Health Policy Commons^™

Gender And Disability: An Exploration Of Reflective Practice For Protection And Access Amid Complex Emergencies, Lindsey A. Mandolini

Electronic Theses and Dissertations

Gender and Disability: An Exploration of Reflective Practice for Protection and Access Amid Complex Emergencies is a qualitative research project exploring under what conditions and in what ways disabled persons’ organizations (DPOs) effectively protect and provide access to women and girls with disabilities amid complex emergencies. The study upheld a participatory approach and rights-based framework, emphasizing that authentic inclusion requires centering disabled voices in research. Drawing on extant research, grey literature, and data collected from online practitioner questionnaires and semi-structured interviews, the study conducted a multi-phased reflexive thematic analysis. The research findings culminate in a composite narrative that brings to …

Assessing The Influence Of Gender Equity In The Us State Legislatures On Prenatal Healthcare Utilization, Prachi Joshi

Electronic Theses and Dissertations

Prenatal care is crucial for achieving public health and primary healthcare objectives. It is one of the goals of Healthy People 2030, which is the US federal initiative to improve the health and well-being of people nationwide. Unfortunately, despite the lofty goals, the United States has the highest maternal mortality rate among developed countries. In 2020, the maternal mortality rate in the US was 24 deaths per 100,000 live births, more than three times the rate in most high-income countries. What is concerning is that it is getting worse. Seven hundred women die of pregnancy-related complications. Among them, black and …

The Purple Heart And Suicidal Behaviors In Post-9/11 U.S. Army Combat Veterans With A Traumatic Brain Injury: A Mixed Methods Study, Jayna Moceri-Brooks

Electronic Theses and Dissertations

Military suicide rates remain high, despite years of targeted efforts to prevent suicide. Specifically, Army Combat Veterans who sustained a traumatic brain injury (TBI) while deployed in support of the Global War on Terrorism are at the highest risk for suicide. This dissertation highlights possible causes for suicidal behaviors within this unique group and provides specific military suicide prevention recommendations. The dissertation is organized into three publishable manuscripts: The first manuscript (Chapter 1) is a mixed-methods dissertation research proposal written according to the National Institute of Health proposal guidelines. The second manuscript (Chapter 2) is an integrative review of the …

Weathering The Storm: Navigating Urban Ecologies Of Communication In Times Of Crisis, Austin Hestdalen

Electronic Theses and Dissertations

This project explores cities as urban ecologies of communication in which crises emerge and are given significance within the dialogic relations cultivated among public actors attempting to make a living, together, within the shared historical-cultural contexts of everyday life. To describe cities as urban ecologies of communication is to describe them in terms of urban communication and its interdisciplinary foundations in the study of rhetoric, philosophy, planning, policy, architecture, sociology, geography, and media. The first chapter introduces the challenges of urban risk and crisis management within the complex ecologies of communication constituted by cities and reviews how ‘risk’ and ‘crisis’ …

Emergency Care For Youth Who Experience Suicidality And Identify As Lesbian Gay Bisexual Transgender Queer/Questioning (Lgbtq+): An Interpretive Phenomenology, Theresa Schultz

Electronic Theses and Dissertations

Purpose: Suicide is a leading cause of death in children; youth who identify as LGBTQ+ are at an exponentially higher risk of suicide. The purpose of this study was to explore the lived experiences of young adults who identify as LGBTQ+ and sought emergency care for suicidality when they were adolescents.

Methods: Heideggerian hermeneutics phenomenology is the research method used in this study. Youth, ages 18-25 years, who identify as LGBTQ+ and sought emergency treatment for suicidality when they were adolescents (13-17 years) were recruited to participate;fifteen youth enrolled. Individuals ranged in age from 20 to 25 years. Participants described …

Meeting The Mental Health Needs Of College-Aged Young Adults: Evaluating The Value And Impact Of Digital Mental Health Interventions., Sara Atherton Choate

Electronic Theses and Dissertations

BACKGROUND: The growing prevalence of common mental health problems poses a serious hindrance to young adults, and the majority of those in need of mental health support do not seek professional psychological services. Digital mental health interventions (DMHIs) that allow for self-management of mental health symptoms could provide a useful adjunctiveto traditional one-on-one counseling or therapy and offer a useful prevention tool for students at risk for experiencing mental health crises. This dissertation explored the efficacy of self-guided DMHIs targeting college students, the factors associated with help-seeking in young adults, and the impact of implementing an evidence-based DMHI at a …

Nurses Leading In Bridging The Culture Gap: Communicating With The Deaf Community, Veronica C. Leftridge

Electronic Theses and Dissertations

Nurses provide patient care in clinics, hospitals, homes, churches, schools, communities, and military, as well as on emergency medical helicopters. When a nurse is assigned to care for a patient, the patient expects the nurse to be culturally competent, communicate effectively, and provide safe quality care. However, cultural incompetence is observed when nurses provide care for Deaf patients, but they are unfamiliar with Deaf culture. In addition, communication is a fundamental skill nurses learn in nursing school, but course content in nursing programs rarely touches on how to communicate effectively with Deaf patients. Of the approximately 325 million people in …

Where Virtual Well-Being Becomes Reality, Colleen M. Reilly

Electronic Theses and Dissertations

Strategies to mitigate the spread of COVID-19, specifically quarantine and social distancing protocols, have exposed a troubling paradox: mandated isolation meant to save lives has inadvertently contributed to a decline in America’s well-being. Prolonged isolation due to more remote work and decentralized workplaces has been associated with widespread loneliness and diminished physical and mental health, with effects compounded by limited face-to-face access to social support systems. While remote communication technologies (e.g., video chat) can connect individuals with colleagues and social networks, remote technologies might have limited effectiveness in business and social contexts. This study uses Roger’s Diffusion of Innovation Theory …

Exploring The Relationship Between Historical Redlining And Place-Based Reproductive Health Inequities: A Qualitative Gis Approach, Kristi L. Roybal

Electronic Theses and Dissertations

Individual-level risk factors and characteristics do not fully explain racial, ethnic, and socioeconomic inequities in preterm birth in the United States, and evidence suggests that medical advancements, increased access to prenatal care, and high per-capita spending on health care have done little to reduce these inequities. Health inequities research has shifted its attention from individual-level factors that influence health outcomes to the social determinants of health. Neighborhoods, considered an important upstream social determinant of health, can influence health outcomes through their social, service, and physical environments, and have been consistently linked to birth outcomes. Despite increased attention to neighborhood influences …

States' Public Health Funding And Population Health Outcomes: An Examination Through A Socio-Ecological Lens, Maureen K. Akubu-Odero

Electronic Theses and Dissertations

The US public health system has been underfunded for decades, despite its significant mandate of improving overall population health outcomes. This ecological study evaluates the association between state public health funding and population health outcomes and the role of state public health funding in reducing state-level health disparities. The findings show that the relationships between public health investments and improvements in health outcomes and health disparity in states are moderated by socioeconomic contextual factors. The findings suggest a need for continued and increased public health investments, tailored to community needs and context

A Mixed-Methods Analysis Of Abortion Attitudes And Perceptions Among Women Living In Alabama And South Carolina, Anthony Peluso

Electronic Theses and Dissertations

Legal induced abortion is a safe option for terminating a pregnancy for women of reproductive age in the United States (U.S.), though access has varied since the Roe v. Wade and Doe v. Bolton cases in 1973. Information is lacking on women’s attitudes toward and perceptions of abortion as well as on related constructs such as pregnancy attitudes and contraceptive use. Exploring these constructs is important in that it can provide much needed context to women’s reproductive life planning. This research aimed to explore perceptions of abortion access and safety and examine the potential associations between attitudes toward abortion access …

Peer Verbal Sexual Harassment In Early Adolescence: A Feminist And Sexual Scripts Theoretical Approach., Shawn M. Rolfe

Electronic Theses and Dissertations

Until recently, sexual harassment research has focused primarily on adults and college and high school students with little attention given to younger students. While recent research has noted sexual harassment occurs among younger students, the literature addressing sexual harassment among middle school students is still sparse. Additionally, most studies of sexual harassment have focused on sexual harassment generally, with no distinction made between verbal and sexual harassment. In fact, only limited research has been exclusively conducted on verbal sexual harassment. Using self-report data, the current study adds to the literature by examining the nature of verbal sexual harassment as well …

Poverty In The United States: An Analysis Of Its Measurement And The Long-Term Social And Economic Costs, Abby Magnus

Electronic Theses and Dissertations

This thesis examines the role of poverty in the United States and how it has impacted social and economic systems. It explores how U.S. poverty measurements developed in the 1960s may not be accurately measuring poverty now, and the ways in which these measures could be improved upon. This work also reviews literature on health and educational inequities stemming from socioeconomic class, and the role these play in long-term economic mobility. Finally, it analyzes how larger social institutions like mass incarceration and capitalism have developed around poverty, and the role they play in maintaining its prevalence today. This thesis finds …

Racial Differences In Factors Influencing Childhood Overweight And Obesity In The Us, Brendan C. Ibe

Electronic Theses and Dissertations

Background: Childhood overweight and obesity in the US has persisted as a serious public health concern despite efforts to address it. Children today are now estimated to live shorter life expectancy than their parents due to the consequences of childhood overweight and obesity. The earlier focus on healthy diets and an increase in physical activity have proved inadequate in reversing the trend. Using the social ecologic model (SEM), this study assessed the ecological and behavioral influences on childhood overweight and obesity among Non-Hispanic white, Non-Hispanic black, and Hispanic children. Methods: The study data were derived from the 2016 National Survey …

Naloxone Availability In Georgia Retail Pharmacies 44 Months After Implementation Of A Statewide Standing Order, Enjoli Willis

Electronic Theses and Dissertations

Opioid overdose deaths have quadrupled since 1999. Georgia is one of 35 states with a significant increase in drug overdose deaths from 2013 – 2017, with deaths increasing by 70% during 2010-2018. Many states, including Georgia, have implemented naloxone standing orders to remove barriers to access to naloxone, an opioid overdose reversal drug that reverses opioid overdose symptoms. However, it is still not readily available in places where it is most needed. This research investigates naloxone availability in Georgia 44 months after the implementation of a statewide standing order. This research also seeks to determine if pharmacy and community-level factors …

The Ethical Justification Of Increasing Awareness Of Preventive Medicine Among Healthcare Professionals, Patients And The General Public In The United States, Karishma Ether Moazzam

Electronic Theses and Dissertations

While practiced for centuries, preventive medicine has received increased attention during the recent times. Preventive medicine has a distinct mission to protect, promote, and maintain health as well as to prevent diseases, disabilities, and premature deaths. It aims to fulfill its mission through the combined form of clinical intervention and health promotion. In the recent years, preventive medicine has begun to lean more towards the clinical interventions, taking away from the health promotion. This imbalance has caused preventive medicine to lose its effectiveness in fulfilling its mission. One of the leading causes for such imbalance is the lack of proper …

Comparative Spending Of Medicaid Dollars On Child Participants Of Kentucky’S Sobriety Treatment And Recovery Teams Program Versus A Matched Comparison Group., Matthew Thomas Walton

Electronic Theses and Dissertations

Child protective services agencies have long observed the complicating role that parental substance use and addiction plays in cases of child maltreatment. Families who struggle with these problems present unique challenges for child welfare professionals. These families are typically more difficult to engage, more likely to have children removed from the home, and have poorer outcomes when compared to other families. These poorer outcomes often include health problems. Addiction has well-known effects on health, and the specific manifestations of these problems for parents have been documented for years in child protection casework. However, what has been less investigated are the …

Wellness Policy Awareness Among School Leaders And The Impact On Written Policy Scores, Mariah Reil

Electronic Theses and Dissertations

Background: All schools participating in the National School Lunch Program must possess a written School Wellness Policy (SWP) as mandated by the Healthy, Hunger- Free Kids Act of 2010.1 School officials and leaders play a major role in SWP implementation. It is essential to written SWP implementation that school level officials and leaders in the district are aware of the SWP. However, the association between school leader awareness of SWP and policy quality has not yet been studied.
Purpose: The purpose of the present study was to determine if school leader awareness of a SWP impacts the written SWP quality. …

Does Medicaid Increase Emergency Room Use: Evidence From Oregon Health Program?, Md Fourkan

Electronic Theses and Dissertations

This thesis paper strives to identify the relationship between Medicaid expansion and Emergency Department use. I use a Monte Carlo simulation for demonstrating the endogeneity problem and a copula model using the Oregon Health Program (OHP) data to show the previous literature has exaggerated the causal relation between Medicaid expansion and Emergency Department use. This paper can be divided into two parts. First, it tries to focus on the under-identification of multiple endogenous variables problem in typical econometrics papers, where researchers correct for a single endogenous variable but intentionally or unintentionally ignore the endogeneity of one or more other independent …

Prevention Of Violence Against Children: A Systems Readiness Assessment In Côte D’Ivoire, Marie-Kaye Soletchi Seya-Sery

Electronic Theses and Dissertations

Violence against children (VAC) is a global problem with significant consequences. Recognizing the need to better understand the problem of VAC in Côte d’Ivoire (CI), the government of CI recently completed a survey on violence against children. The recent data will support an evidence-based national action plan for the prevention of VAC. Research shows that initiatives tackling specific problems will only be as successful as the community’s readiness to take action. This study applied the community readiness model to assess the readiness of the multisectoral task force (MSTF) to implement the national action plan in CI. Eight MSTF participants’ interview …

Let Me Upgrade You: Common Measures In Public Health Accreditation Action Plans, Gurleen K. Roberts

Electronic Theses and Dissertations

Objectives: The purpose of this study is to understand the success rates for health departments pursuing and achieving accreditation in version 1.0 and 1.5 of the Public Health Accreditation Board (PHAB) standards and measures. During the accreditation process, health departments that present performance gaps are asked to complete an Action Plan to specify how they plan to improve to meet the desired conformity. This study will highlight specific measures that are often included in Action Plans so that health departments pursuing accreditation can be better prepared to address these common pitfalls.

Methods: This study is a non-experimental, secondary …

The Core Relation Between Hospitality (Philoxenia), Dignity And Vulnerability In Orthodox Christian Bioethics: A Contribution To Global Bioethics, Rabee Toumi

Electronic Theses and Dissertations

In a pluralistic world, reaching consensus in matters of bioethics has proved to be difficult, especially with the political polarization that nurtures inimical differences. This dissertation argues that a middle ground can be identified between the plurality of value systems in contemporary bioethics based on an anthropological approach. This middle ground that reflects commonalities of the human condition can be explored in relation to the foundational principles of Orthodox Christian anthropology. To identify this middle ground the analysis discusses the core relation between hospitality, dignity, and vulnerability as a contribution to global bioethics.

In general, based on Orthodox Christian theology …

Cost Burden Of Social Isolation For Wheelchair Users In Louisville, Kentucky., Connie Light

Electronic Theses and Dissertations

Background: Social isolation is an important predictor for poor health status, chronic diseases, and healthcare utilization and costs. There is a growing number of Americans with one or more disabilities, and evidence suggests that many are also socially isolated. This is especially true for those with immobility, as the built environment including housing structures are not universally designed to be accommodating. Immobility describes those who use walkers, canes, or wheelchairs, with the latter suffering the most impact. The cost of social exclusion can be measured by the exacerbation of disease in wheelchair users, whose fragile health status and social networks …

Constructing And Validating An Integrative Economic Model Of Health Care Systems And Health Care Markets: A Comparative Analysis Of Oecd Countries, Jesse Helligso

Electronic Theses and Dissertations

This dissertation argues that there are three basic types of health care systems used in industrial nations: free market (private insurance and provision), universal (public insurance and private provision), and socialized (public insurance and provision). It examines the role of market forces (supply and demand) within the health care systems and their effects on health outcomes by constructing an integrative model of health care markets and policies that is lacking within the scientific and academic literature. The results show that, free market systems have decreased access to care, good quality of care, and are economically inefficient resulting in 2.7 years …

Social Media As A Healthcare Tool: Case Study Analysis Of Factors Influencing Pediatric Clinicians' Behavioral Intent To Adopt Social Media For Patient Communication And Engagement, Rachel Mustonen

Electronic Theses and Dissertations

Social media aids communication among users worldwide. However, a notable gap exist among social media users, healthcare professionals utilizing social media in the work place. While the concept of harnessing social media as a professional tool is not novel, healthcare professionals have yet to embrace the practice as standard workflow. This study identifies factors influencing clinicians' behavioral intent to adopt social media for patient engagement and communication. A new framework, the Healthcare Social Media Adoption Framework (HSMA), guided this mixed-method approach to assess 7 factors identified by theory and literature as adoption influencers. A custom, web-based survey collected data from …

Examining The Influence Of Personal And Environmental Factors On Treatment Outcomes In Opioid Dependent Medication-Assisted Treatment Patients., Vierne Placide

Electronic Theses and Dissertations

Opioid abuse has become a global epidemic and is now a huge public health concern here in the US. Non-medicinal use of opioid prescription drugs is at the forefront of the epidemic and considered the "gateway" drug to other illicit opioid use. As opioid prescribing has increased over the last decade in the US, so has opioid-related deaths, surpassing car accidents and suicide as the leading cause of injury-related deaths. Medication assisted treatment (MAT) is fundamental in decreasing opioid abuse overdose and mortality. Therefore, the research study aims to determine if counseling adherence, opioid abstinence, and retention in MATs are …

Risk In Privacy Breach Determination: The Application Of Prospect Theory To Healthcare Privacy Officers, Amanda Walden

Electronic Theses and Dissertations

A significant concern in healthcare is that of patient privacy and how organizations protect against unauthorized access to protected health information. The federal government has responded by instituting policies and guidelines on requirements for protection. However, the policy language leaves areas open to interpretation by those following the guidelines. Reporting to the Office for Civil Rights and/or the patient can open an organization to risk of financial and possible criminal penalties. There is a risk of harm to their reputation which could impact patient visits and market share. Therefore, Privacy Officers might view risk in different ways and therefore handle …

Interaction Between Income, Health Insurance, And Self-Rated Health: A Path Analysis., Atalie Ashley West

Electronic Theses and Dissertations

The political focus of equitable health outcomes in the United States have long centered on access to medical care. However, there is compelling evidence that access to medical care is only the bare minimum necessary to achieve health, and the true influence of health insurance on health is still unclear. Widely accepted models of health estimate that less than 20% of health outcomes can be attributed to clinical care, while greater than 50% is related to social and economic determinants of health, with income being the most consistent predictor. As a result, this study investigated whether earned income is related …

The Effect Of Registered Nurse Supply On Population Health Outcomes: A Distributed Lag Model Approach, Carla Jackie Sampson

Electronic Theses and Dissertations

Registered nurses (RNs) are essential to providing care in the healthcare system. To date, research on the relationship between healthcare provider supply and population health has focused on physician supply. This study explored the effect of RN supply on population health outcomes in the U.S. This is a retrospective, cross-sectional study of U.S. counties and county equivalents using national data. Seven population health outcomes (total and disease specific mortalities and low infant birth weight rate) were the response variables. The predictor variable, RN supply, and some control variables were anticipated to have an asynchronous effect on the seven outcome variables …

Access To Healthy Foods: A Descriptive Analysis Of Farmers’ Markets, Food Deserts & Usda Food Assistance Programs In Tennessee Census Tracts, Twanda D. Wadlington

Electronic Theses and Dissertations

Food deserts are a growing problem in the United States, and occur in areas of low-income where people have limited access to healthy foods. In response, the presence of farmers’ markets has grown exponentially, and improved healthy food access. Additionally, the USDA has strived to connect families to healthy foods through food assistance programs such as the Supplemental Nutrition Assistance Program (SNAP), the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC), and the Senior Farmers’ Market Nutrition Program (SFMNP). This study investigated the relationship between farmers’ markets, their acceptance of food assistance benefits, and their locations within Tennessee …