Health Services Research Commons^™

Operability, Usefulness, And Task-Technology Fit Of An Mhealth App For Delivering Primary Health Care Services By Community Health Workers In Underserved Areas Of Pakistan And Afghanistan: Qualitative Study, Shehla Zaidi, Abdul Momin Kazi, Atif Riaz, Ammarah Ali, Rabia Najmi Taha, Rawshan Jabeen, Umerdad Khudadad, Saleem Sayani

Community Health Sciences

Background: The recent proliferation of digital health technology in low- and middle-income countries has made it possible for community health workers (CHWs) to use mobile health (mHealth) to perform tasks such as data collection and training. Although most studies focus on the prospect of digital apps to motivate and connect CHW, only a few have captured end-user experiences with mobile-based apps. We examined the experience of frontline health workers with a move towards digitalized real-time data to record maternal and childcare services in remote areas of Afghanistan and Pakistan.
Objective: Our study aimed to explore CHW perceptions on the operability …

Ethics And Economics Of The Covid-19 Pandemic In The United States, Peter Hilsenrath, Tyrone F. Borders

Health Management and Policy Faculty Publications

The Covid-19 experience provides a natural experiment in personal and social ethics. Difficult decisions are routinely made to optimize lives and livelihoods. This commentary provides background and insight into the ethical and economic foundations underpinning dilemmas of this historic pandemic.

Artificial Intelligence–Powered Smartphone App To Facilitate Medication Adherence: Protocol For A Human Factors Design Study, Don Roosan, Jay Chok, Mazharul Karim, Anandi V. Law, Andrius Baskys, Angela Hwang, Moom Roosan

Pharmacy Faculty Articles and Research

Background: Medication Guides consisting of crucial interactions and side effects are extensive and complex. Due to the exhaustive information, patients do not retain the necessary medication information, which can result in hospitalizations and medication nonadherence. A gap exists in understanding patients’ cognition of managing complex medication information. However, advancements in technology and artificial intelligence (AI) allow us to understand patient cognitive processes to design an app to better provide important medication information to patients.

Objective: Our objective is to improve the design of an innovative AI- and human factor–based interface that supports patients’ medication information comprehension that could potentially …

Innovating The Study Of Context: Using A Qualitative Study On Subjugation And Resistance To Explore The Utility Of Foucauldian Governmentality As A Framework For Enriching Situational Analyses, Hannah Kia, Carol Strike, Daniel Grace, Lori E. Ross

The Qualitative Report

Situational analysis has, as an emerging poststructuralist approach to grounded theory, recently grown in use across a diverse range of disciplines and substantive areas. In this paper, we consider the complementarity of Foucauldian governmentality as a theoretical framework for supporting and enriching situational analyses. Our work is based on the findings of a recent study, informed by situational analysis, in which we interviewed 27 HIV-positive (n=16) and HIV-negative (n=11) gay men ages 50 and over about their health care experiences, and used these data to examine processes of subjugation and resistance reflected in their accounts. Drawing on our analytical process, …

Preterm Birth Prevention In Appalachian Kentucky: Understanding Barriers And Facilitators Related To Transvaginal Ultrasound Cervical Length Surveillance Among Prenatal Care Providers, Anna Hansen, Mairead E. Moloney, Cynthia Cockerham-Morris, Jing Li, Niraj R. Chavan

Sociology Faculty Publications

Background: Appalachian Kentucky has higher-than-average rates of preterm birth (PTB)—a health disparity associated with increased maternal and fetal/neonatal morbidity and neonatal mortality. Transvaginal ultrasound (TVU) cervical length measurement is the best predictor of PTB risk, but is underutilized in Appalachia. This study explores prenatal care providers' TVU-related knowledge and practices, and identifies barriers and facilitators, which impact the adoption of this evidence-based technology.

Materials and Methods: This study recruited providers from three Appalachian Kentucky health care sites. Prenatal care providers took part in semistructured interviews and completed brief survey scales. Questions focused on PTB knowledge, TVU-related barriers, and suggestions for …

Beyond Clinical Food Prescriptions And Mobile Markets: Parent Views On The Role Of A Healthcare Institution In Increasing Healthy Eating In Food Insecure Families., Emily Dewit, Emily Meissen-Sebelius, Robin P. Shook, Kimberly Pina, Evelyn Donis De Miranda, Michelle J. Summar, Emily A. Hurley

Manuscripts, Articles, Book Chapters and Other Papers

BACKGROUND: Children in food-insecure families face increased barriers to meeting recommendations for fruit and vegetable consumption. Hospitals and pediatric healthcare institutions have attempted to alleviate food-insecurity through various internal programs like food prescriptions, yet little evidence for these programs exist. Consistent with a patient-centered perspective, we sought to develop a comprehensive understanding of barriers to fruit and vegetable consumption and a parent-driven agenda for healthcare system action.

METHODS: We conducted six qualitative focus group discussions (four in English, two in Spanish) with 29 parents and caregivers of patients who had screened positive for food-insecurity during visits to a large pediatric …

Patient Navigation And Cancer-Related Care: Policy Solutions To Improve Access To Pennsylvania’S Complex System Of Care, Nirmal Ahuja

Harrisburg University Faculty Works

In Pennsylvania, cancer patients experience disparate cancer-related health outcomes. Patient navigation, a patient-centered evidence-based approach effectively addresses barriers to care, and reduces cancer-related disparities and burden. We performed a literature search with specific inclusion and exclusion criteria to identify literature emanating from the United States which potentially described the development, efficacy and cost effectiveness of patient navigation across the United States and in Pennsylvania. The results from this review signified that, over last two decades there has been a rapid growth in the field of patient navigation programs across the United States which includes the state of Pennsylvania. However, despite …

Hs-4100 - Global Health Issues, Jose Nanin

Open Educational Resources

This syllabus includes OER materials and college policies for a fully online course that takes a comprehensive look at global health issues. In this course, the assessment of health issues are analyzed from various perspectives including geographic, ethnic, religious, human rights, socioeconomic, social, cultural, and political influences. Students learn about global environmental causes and consequences of infectious diseases, major diseases, mental illness, natural disasters, malnutrition, drug and alcohol addiction, violence and injuries.

Modeling The Impact Of Inclusion Of Family Planning Services In Ghana's National Health Insurance Scheme, Justin Archer, Gillian Eva, Augustine Ankomah, Saumya Ramarao, Kamil Fuseini, Anne Coolen, Stephen Duku, Benjamin Bellows

Reproductive Health

While access to and uptake of modern family planning (FP) in Ghana has steadily risen over the last decade, the modern Contraceptive Prevalence Rate (mCPR) among all women reached only 22% in 2019 with 30% of women still reporting unmet need. To increase FP uptake via mitigation of cost barriers among women with unmet need, the Government of Ghana is seeking to integrate claims-based FP services into the National Health Insurance Scheme benefits package. The impact of these activities has the potential to be significant with the proportion of women accessing modern FP shifting dramatically to public facilities over the …

Global Strategies And Local Implementation Of Health And Health-Related Sdgs: Lessons From Consultation In Countries Across Five Regions, Sameen Siddiqi, Wafa Aftab, Fahad Javaid Siddiqui, Luis Huicho, Roman Mogilevskii, Peter Friberg, Johanna Lindgren-Garcia, Sara Causevic, Anil Khamis, Mashal Murad Shah, Zulfiqar Ahmed Bhutta

Community Health Sciences

Evidence on early achievements, challenges and opportunities would help low-income and middle-income countries (LMICs) accelerate implementation of health and health-related sustainable development goals (HHSDGs). A series of country-specific and multicountry consultative meetings were conducted during 2018-2019 that involved 15 countries across five regions to determine the status of implementation of HHSDGs. Almost 120 representatives from health and non-health sectors participated. The assessment relied on a multidomain analytical framework drawing on existing public health policy frameworks. During the first 5 years of the sustainable development goals (SDGs) era, participating LMICs from South and Central Asia, East Africa and Latin America demonstrated …

Relationship Between Spirituality And Acceptance Of Illness Level In Bipolar Patients, Olga Putri Atsira, Erikavitri Yuliati, Atika Atika, Abdurachman Abdurachman, Margarita Maria Maramis

Kesmas

Bipolar disorder is a chronic mental condition that affects patients’ quality of life. The management process is affected by acceptance of illness. The ability to accept the illness is related to the spirituality level which is something that is held strongly by Indonesian people. There has been very little research related to the relationship between spirituality with bipolar disorder. This study aimed to analyze relationship between spirituality levels with acceptance of illness in patients with bipolar disorder. This study is a correlational study using questionnaire from bipolar disorder patients contacted through Harmony in Diversity online community as a sample. Samples …

Physiological Factors And Physical Activity Contribute To The Incidence Of Type 2 Diabetes Mellitus In Indonesia, Demsa Simbolon, Afriyana Siregar, Ruzita Abd Talib

Kesmas

Type 2 diabetes mellitus (T2DM) is the sixth highest cause of death in Indonesia. Thus, it must be prevented and overcome with appropriate management. This study aimed to determine the contribution of physiological factors and physical activities to the incidence of T2DM. The study used a cohort retrospective design using secondary data from the Indonesian Family Life Survey (IFLS) from 2007 to 2014, which included a sample of 14,517 people involved for more than 20 years. Data analysis was performed using multiple logistic regressions. The results revealed a 3.8% incidence of T2DM in Indonesia. Record of hypertension risk increased the …

Evaluation Of Anthropometric Parameters Of Central Obesity Among Professional Drivers: A Receiver Operating Characteristic Analysis, Muhammad Asif, Muhammad Aslam, Saima Altaf, Abdul Majid, Saima Atif

Kesmas

Different anthropometric parameters have been proposed for assessing central obesity. The diagnostic performance of these anthropometric parameters and their ability to correctly measure central obesity for the professional community, like drivers, is questionable and needs to be assessed. The study aimed to examine the diagnostic performance of anthropometric parameters as indicators of central obesity in drivers as measured by waist circumference (WC) and to determine the best cut-off values for these parameters that would identify obese drivers. Anthropometric measurements from a cross-sectional sample of 197 professional drivers were taken under standard protocol. Receiver operating characteristics (ROC) analysis was used to …

Gerakan Nusantara Program On Children’S Nutrition Practices, Syilga Cahya Gemily, Sandra Fikawati, Ahmad Syafiq

Kesmas

Gerakan Nusantara is a nutrition education program that aims to change the nutrition knowledge, attitudes, and practices of elementary school children in Indonesia. The program was implemented in 2015–2018 in Jakarta, Bandung, Surabaya, Makassar, Medan, Yogyakarta, Pontianak, East Nusa Tenggara, Pekanbaru, Padang, Jambi, and Sorong. The present study sought to determine the effects of Gerakan Nusantara on the nutrition practices of school-aged children and describe the extent of changes in each nutrition practice component covered by the program. This study used secondary data on Nutrition and Health Knowledge, Attitudes, and Practices studies collected from students participating in the program and …

Vitamin D And Reduced Academic Stress Of Health Students, Yuni Kusmiyati, Emy Suryani, Lucky Herawati, Amalia Firdausi

Kesmas

Stress conditions can reduce academic ability, influencing student grade point averages and encouraging negative behaviors. The object of this research was to discern the influence of vitamin D in the reduction of academic stress of health students. The study used a randomized controlled trial (RCT). The population was midwifery students who lived in the Health Polytechnic dormitory, Ministry of Health, Yogyakarta, in 2017. Samples were 77 students of midwifery who did not suffer from any chronic disease, nor did they experience academic stress. They all agreed to become research subjects. Samples were 39 respondents in a treatment group who were …

Family Planning Communication Between Wives And Husbands: Insights From The 2017 Indonesia Demographic And Health Survey, Dian Kristiani Irawaty, Suziana Mat Yasin, Hadi Pratomo

Kesmas

Frequent inter-spousal communication is regarded as an indicator of safe family planning practice. Nevertheless, communication about family planning within couples in Indonesia is still largely unexplored. This study assessed the levels of inter-spousal communication about family planning and its associated determinants, using cross-sectional and nationally representative data from the 2017 Indonesia Demographic and Health Survey (IDHS), from a randomly selected cohort of 8,925 currently-married couples. Data on sociodemographic characteristics, inter-spousal communication behaviors, and attitudes regarding family planning were collected. The dependent variable in this study is how frequently couples discuss family planning, based on wives’ responses. The analyses were stratified …

Education Through Whatsapp Media In Changing Of Smoking Behavior Among Senior High School Students, Yusriani Yusriani, Joel Rey U. Acob

Kesmas

Teenagers, who are considerably susceptible to smoking, must be educated to prevent smoking behavior that can cause health problems and even death. The aim of this study was to assess the effect of education through social media such as WhatsApp in the modification of smoking behaviors among senior high school students in Pangkep District, Indonesia. It employed a quasi-experimental, pretest-posttest-only control group design. The experimental group received education in the use of WhatsApp social media, while the control group was provided with leaflets. Data were collected through observation and interviews with a total of 180 students in both groups, with …

Effect Of The Covid-19 Pandemic On Eating Habits And Food Purchasing Behaviors Of University Students, Hacı Ömer Yilmaz, Ramazan Aslan, Cihan Unal

Kesmas

COVID-19 disease, which spread rapidly all over the world after the first case was detected, became the primary agenda of the countries. Radical measures have been taken by governments to prevent the spread of the disease. Precautions and warnings to prevent disease caused some changes on daily life activities of people. University students who have to stop education are among the groups most affected by this disease sociologically, psychologically and physiologically. The aim of this study was planned and conducted to determine the effect of COVID-19 on university students' eating habits and food purchasing behavior. The study was completed with …

Best Bets For Accelerating Family Planning In Pakistan: The Case For Engaging Family Physicians And The For-Profit Private Sector, Ashfaq Rehman, Anam Malkani

Reproductive Health

Many women in the developing world already rely on private sector providers for various types of treatment, as well as for family planning (FP) services, due to ease of access, shorter waiting times, and a perception of better service. Drug shops and pharmacies are also important for improving access and basic information about contraceptive products. Private pharmacies and shops are key when public sector facilities face frequent shortages and stock outs.

Best Bets For Accelerating Family Planning In Pakistan: Inducting Men, Sharing Responsibility, Kiren Khan, Zeba Sathar

Reproductive Health

Pakistan's family planning (FP) program remains more or less exclusively aimed at women, yet evidence from both international as well as programming from within Pakistan suggests that including men in FP could improve results. Given the large youth cohort entering reproductive life in Pakistan, there are compelling grounds for also including younger men and adolescent boys, especially those about to wed, within the country's reproductive health (RH) and FP strategies.

Best Bets: Additional Funding For Family Planning—International Evidence On Financing Of Family Planning, Zeba Sathar

Reproductive Health

Additional financing for family planning (FP) in Pakistan is strongly justified, not only to increase contraceptive prevalence, reduce unmet FP need, and avert millions of unwanted pregnancies, but also to reduce maternal mortality and effect improvements in other spheres of development. As a safeguard against unintended fertility, FP contributes to national savings in multiple ways, and additional annual funding of $93 million—or 40 cents per capita—is a relatively minor investment that promises huge dividends.

Best Bets For Accelerating Family Planning In Pakistan: Invest In Community Health Workers, Ali M. Mir, Kiren Khan

Reproductive Health

Integration of trained, equipped, and supported community health workers (CHWs) within a health system is recognized as a proven high impact practice for family planning (FP) services, with evidence from around the world confirming the need to complement facility-based FP services with CHW programs, particularly in areas where people’s access to health care is limited. There is also substantial evidence that delivering essential health services through CHWs can be cost-effective in a diversity of contexts, with a review of FP programs in 10 developing countries revealing that the average cost per couple-year of protection (CYP) was considerably lower among programs …

Factors Associated With Binge Drinking During The Transition Into Adulthood: Exploring Associations Within Two Distinct Young Adult Age Ranges, Tamara Leech, Sarah Jacobs, Denis Watson

Department of Public Health Scholarship and Creative Works

Background:

Binge drinking among young adults aged 18-21 years has declined over the past decade, but binge drinking rates among people 22-25 years old have remained largely the same. This steady trend in later years represents a departure from the traditional course of maturing out of risky alcohol use, perhaps because young adults are delaying the transition into adulthood.

Aims:

This paper explores the relationship between binge drinking and aspects of the transition into adulthood that could inform interventions targeting these two distinct groups of young adults.

Methods:

We use survey data on 1,081 young adults aged 18-25 living in …

Lean Daily Management: Keeping Quality And Safety At The Forefront During The Covid-19 Pandemic, Suneela Nayak, Ruth Hanselman, Natalia Johnson, Sydney Green

Operations Transformation

This storyboard describes how our Operational Excellence Platform pivoted to keep quality at the forefront of the Covid-19 response. Applying the Framework for Safe Effective and Reliable Care, we implemented the following innovations:

• Daily quality huddles became virtual, with 70-100 frontline leaders sharing alerts, announcements and celebrations
• Traditional Gemba Walks transformed into daily Executive Gemba Rounds visiting all care teams and focusing on patient and workforce safety.
• Patient and Workforce safety concerns were resolved real time and those requiring coordinated response were triaged to the Hospital Incident Command System (HICS) for accelerated action.

Innovative communication strategies were adopted to clarify …

Remedying Healthcare Disparities Affecting The Black Community, Savonna Reed

San Marcos, Summer 2020

The purpose of this literature review is to determine how black communities are being impacted by racial/social determinants of cardiovascular health, and to investigate potential healthcare solutions to eliminate these disparities.

As physical therapists, we commonly treat patients following lumbar spinal fusion surgery. Post-op outcomes have been found to be impacted by racial disparities in decision making in whether care providers offer surgical care, differences in access to care due to socioeconomic barriers, and differences in attitudes towards surgical care among ethnic groups.

Review of current literature has revealed that more research should be done to establish ways of remedying …

Utilization Of Nurse Practitioners In States With Full Practice Authority: Does Geography Matter?, Jana Zwilling

Theses & Dissertations

Background: Over 80 million Americans reside in or are part of a population designated as Health Professional Shortage Areas (HPSAs). Of the primary medical HPSA areas designated in the U.S., 66.74% are located in rural or partially rural areas (HRSA, 2020). To combat this shortage, 23* states and Washington, D.C. have enacted full practice authority laws for nurse practitioners (NP). Over 60% of NPs work in communities of less than 250,000.

Problem: The variability and extent of utilization of NPs in states with full practice authority (FPA) is unknown. To ensure access to quality healthcare, nurse practitioners need to be …

Promoting Community Engagement Through Basic User Tutorial Of Epa Geospatial Screening Tools, Jonas Nguyen

Master's Projects and Capstones

Social inequalities are riddled with health disparities and outcomes leading toward lower life expectancy. Communities of color, low income, and rural neighborhoods lack the voice and resources to effectively oppose industrial settlement which would likely lead to the release of toxic wastes into the water, air and ground ultimately affecting residential health. Empowering members through community engagement is a relatively new strategic process where researchers are finding mutual benefits in design, implementation, and results. This study aims to identify and promote tools for community engagement within the scope of environmental justice by working with EPA geospatial screening tools and designing …

Con Confianza: Using Community-Based Participatory Research Principles To Inform Community-Academic Partnership Practices And Build Trust In Hispanic Communities, Sharon Tafolla

Master's Projects and Capstones

Hispanic communities are at disproportionate risk for chronic diseases and researchers have cited the need for further community and culturally informed studies to improve research outcomes to either make treatments and interventions more generalizable or modify them to the needs of Hispanic communities. However, many of the same linguistic and cultural barriers to health care access and utilization also impact the ability for Hispanic groups to participate in research studies. Community Academic Partnerships (CAPs) are positioned to conduct culturally and linguistically competent research in Hispanic communities. For research in Hispanic communities to be effective, CAPs must prioritize practices that build …

Collaborative Strategies To Reduce Incomplete Operating Room Instruments Trays, Richard Neusch, Nicole Wagner, Colby Fike, Suneela Nayak

Operations Transformation

In an academic tertiary medical care center, the OR was receiving incomplete instrument trays. This issue became increasingly problematic in wasted staff time and cost to the institution.

Using a tracking system to generate a missing instrument report, baseline metrics were established. Reviewing each report, an interdepartmental team comprised of members of the OR and sterile processing departments, initiated a number of countermeasures.

Since the start of these countermeasures, there has been a reduction in the receipt of incomplete OR trays. Next steps include creating a tag process by which the OR instrument trays from one case would be kept …

Special Issue – July 2021 The Impact Of Inequity & Health Disparities On The Human Experience, Patient Experience Journal

Patient Experience Journal

Patient Experience Journal (PXJ) is excited to announce the call for submissions for its July 2021 special issue on the impact of racial inequality, health disparities, and discrimination on the human experience. The world now finds itself in the grips of a global pandemic that is taking its toll on communities socially and economically, placing strain on healthcare workers and revealing the very systemic weaknesses and inherent biases that have been resting just beneath the surface of our society for years. The challenge of disparity and inequity is not unique to healthcare, but in the era of COVID-19, what many …