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 …

A Quality Improvement Initiative To Streamline Flu Vaccine Documentation And Increase Staff Engagement, Carla E. Giron

Master's Projects and Capstones

Objective: This quality improvement project was implemented in an urban community health clinic primarily serving low-income and Latinx patients. Factors such as demographics, socioeconomic status, health, and transportation contribute to low U.S. influenza vaccination rates (Chen et al., 2020), while EHR training can improve provider satisfaction and efficiency (DiAngi et al., 2019). This microsystem faced inconsistent workflow processes, limited EHR training, and documentation errors that contributed to low staff satisfaction rates and influenza vaccination rates. An average of 11.4% of patients received a flu vaccine in October 2023 and 2024. Medical assistants (MAs) completed a pre-intervention survey indicating that 35% …

Improving Staff Satisfaction And Flu Vaccine Uptake Through Standardized Workflow Tools, Salma Adriana Blanco

Master's Projects and Capstones

Objective: Insufficient workflows can cause documentation to be confusing, which ultimately

limits staff engagement. This has led to staff dissatisfaction and a low vaccination uptake in

outpatient clinics. The implementation of a standardized workflow tool and proper staff

education and training can improve staff satisfaction and vaccination adherence, as indicated by

a review of literature. Aim: The purpose of this quality improvement project is to implement a

change in workflow in the electronic health record and staff training in an urban community

health clinic primarily serving low income and Latino patients. This intervention seeks to

increase medical assistant user satisfaction …

Evaluating Covid-19, Influenza, And Rsv Vaccine Effectiveness, Iromi N. Jayawardena

All Dissertations

Respiratory infectious diseases, including COVID-19, influenza, and RSV, pose significant public health challenges, especially during the respiratory virus season. Vaccination remains the primary intervention to mitigate morbidity and mortality associated with these diseases. Vaccine effectiveness (VE) can vary between seasons and populations, necessitating continuous evaluation. This study aims to evaluate the effectiveness of the 2024-2025 COVID-19 mRNA vaccine, 2024-2025 seasonal influenza vaccine, and single-dose RSV vaccine over two seasons.

Utilizing electronic health records (EHRs) from the Prisma Health healthcare system, this dissertation emulated target trials to assess the vaccine effectiveness of each vaccine. Risk set propensity matching was used to …

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 …

The Effects Of Medical Misinformation About Vaccines On Parents Of Pediatric Patients, Mya Izabela B. Emelia

Nursing | Senior Theses

Abstract

Purpose

The purpose of this study is to evaluate the effectiveness of an educational intervention designed for parents of pediatric patients who are vaccine hesitant and its impact on childhood vaccination rates. This research proposal aims to assess whether targeted education addressing vaccine misinformation, safety concerns, and benefits influences parental decision-making and improves vaccine uptake.

Methods

Parents of pediatric patients will be recruited from pediatric clinics and community health centers. Participants will complete a baseline survey before receiving an educational intervention addressing vaccine misinformation, social media-driven misconceptions, and hesitancy. A post-intervention survey will then assess changes in vaccine hesitancy, …

Investigating The Extent To Which Diet-Induced Obesity Alters Gene Expression In Hematopoietic Stem And Progenitor Cells Following Influenza Immunization In Mice, Chaitanya Lahari Chowdary Pathipati

Theses, Dissertations and Capstones

Vaccines are a vital tool in preventing diseases, but their effectiveness varies depending on factors like diet and body weight. Obese individuals often experience reduced vaccine protection, as seen with influenza vaccines, where they have twice the risk of getting the flu compared to healthy-weight individuals after vaccination. This study aims to understand why obesity weakens vaccine effectiveness, focusing on the role of blood-forming stem cells in the bone marrow, known as hematopoietic stem and progenitor cells (HSPCs). These cells are crucial for producing immune cells that defend the body against infections. Previous research has shown that diet-induced obesity alters …

Effects Of Misinformation And Disinformation On Vaccine Hesitancy And Routine Vaccine Uptake, Cindy Chen

Master's Projects and Capstones

This literature review was conducted to identify the role misinformation and disinformation plays on the rates of vaccine hesitancy and vaccine uptake for routine immunization among the child and adult populations of the United States. Fifteen articles between 2018-2024 were extracted from PubMed and Google Scholar databases. As shelter-in-place and social distancing protocol wanes, the risk of common vaccine preventable diseases (VPDs) reemerges, especially in populations that have not kept up with routine immunization schedules. Current efforts to restore mass vaccination campaigns are underway, but do not provide the necessary modifications to include social, behavioral, and cultural factors that influence …

Disparities In Seasonal Influenza Immunization Between Hispanic And Non-Hispanic White Populations Within The United States: Findings From The 2022 Behavioral Risk Factor Surveillance System, Susanna Stageberg

Capstone Experience: Master of Public Health

Objective: To determine if inequities in influenza immunization exist between Hispanic and non-Hispanic White populations living in the United States.

Methods: Statistical analyses were executed to study the association between ethnicity and influenza immunization. Logistic regression was performed to determine probabilities related to vaccination. Data from the 2022 Behavioral Risk Factor Surveillance System (BRFSS) was utilized.

Results: Hispanic respondents had higher odds of not being vaccinated against the flu when compared to non-Hispanic White respondents (COR = 1.82, 95% CI [1.73, 1.91]). Ethnicity, household income, education, insurance status, age, sex, preferred language, and primary care provider status …

Decreasing Influenza Vaccination Disparity Rates By Utilization Of Hotspot Deployments Of A Mobile Health Vehicle, Geneveve Deasis Tejada

Student Scholarly Projects

Practice Problem: Influenza vaccination for Black/African American patients is historically lower than White patients across all healthcare organizations (Quinn, 2018). In the organization’s 2022 performance, only 13.98% of Black/African American patients ages 19 and older were vaccinated compared to 27.81% of White/Caucasian patients.

PICOT: The PICOT question that guided this project was for Black/African American patients ages 19 and older receiving care from primary care clinics in Southeast San Diego (P), what is the impact of adding access to influenza vaccinations through hotspot-driven MHV deployments (I) compared to usual vaccination delivery in the medical office building (MOB) (C) on influenza …

The Effects Of An Influenza Vaccine Education Bundle On Environmental Management Services Workers, Michelle Keister

Student Scholarly Projects

Practice Problem: Environmental Management Service Workers have low vaccination rates. They work around a vulnerable patient population.

PICOT: For Environmental Management Services (EMS) workers (P), does the use of an Influenza Vaccine Education Bundle (I) compared to the current practice (C) impact EMS worker influenza vaccine compliance (O) within a 10-week period (T)?

Evidence: Using an educational vaccine bundle that increases access to the vaccine, provides education regarding the vaccine, and comes from a trusted source will increase flu vaccination rates among Environmental Management Services workers.

Intervention: Implement a vaccine education bundle.

Outcome: After implementation in 2023, vaccination rates …

Effects Of Education On Correcting Misconceptions And Acceptance Of The Influenza Vaccination Among A College Campus, Travis E. Fairbanks

Doctor of Nursing Practice Scholarly Projects

Educating patients on the influenza vaccination is an important goal for health care providers. It fosters a working relationship between provider and patient and allows patients to make an informed decision on their health care needs. The percentage of individuals who receive the influenza vaccine in the United States has been consistently below goals set by the committee for Healthy People 2020. This DNP scholarly project aimed to determine whether the introduction of education was effective at increasing individuals’ choice to vaccinate against the influenza virus among college campus students. The study was a non-experimental, non-randomized control trial that utilized …

Rates And Perceptions Of Covid-19 Vaccination From University Of Mississippi Students, Josie Parham

Honors Theses

The trials, tribulations and triumphs of the global COVID-19 pandemic are impacted by and are a product of behaviors that occur at the level of nations, states, cities and, ultimately, communities. In the wake of the development of safe and effective vaccines against SARS-CoV2, the virus responsible for the pandemic, the significance of the vaccine is closely linked to the number of individuals that receive the vaccine. To date, surveys have measured sizable variations in vaccination rates between nations, states, cities, and communities. Focusing on events that have transpired in one such local community, the present study (i) measured the …

Evaluation Of Antibody Response Against G4 And G1 Eurasian Avian-Like H1n1 Strains With Ha Vaccination In Swine., Callie Jo Olson

Honors Thesis

We are investigating the use of the Huber laboratory H1N1 influenza broad-antibody response vaccine product candidates HA-111 and HA-113 against emerging swine H1N1 virus variants G1 and G4 that are circulating in China. The question is, what would happen in the event that the G1 and/or G4 viruses were to jump from swine to humans and become transmissible between humans? As a subtype of influenza A viruses, H1N1 viruses have pandemic potential due to their ability to infect a variety of hosts other than humans and acquire new gene segments from those other reservoirs. Broad-coverage influenza vaccines are of great …

Characteristics Of Covid-19 Vaccine-Hesitant Ucf College Students And Potential Avenues For Increasing Vaccination Rates, Justin A. Barthel

Honors Undergraduate Theses

The COVID-19 pandemic has been an ongoing disaster that has devasted millions of lives. With the development of COVID-19 vaccines in late 2020, there was a potential for populations to gain artificial active immunity in order to prevent future outbreaks. However, despite successful clinical trials, millions of citizens have been hesitant to receive the COVID-19 vaccines (Khubchandani et al., 2021). Demographics of the most prominent US vaccine-hesitant populations consist of ethnic/racial minorities and Republicans groups (Khubchandani et al., 2021). Little information is known about COVID-19 vaccine hesitancy in colleges and universities. Colleges provide an elevated risk for infection through their …

The Combination Of Tlr7/8 And Tlr4 Adjuvants In An Influenza Vaccine Produce Unique Antigen-Specific Adaptive Immunity And Protect Against Lethal Heterologous Influenza Challenge, Shelby Lynn Cole

Graduate Student Theses, Dissertations, & Professional Papers

Influenza virus infection is a global health concern resulting in death and illness each year, which disproportionally effects high-risk individuals. While there are several approved vaccines for seasonal influenza, there are some limitations to consider: current vaccines provide minimal cross protection against seasonally drifted influenza subtypes, influenza vaccine strains change each year, requiring timely manufacture of a new vaccine. Thus, vaccines capable of inducing a more robust and broadly protective immune response to multiple influenza subtypes remains a critical unmet need. Adjuvants and novel delivery systems are an interesting and promising avenue of exploration for enhancing and broadening seasonal influenza …

Hpv Vaccine Hesitancy, Ellen Fountain

Health, Human Performance and Recreation Undergraduate Honors Theses

Human papillomavirus (HPV) is a virus spread through close contact, often sexual contact. Those infected will be at high risk of developing HPV-related cancers later in life. In 2006, the HPV vaccine was approved for use in the United States, but many were, and continue to be, hesitant to vaccinate their children. While other factors come into play, many times there are misconceptions contributing to hesitancy and ultimate refusal of the vaccine. The goal of this analysis is to review these factors and misconceptions and explore education-based interventions designed to minimize HPV vaccine hesitancy.

A Survey Of Primary Care Providers’ Strategies To Affect Influenza Vaccination Rates, Jennifer Moffett, Tracy Mitchell, Vera Simmons

MSN Research Projects

Influenza is a vaccine preventable disease that affects millions of Americans and causes thousands of deaths and billions in healthcare costs. Annual influenza vaccination is regarded by researchers and healthcare governing bodies as the most effective way to prevent contracting the flu. A large body of research exists supporting primary care providers as influential in regard to patients’ healthcare decision making. However, if strategies are consistently being implemented to affect influenza vaccination rates remains unclear. The purpose of this study was to identify strategies being implemented to affect influenza vaccination rates by asking two questions: 1. Do primary care providers …

Reviewing Patient Satisfaction Of Lifecare Alliance Services Provided To The Columbus Community, Sean Ruffner

Masters Theses/Capstone Projects

Two separate patient satisfaction surveys were sent out to LifeCare Alliance’s customers. Each patient was asked a set of five questions that generalized the encounters as a whole experience. The first survey is for patients that were seen by nurses for footcare, general wellness and more (1A - PowerPoint). The other survey was sent to clients who received the flu vaccine (1B - PowerPoint). To conclude, data was then collected and analyzed using an excel spreadsheet (1C – PowerPoint).

Influenza Vaccination Coverage In Pediatric Patients With Inflammatory Bowel Disease, Kelly Brown

Senior Theses

Background: Children with chronic health conditions, including inflammatory bowel disease (IBD), are at especially high risk for influenza infection and complications. The Crohn’s & Colitis Foundation and American College of Gastroenterology recommend that IBD patients should receive annual influenza vaccination. The aims of this study were to evaluate influenza vaccination coverage over time and identify predictors of flu vaccination in pediatric IBD and non-IBD patients.

Methods: We utilized longitudinal data (2000 to 2016) from South Carolina Medicaid to conduct a matched cohort study. The primary exposure of interest was IBD diagnosis based upon ICD-9/10 diagnosis codes. Children with IBD were …

Missed Shots: Increasing Flu Vaccine Documentation Utilizing A Clinical Reminder In A Student Health Clinic, Noelle Simms

Doctor of Nursing Practice Final Manuscripts

Objectives: The primary purpose of this evidence-based practice project is to increase influenza vaccination documentation in the student health setting utilizing a standardized clinical reminder.

Participants: 1,337 undergraduate and graduate students at a private university is Southern California.

Methods: A clinical reminder template was created and added to the intake form in the electronic medical record. The medical assistants complete the template with the patient. The provider then orders the vaccine or educates the patient based on the documented refusal reason.

Results: During the 10-week implementation period there was a 46% increase from baseline in flu vaccine documentation at the …

The Efficacy Of An Educational Intervention To Improve Low Influenza Vaccination Rates Among Federal Health Care Workers, Cynthia Berfect-Shelby

Electronic Theses and Dissertations

Influenza is a preventable communicable illness that has a significant impact on people of all ages. In 2018 it was estimated that 80,000 people died of influenza-related illnesses. Infants and elderly people are among the most vulnerable populations. The Centers for Disease Control and Prevention and Healthy People 2020 recommend that health care facilities have a 90% vaccination rate. Despite the recommendations and a mandatory directive, many facilities within the Veterans Health Administration struggle to reach influenza vaccination rates above 60%. Pender’s health promotion model was used as the theoretical framework to explore the reasons why health care workers refuse …

Associations Between Nurse Experience, Clinical Specialty Setting, And Level Of Nursing Education With Adherence To Clinical Practice Guidelines For Inpatient Influenza And Pneumococcal Vaccination Administration, Amy C. Alsante, Dnp, Ms, Rn, Ne-Bc, Chep

Doctor of Nursing Practice Projects

Background: This research project examines associations between years of nursing practice and compliance with clinical practice guidelines for inpatient influenza/pneumococcal vaccination administration. Previous research demonstrates novice nurses are at higher risk for errors of omission and face challenges with critical thinking.

Objectives: 1) Identify associations between years of practice and compliance with clinical practice guidelines for inpatient influenza/pneumococcal vaccination administration and 2) to identify associations among independent variables including levels of education, and specialty setting.

Methods: A retrospective chart review was conducted to identify associations between years of practice and compliance with clinical practice guidelines for inpatient influenza/pneumococcal vaccination administration. …

A Comparison Of Influenza & Tdap Vaccination Rates By Characteristics Of Child-Bearing-Aged Women, Francis Connor, Dnp, Msn, Mph, Fnp-Bc

Doctor of Nursing Practice Projects

Background

The Advisory Committee on Immunization Practices recommend childbearing-aged women receive an annual influenza vaccine, one dose of Tdap instead of TD after 18 years of age, and one dose of Tdap during the 3^rd trimester of each pregnancy. Despite these recommendations, influenza and Tdap vaccination rates remain lower than current goals.

Objectives

The purpose was to assess influenza and Tdap vaccination rates among women of childbearing age by pregnancy status, age group, and race/ethnicity.

Methods

The retrospective secondary data analysis included a nationally representative sample of women aged 18 to 44 years from the 2014 Behavioral Risk Factors …

The Effectiveness Of Combined Appointments And Influenza Immunization Rates In A Rural Wic Population, Lisa L. Sitler

Dissertations

Purpose: The purpose of this descriptive retrospective study was to examine predictors and barriers to influenza immunizations receipt in a low-income WIC population.

Method: A quality improvement project was conducted in October 2010 in which 129 caregivers of children having WIC appointments were randomly assigned to receive (a) influenza immunizations at the time of the WIC visit or (b) educational materials and a later immunization. Caregivers completed a survey about their perceptions of influenza immunizations. Tanahashi’s access to care model (1978) was used to identify predictors (acceptability, accessibility, availability, and effectiveness) of influenza immunizations.

Analysis: In analysis …

Avian And Pandemic Influenza Knowledge And Risk Perception In Southern Minnesota, Holly Munch

All Graduate Theses, Dissertations, and Other Capstone Projects

Avian influenza is an important public health issue because such viruses have the potential to mutate into a pandemic influenza virus with widespread, even global, morbidity and mortality. Studies have indicated that knowledge about avian and pandemic influenza and perception of pandemic risk are low among the public and even in the health professions. This study was undertaken to evaluate the level of avian and pandemic influenza knowledge and risk perception among adults in southern Minnesota with a view to preparing effective educational interventions and improving preparedness for an influenza pandemic. An 18-question electronic survey was administered to 99 people …

The Efficacy Of The Influenza Vaccine And The Implications On Vaccination Policy, Alexandra Dipietro

Honors Senior Capstone Projects

The purpose of this paper is to examine the efficacy of the influenza vaccine and its implication on vaccination policy as maintaining or increasing vaccination efficacy is important to public health intervention against this virus. To achieve this purpose a literature review will be conducted based on peer-reviewed research to examine current vaccination policy, efficacy of the influenza vaccine, approaches to improve efficacy, and the gap between vaccination policy and scientific evidence.

Factors Influencing Influenza Vaccination Rates Among Rural Ontario Paramedics, Tonya A. Leduc

Theses and Dissertations (Comprehensive)

Introduction. Influenza vaccination rates have traditionally been very low among healthcare workers (HCWs) however; very few studies have examined vaccination rates andmotivators among paramedics.

Objectives. The Health Belief Model (HBM) (Rosenstock,1974) was used as a guideline in this study to better understand the motivators and barriers to flu vaccination among rural Ontario paramedics. This group represents a considerable proportion of the HCW community, yet it has been virtually omitted from previous research.

Methods. Through the use of self-report questionnaires, and using the HBM as a guideline, a graphical representation of the decision-making process regarding flu vaccination was generated. The sample …

Prevention Of Vaccine-Preventable Diseases Through Information And Education At The California Department Of Public Health, Vaisali M. Patel

Master's Projects and Capstones

Immunizations are one of the most important developments in the twentieth century towards the prevention of infectious diseases. Vaccinations against communicable diseases have helped reduce morbidity and mortality all over the world. Despite having numerous vaccines that protect individuals from serious and deadly diseases, vaccination rates in the United States remain at an all-time low. The Information and Education section of the Immunization Branch within the Division of Communicable Disease Control at the California Department of Public Health (CDPH) focuses on working with local health departments, primary care providers, immunization coalitions, and other statewide organizations to increase the rates of …

Development Of Novel Subunit Vaccine Against H5n1 Influenza, Lu Zhang

Graduate Theses and Dissertations

Influenza is a common infectious disease resulting from a frequently mutated RNA virus. Vaccination is currently the most effective method to prevent people from seasonal or pandemic influenza. The production of traditional egg-based influenza vaccine is time-consuming and provides limited effect against new strains. Therefore, it is necessary to develop a rapid method to produce influenza vaccines. We proposed a novel influenza vaccine based on the E.coli expression system. Hemagglutinin (HA) is the major target surface protein of influenza virus for vaccine development. In this study, we sub-cloned the HAs encoding gene into an E. coli expression vector; the signal …