atik Nurwahyuni

Journal of Indonesian Health Policy and Administration

After the implementation of halal product assurance (HPA) became a public policy, the assurance for halal pharmaceutical products is a must. However, the implementation has been relaxed for several years. This shows that the policy implementation is complicated. This study aimed to analyze and evaluate the implementation process of the HPA policy for pharmaceutical products in Indonesia. We applied Van Meter Van Horn’s theory using the qualitative method through in-depth interviews with eight informants and a review ten documents. The result shows that the implementation is going well but is still not optimal, especially from the point of view regarding …

Covid-19 Pandemic Handling Strategies By The Baduy Tribe, Randi Irmayanto, Ede Surya Darmawan

Journal of Indonesian Health Policy and Administration

The first case of COVID-19 in Indonesia was announced by the President on March 2, 2020. As of June 22, 2022, the cumulative number of confirmed positive cases in Indonesia is 6,072,918 cases, with 5,904,825 recoveries and 156,702 deaths. In response to this case, the government made a policy starting with Large-Scale Social Restrictions contained in Government Regulation Number 21 of 2020 until the Enforcement of Restrictions on Community Activities based on levels (4, 3, 2, and 1) set by the Ministry of Home Affairs. The government's strategy to deal with this is through the 5M health protocol (wearing masks, …

Telemedicine And Electronic Health Record Implementation In Rural Area: A Literature Review, Arifah Alfiyyah, Dumilah Ayuningtyas, Agus Rahmanto

Journal of Indonesian Health Policy and Administration

The Indonesian Minister of Health 2019 issued regulations regarding the implementation of telemedicine services between health service facilities. Telemedicine is aimed primarily at rural areas. This research aims to look at the quality of telemedicine-based services, which are documented in an electronic health record (EHR) with complete information. This research uses the narrative literature review method: Garuda journal channels, Google Scholar, IEEE Explorer, ProQuest, PubMed, Science Direct, and Scopus. With the input-output process approach, eight scientific articles were published on countries with telemedicine/telehealth policies in rural areas. The implementation of telemedicine has advantages and disadvantages depending on the things supported …

Feasibility And Effectiveness Of A Prehabilitation Program Prior To Breast Cancer Surgery: A Critically Appraised Topic, Emma Choi, Alissa Lee, Kayla Woods, Morgan Mills, Carol Houston

Master of Occupational Therapy Student Critically Appraised Topics

The purpose of our project is to determine the feasibility and effectiveness of a prehabilitation (prehab) program for patients undergoing breast cancer surgery as compared to only receiving post-surgical rehabilitation. Our clinical mentor has recently obtained certification as a lymphedema specialist and is assisting with the opening of an outpatient mastectomy clinic through the Methodist University systems. Through our research process, we critically appraised two Level II articles, two Level III articles, and one Level IV article. Positive outcomes related to the feasibility were identified, however there is limited significant evidence supporting the effectiveness of the intervention. We recommend using …

Effects Of Sensory Intervention On Neurological Development In The Neonatal Intensive Care Unit: A Critically Appraised Topic, Paulina Bullard Mot/S, Emma Gadberry Mot/S, Siham Sherif Mot/S, Virginia Strawn Mot/S, Courtney Travis Mot/S, Delaney Weller Mot/S

Master of Occupational Therapy Student Critically Appraised Topics

The final portfolio contains four research articles from both national and international journals. Study designs include a randomized clinical trial, a randomized control trial, a systematic review and meta-analysis, and an integrative review. All studies relate directly to components of the evidence-based practice question and will be used to recommend sensory intervention for neurological development of premature infants in the neonatal intensive care unit (NICU). One of the articles describes statistically significant effects. One of the articles describes both statistically significant and non-statistically significant effects of sensory intervention on neurological development of premature infants in the NICU. The other two …

Group Therapy For Adults With Hip Replacements, Riley Burford Mot/S, Hillary Talley Mot/S, Elizabeth Seals Mot/S, Alishah Pirwani Mot/S, Tylan Wakefield Mot/S

Master of Occupational Therapy Student Critically Appraised Topics

The purpose of our critically appraised topic is to synthesize the best current evidence regarding the feasibility of group occupational therapy and outcomes related to ADL performance. The final portfolio contains a total of four research articles. Study designs include two randomized control trials, one cohort design, and one systematic review. All studies related directly to the PICO question and were used to determine best evidence for the feasibility of group therapy of the older adult population who have hip replacements in a rehabilitation setting.

Bedside Nurses' Perceptions Of Effective Nurse-Physician Communication In General Medical Units: A Qualitative Study, Hirotaka Kato, Jessica M. Clouser, Preetham Talari, Nikita Vundi, Akosua Adu, Kishore Karri, Kathy B Isaacs, Mark V Williams, Romil Chadha, Jing Li

Center for Health Services Research Faculty Publications

Background

There is a dearth of research on successful interventions to improve nurse-physician communication (NPC). An important step is identifying what matters to bedside nurses and their perceptions of effective NPC communications and actions.

Methods

We conducted three focus groups with a total of 19 medical unit nurses across two hospitals in one academic medical center in the United States. Using a convenience sampling strategy, five to eight nurses voluntarily participated in each focus group. The recording was transcribed verbatim and two independent coders performed coding and resolved any discrepancies in codes. Qualitative content analysis was pursued to identify themes …

Effect Of Early Mobilization On Length Of Hospital Stay In Covid-19 Patients: A Critically Appraised Topic, Ashlee Hodges, Anna Claire Briscoe, Anna Beth Willoughby, Carlton Hubbard, Nathan Smith

Master of Occupational Therapy Student Critically Appraised Topics

For this project, we created a critically appraised topic to study the effects of early mobilization on length of hospital stay in COVID-19 patients in the ICU.

How Environmental Change Will Impact Mosquito-Borne Diseases, Arsal Khan

Master's Projects and Capstones

Mosquitos, the most lethal species throughout human history, are the most prevalent source of vector-borne diseases and therefore a major global health burden. Mosquito-borne disease incidence is expected to shift with environmental change. These changes can be predicted using species distribution models. With the wide variety of methods used for models, consensus for improving accuracy and comparability is needed. A comparative analysis of three recent modeling approaches revealed that integrating modeling techniques compensates for trade-offs associated with a singular approach. An area that represents a critical gap in our ability to predict mosquito behavior in response to changing climate factors, …

The Headaches Of Case Study Research: A Discussion Of Emerging Challenges And Possible Ways Out Of The Pain, Malin Knutsen Glette, Siri Wiig

The Qualitative Report

Case study research is a widely-used approach in qualitative research. The advantages of case study research include its ability to investigate complex social phenomena and to handle dense data. However, it has several drawbacks, such as defining the case and ensuring rigour. The large variety in descriptions of case study implementation makes the application of case study research a challenge for novice and experienced researchers alike. The aim of this paper is to describe a novice’s foray into case study research, illustrating advantages, drawbacks, and applications of case study research through examples from a previously conducted case study. By mapping …

Factors Affecting Emergency Department Mental Health Visits, Logan Daul

Honors Thesis

Research has shown that current quantities of emergency department visits for mental health and substance use are increasing at a startling rate. These increases are acknowledged in quantitative studies and some important information can be gathered from qualitative studies however determining specific causes for these emergent visits are difficult. The purpose of this study is to derive findings from statistical analyses focusing on quantities of emergency department visits for mental health and substance use disorders. Comparisons will be drawn at the state level between the per capita quantity of emergency department visits and poverty rate, climate, psychiatric healthcare infrastructure, urban …