Nourishing Births: A Program Evaluation Proposal For Community-Based Nutrition Education, Food Access, And Garden Engagement Among Black Birthing People, Naa Deedei-Vera Hammond

Master's Projects and Capstones

Black birthing people in the United States continue to experience unequal maternal health outcomes, shaped in part by racism and barriers to nutritious food, culturally relevant health education, and supportive community spaces. While prenatal nutrition education and food assistance programs can provide important resources, information alone cannot address the challenges many people face when trying to access healthy and affordable food during pregnancy. The Nourishing Births Initiative is a proposed community-based maternal health program designed to respond to these needs by bringing together prenatal nutrition education, help connecting to food resources, community gardening, and peer support for Black birthing people …

Integrating Matrescence Into Birth Worker Practice: A Practice Improvement Project, Kelsey B. Green

Doctor of Nursing Practice (DNP) Projects

Background: Perinatal mood and anxiety disorders (PMADs) affect 20–25% of mothers worldwide and are a leading cause of maternal complications. Stigma, fragmented care, and limited provider training leave families vulnerable, while birth workers offer trusted, continuous support.

Problem: Birth workers' maternal mental health (MMH) training is minimal and often excludes matrescence, the developmental transition to motherhood, limiting their ability to distinguish normal adjustment from clinical PMADs and delaying intervention.

Methods: A single-group, pre-/post-test design evaluated a matrescence-informed workshop at Roots Community Health's 2nd Annual Symposium. Anonymous surveys measured knowledge, attitudes, and confidence, analyzed with Mann–Whitney U, Wilcoxon signed-rank tests, and …

Clinician Perspectives On Fistula Mental Health, Victoria K. Leonard

Doctoral Dissertations

Background – Obstetric fistula is a childbirth injury caused by prolonged labor that leads to stillbirth and incontinence, spurring social exclusion and isolation. These layers of trauma put women with fistula at great risk for psychological suffering, which has profound negative socioeconomic impacts on them, their families, and communities. This study captured treatment as usual at Comprehensive Community Based Rehabilitation in Tanzania (CCBRT), the country’s largest provider of fistula care.

Method – Improving holistic fistula treatment requires engaging the clinicians who care for women with fistula. This study aimed to investigate the training, beliefs, and treatment approaches of nurses and …

Matrescence: An Emerging Concept For Birth Worker Practice, Kelsey B. Green

DNP Qualifying Manuscripts

The maternal mental health (MMH) crisis, affecting up to 25% of birthing individuals, is exacerbated by significant gaps in perinatal support. While birth workers are uniquely positioned to provide care, they often lack specialized training beyond basic screening checklists to address the complex transition to motherhood, defined as matrescence. This clinical innovation proposal outlines a matrescence-informed educational curriculum, guided by the Comprehensive Model of Mental Health during the Perinatal Period. The intervention is designed to build tangible, implementable skills, training birth workers to: (1) operationalize matrescence as a psychoeducational tool to normalize distress; (2) use clinical differentiation to distinguish the …

The Impact Of Culturally Grounded Breastfeeding Programs On Black Maternal And Infant Outcomes: A Scoping Review, Kelsey B. Green

Master's Projects and Capstones

Abstract

Background: The lack of culturally grounded breastfeeding programs and understanding of their impact on Black breastfeeding initiation, duration, and health outcomes hinders improving Black breastfeeding rates in the U.S.

Research aim: This scoping review examines the impact of culturally grounded breastfeeding programs on Black mothers' and infants' health, and factors contributing to their success.

Methods: A scoping review of the literature was conducted using the CINAHL and SCOPUS databases. In the end, 34 scholarly articles were chosen for this review because they examined the impact of culturally grounded breastfeeding programs on Black breastfeeding rates and health outcomes.

Results: Culturally …

Infant Mortality Data: Missing Pieces To Prevention In Lesotho, Jacinda Croissant

Master's Projects and Capstones

Lower-middle-income countries (LMICs) like Lesotho lack complete and quality infant mortality data. Without infant mortality data, it can be challenging to develop public health education, programming, and policies to address preventative infant deaths in specific populations (Rao et al., 2004). A literature review identified strategies to improve infant mortality data in LMICs. Through a community engagement model and digital storytelling, community members can gain awareness, begin an ongoing conversation about local public health issues, and participate in an improved data collection system. Infant mortality is often used as an indicator of health for a population; improved infant mortality data can …

The Impact Of Adverse Childhood Experiences And Allostatic Load On Premature Birth Rates: A Literature Review, Roxane J. Scherek

Master's Projects and Capstones

This paper examines the relationship between Adverse Childhood Experiences (ACEs), allostatic load, and the likelihood of women giving birth prematurely in the United States and Canada. I searched multiple databases exploring this association, identifying nineteen articles published between 2004 and 2024. The literature highlights that racism and discrimination are a cause of chronic stress, and that this stress, and implicit bias, are both implicated in preterm birth. While ACEs scores have been found to be associated with preterm birth, the results for allostatic load are mixed. The results suggest that more attention should be paid to mitigating the stress associated …

Addressing The Increased Prevalence Of Gestational Diabetes Among Hispanic/Latino Pregnant Persons In The Central Valley Of California, Kathleen Janise Farrell Wardell

Master's Projects and Capstones

Gestational Diabetes (GDM) is a preventable noncommunicable disease that has been on the rise over the last 60 years. Pregnant persons with gestational diabetes are 10 times higher of acquiring Type 2 Diabetes after pregnancy (Ionannou et al., 2024). There is an urgent need to address this public health threat because of its increase in mortality. To address this complex chronic disease, this literature review explored multi-level interventions using the socioecological model to mitigate GDM in the Central Valley’s, Tulare County. Tulare County is disproportionately affected by chronic diseases like diabetes especially among the Hispanic and Latinx communities. Therefore, it …

Impact Of Temperature On Children’S Nutrition: A Comparative Study Of Three Ecological Regions Of Nepal, Prakriti Shakya

Master's Theses

Nutrition obtained during the growth period of childhood significantly influences long-term well-being and overall productivity, ultimately contributing to the economy of a society. However, weather shocks can wreak havoc by damaging crops, changing yields of important crops and disrupting market access, which directly impacts the food intake of both adults and children. When these adverse events occur during childhood, short term and long term inadequacy in nutrition as well as disease incidence can cause malnutrition leading to stunted growth and cognitive impairment that may persist into adulthood, affecting the labor market and increasing health expenditure. To address this issue, we …

Chronic Lower Back Pain Among Women In India: Evidence-Based Approach To Risk Factors And Interventions, Aelita Matosova

Master's Projects and Capstones

Chronic lower back pain (CLBP) is a prevalent issue worldwide, affecting about 1.71 billion people, with a significant proportion being women. CLBP is a major health concern in India, particularly among women, which were 80% reported experiencing this condition. Several factors, such as personal beliefs, sociocultural norms, restricted healthcare access, repetitive movements, and psychological aspects, contribute to this high prevalence leading to severe health and economic implications, including reduced work productivity and income. Although there have been several reports on prevalence and risk factors of CLBP, to our knowledge, there has not been enough work focusing on evidence-based interventions to …

‘Safe Couch, Safe House’ Program (Scshp): Reducing Exposure To Toxic Flame Retardants For Children In A Low-Income Public Housing At Hunters View, Bayview-Hunters Point, San Francisco., Aliza Khan

Master's Projects and Capstones

Since the 1970s, flame retardants have been used extensively in consumer goods, including furniture, textile, and electronics, to meet California’s flammability standards. (Gibson et al.,2019) Polybrominated Diphenyl Ethers (PBDEs), once the most widely used flame retardants being used in consumer products, were phased out from use in manufacturing as evidence emerged about PBDEs persistence and toxicity. (Hoffman et al.,2017) PBDEs were replaced by Organophosphate Flame Retardants (OPFRs), which has proven to be a case of ‘regrettable substitution’ as exposure to OPFRs is ubiquitous and pervasive in humans due to their volatility and propensity to leach from products into the environment. …

A Public Health Educational Campaign For Sudden Unexpected Infant Death (Suid) Intervention, Elia G. Peralta Landeros

Master's Projects and Capstones

Purpose: The rate of infant mortality serves as a crucial indicator of the overall health of society (CDC, 2022). The five leading causes of infant mortality are birth defects, preterm birth, sudden infant death syndrome, injuries, and maternal pregnancy complications. The prevalence of infant mortality varies across states, with eastern states and minority-ethnicity infants having higher prevalence. This thesis proposes utilizing the Safe to Sleep framework to introduce Giving Breath, a public health education campaign that introduced breastfeeding as an intervention to Sudden Unexpected Infant Death (SUID).

Methods:

1. Analyze current and new policies' impact on women's rights to breastfeed …

Meet Me In The Middle: A Scoping Review On Understanding Adolescent Needs In Climate Communication, Gwendolyn Monica Hoff Anderson

Master's Projects and Capstones

The greatest effects of climate change are likely to be felt by youth. Young people are disproportionately affected by climate change due to their critical developmental stage and lack of power, and they experience both higher severity and prevalence of mental health issues related to climate change. Strong emotions have long been recognized as potential catalysts for action, or they may lead to paralyzing feelings of being overwhelmed. Climate communication is a critical tool to spark climate concern and encourage action. Activism, in turn, may help youth manage their anxiety about climate change. This scoping review examines emerging evidence on …

Building Sustainable Environmental Activism Programs For Youth, Aminah Habib

Master's Projects and Capstones

As the negative impacts of climate change become more and more common across the United States, many youth are experiencing eco-anxiety or other negative mental health impacts due to the state of the environment. Engaging with activism has been named as a potential mitigator of the negative impacts of climate change among youth, but the relationship between activism and youth well-being is an emerging area of research. To explore this relationship, this scoping review explored and synthesized available literature to inform the next steps. In addition to the community-level and society-level contributions that come from youth activism, there are also …

Observational Study Of The Clinical Performance Of A Public-Private Partnership National Referral Hospital Network In Lesotho: Do Improvements Last Over Time?, Nancy A. Scott, Jeanette L. Kaiser, Brian W. Jack, Elizabeth L. Nkholongo, Allison Juntunen, Tshema Nash, Mayowa Alade, Taryn Vian

Nursing and Health Professions Faculty Research and Publications

Public-private partnerships (PPP) may increase healthcare quality but lack longitudinal evidence for success. The Queen ‘Mamohato Memorial Hospital (QMMH) in Lesotho is one of Africa’s first healthcare PPPs. We compare data from 2012 and 2018 on capacity, utilization, quality, and outcomes to understand if early documented successes have been sustained using the same measures over time. In this observational study using administrative and clinical data, we assessed beds, admissions, average length of stay (ALOS), outpatient visits, and patient outcomes. We measured triage time and crash cart stock through direct observation in 2013 and 2020. Operational hospital beds increased from 390 …

Child Health In Darfur, Sudan: Addressing The Effects Of Armed Conflict On Children's Health In Darfur, Judith Natukunda

Master's Projects and Capstones

ABSTRACT

Background: For 19 years, the Darfur region of Sudan has experienced unending civil unrest and war, resulting in more than 2 million deaths and over 4 million displaced persons. The war led to severe food insecurity, clean and safe drinking water shortages, high disease prevalence, destruction of infrastructure, and a broken health care system. Despite the interventions by the global community and various humanitarian agencies, over 2.8 million people are still displaced and living in IDP camps across Darfur. Over 300,000 children are living in neighboring Chad. The armed conflict led to high levels of child malnutrition, a high …

Standardizing Perinatal Mental Health Interventions: A Guide For The U.S., Maile Lauren Robles

Master's Projects and Capstones

The term perinatal individual refers to women and other individuals who are pregnant or who have been pregnant within the last 12 months. Every year, in the United States there are 700 pregnancy-related deaths and 10% are due to mental health causes including death by suicide. Mental health conditions including but not limited to anxiety, depression, substance use disorders, and post-traumatic stress disorder affect one in five perinatal individuals throughout the United States. This increases perinatal morbidity, hospitalization costs, and economic burden nationwide.

After 43 days postpartum, mental health conditions are the second leading cause of death. The United States …

No One Should Have To Give Birth Alone: An Analysis Of The Efficacy Of Community-Based Doula Programs Serving Ethnic Minorities In San Francisco, Maria Margaret Nelson

Master's Projects and Capstones

Adverse birth outcomes for both the parent and the child disproportionately affect people of color. Evidence demonstrates that one of the ways to mitigate these negative consequences is through the utilization of a doula, a trained birth companion that is not a medical provider but whose role it is to physically and emotionally support the patient through pregnancy, birth, and postpartum. Community-based doula programs, where the doula is of the same cultural background as the client, are particularly effective in improving birth outcomes in communities of color by providing culturally competent care and helping to navigate a healthcare system that …

The Child Care Crisis: Through The Social Ecological Lens, Jocelyne Saldana

Master's Projects and Capstones

Abstract

Objective - Working mothers face mental strain when returning to work due to the challenges of the current child care system. It is unclear how the instability of the child care sector impacts the mental health of working mothers.

Methods - The systematic review of literature was conducted to identify existing evidence to determine the influence access to quality, dependable, and affordable child care has on maternal mental health outcomes in working mothers. Multiple databases were used including PubMed and Scopus.

Results - Subsidized programs help reduce the cost of child care, however, income eligibility criteria makes it difficult …

Ask Your Doctor About: Prescribing Activism For Eco-Anxiety In Adolescents, Lexi Nutkiewicz

Master's Projects and Capstones

Climate change is an ongoing public health crisis. Efforts to protect future generations' physical and mental health are more urgent than ever. Youth, in particular, are experiencing eco-anxiety, a specific form of anxiety relating to stress or distress caused by environmental changes and one’s knowledge of them due to the climate crisis. This scoping review provides a better understanding of the value of youth climate change activism as a strategy to mitigate eco-anxiety. This review evaluates the current definitions of eco-anxiety, the risk factors for eco-anxiety among adolescents, and considers the benefits and drawbacks of youth activism. To identify relevant …

Utilizing Training And Educational Materials To Increase Hand Hygiene Compliance Of Healthcare Providers Participating In Cesarean Sections, Christopher Natividad

Master's Projects and Capstones

Surgical site infections (SSIs) are one of the most common complications of Cesarean section (C-section) procedures. The incidence of SSIs after C-section procedures at Hospital X has increased in each of the past three years. The Labor and Delivery (L&D) unit at Hospital X performs approximately 4,500 C-sections each year. Observation of these procedures illustrated a lack of adhesion to hand hygiene policies and protocols. This quality improvement project involved informing staff members of the poor hand hygiene compliance rates, and re-educating them regarding proper hand hygiene behavior using flyers, emails, and addressing them at shift change. Data collection focused …

Reducing The Postpartum Readmission Rate With Standardized Discharge Teaching, Darlene Day-Herzog

Master's Projects and Capstones

Problem: Hospital readmission rates are one of the quality metrics that matter for hospital reimbursements. In a large Northern California healthcare system, the postpartum readmission rate is often above the national average.

Context: The hospital designated as the main location for high-risk deliveries within a 30-mile radius has an Acute Care Obstetric postpartum population where twenty percent of the patients are at an increased risk for readmission.

Interventions: The project implemented the use of a standardized discharge teaching script and educational materials to be used by nursing staff throughout the patient’s hospital stay to see if multimodal standardization leads to …

Mindfulness-Based Cognitive Therapy Staff Training Program To Tackle Postpartum Depression, Helen Xumin Chen

Doctor of Nursing Practice (DNP) Projects

Abstract

Background: Women in the process of childbirth go through significant physical and psychological changes. The internal changes along with other external factors can be overwhelming. There is a high rate of new mothers suffering from postpartum depression (PPD) as a result. Problem: High prevalence of PPD is a public health crisis. The condition has a negative impact on the mother-baby unit and the wellbeing of the whole family. Aside from the implications on the health of new mothers and babies, PPD is also costly to the economy. Methods: Mindfulness-Based Cognitive Therapy (MBCT) is a common and effective intervention for …

Perinatal Substance Use Screenings In Marin County: A Brief Overview Of Screening Protocols And Identifying Gaps In Care, Breanna Wiliams

Master's Projects and Capstones

Introduction

Perinatal substance use continues to be a major public health issue in women’s health. The purpose of this study was to determine the frequency of substance use screenings in care and assess how well the existing services in Marin County are serving the needs of pregnant and parenting women and identifying the gaps and/or weaknesses in current practice.

Methods

Data for this study was collected via semi-structured interviews with five professionals that worked at the local community clinic, hospital and a non-profit agency. Some questions were slightly modified to be configured toward the participant’s specific profession.

Results

Results from …

Perinatal Anxiety And Depression During The Covid 19 Pandemic, Helen Xumin Chen, Nancy Selix, Marcianna Nosek

DNP Qualifying Manuscripts

Abstract

The novel coronavirus disease 2019 (COVID-19) outbreak places perinatal women at higher risk of developing anxiety and depression. Uncertainty, fear, and confusion in medical, social, economic, occupational and political aspects of life in the US add to existing stressors that perinatal women experience. To optimize the quality of perinatal care during the pandemic, appropriate mental health interventions must be implemented to prevent and alleviate perinatal anxiety and depression and improve maternal and infant outcomes. Measures include increased screening, non-pharmacologic and/or pharmacologic interventions and the use of telehealth for care delivery.

Keywords: perinatal anxiety, perinatal depression, COVID-19, SARS CoV-2, maternal …

A Qualitative Exploration Of Community Ownership Of A Maternity Waiting Home Model In Rural Zambia, Constance P. Fontanet Mph, Rachel M. Fong, Jeanette L. Kaiser, Misheck Bwalya, Thandiwe Ngoma, Taryn Vian, Godfrey Biemba, Nancy A. Scott

Nursing and Health Professions Faculty Research and Publications

Context

Ownership is an important construct of sustainability for community-based health programming, though it is often not clearly defined or measured. We implemented and evaluated a community-driven maternity waiting home (MWH) model in rural Zambia. We engaged stakeholders at all levels and provided intensive mentorship to an MWH governance committee comprised of community-selected members. We then examined how different stakeholders perceive community ownership of the MWH.

Methods

We conducted 42 focus group discussions with community stakeholders (pregnant women, fathers, elders, and community health volunteers) and 161 in-depth interviews with MWH stakeholders (health facility staff, district health officials, and MWH governance …

Using Open Public Meetings And Elections To Promote Inward Transparency And Accountability: Lessons From Zambia, Taryn Vian, Rachel M. Fong, Jeanette L. Kaiser, Viviane Sakanga, Melvin Mwansa, Parker S. Chastain, Thandiwe Ngoma, Nancy Scott

Nursing and Health Professions Faculty Research and Publications

Background
Community-led governance can ensure that leaders are accountable to the populations they serve and strengthen health systems for maternal care. A key aspect of democratic accountability is electing respective governance bodies, in this case community boards, and holding public meetings to inform community members about actions taken on their behalf. After helping build and open 10 maternity waiting homes (MWHs) in rural Zambia as part of a randomized controlled trial, we assisted community governance committees to plan and execute annual meetings to present performance results and, where needed, to elect new board members.

Methods
We applied a principally qualitative …

Black Pregnancy Matters: Racial Reproductive Bias In African American Maternal Mortality, Juhi Khemani

Master's Projects and Capstones

This semester-long research project uncovers how racial biases demonstrated in the reproductive health field, and specifically before, during, and after childbirth, affect the rate of maternal mortality and morbidity for African American mothers in the United States. The rate of maternal mortality for this specific racial group is four times greater as compared to Caucasian women and this discrepancy will be investigated and analyzed throughout this capstone thesis. Interviews were conducted with key figures in the obstetric and gynecological field as well as with Black mothers themselves in an effort to uncover what factors, aside from medical anomalies, are leading …

Evaluating Implementation Effectiveness And Sustainability Of A Maternity Waiting Homes Intervention To Improve Access To Safe Delivery In Rural Zambia: A Mixed-Methods Protocol, Elizabeth G. Henry, Thandiwe Ngoma, Jeanette L. Kaiser, Rachel M. Fong, Taryn Vian, Davidson H. Hamer, Peter C. Rockers, Godfrey Biemba, Nancy A. Scott

Nursing and Health Professions Faculty Research and Publications

Background: In low-income countries such as Zambia, where maternal mortality rates are persistently high, maternity waiting homes (MWHs) represent one potential strategy to improve access to safe delivery, especially for women living in remote areas. The Maternity Homes Access in Zambia project (MAHMAZ) is evaluating the impact of a MWH model on women’s access to safe delivery in rural Zambia. There is a growing need to understand not only the effectiveness of interventions but also the effectiveness of their implementation in order to appropriately interpret outcomes. There is little evidence to guide effective implementation of MWH for both immediate uptake …

Out-Of-Pocket Expenditure For Home And Facility Based Delivery Among Rural Women In Zambia: A Mixed-Methods, Cross-Sectional Study, Jeanette L. Kaiser, Kathleen L. Mcglasson, Peter C. Rockers, Rachel M. Fong, Thandiwe Ngoma, Davidson H. Hamer, Taryn Vian, Godfrey Biemba, Jody R. Lori, Nancy A. Scott

Nursing and Health Professions Faculty Research and Publications

Purpose: Out-of-pocket expenses associated with facility-based delivery are a well-known barrier to health care access. However, there is extremely limited contemporary information on delivery-related household out-of-pocket expenditure in sub-Saharan Africa. We assess the financial burden of delivery for the most remote Zambian women and compare differences between delivery locations (primary health center, hospital, or home).

Methods: We conducted household surveys and in-depth interviews among randomly selected remote Zambian women who delivered a baby within the last 13 months. Women reported expenditures for their most-recent delivery for delivery supplies, transportation, and baby clothes, among others. Expenditures were converted to …