Rural Health Commons^™

Dfend: A Nutrition Education Intervention To Improve Food Budgeting, Shopping, And Meal Preparation Skills Among Adults In Arkansas, Samantha K. Edwards

Human Nutrition and Hospitality Management Undergraduate Honors Theses

Preventive strategies targeting modifiable lifestyle factors related to food, nutrition, and health are needed as chronic health conditions continue to rise. Nutrition literacy refers to having the knowledge and skills needed to obtain, understand, and apply nutrition information to make informed dietary decisions. Without adequate nutrition education and food security, vulnerable populations are at risk of malnutrition and poor dietary behaviors. Educational interventions that increase food literacy can help improve dietary choices and food selection skills.

The purpose of this creative project was to develop a nutrition education toolkit for Extension agents to implement among rural populations with low health …

Determinants Of Hypertension Awareness And Control In Kenya: A Secondary Analysis Of National Survey Data, Alexander K. Davis

Honors Theses

In low- and middle-income countries (LMICs), cardiovascular diseases (CVDs) are prevalent and pose a major concern as the current healthcare systems are oriented primarily towards communicable diseases. The largest contributor to CVDs, hypertension, is a significant issue in Kenya, a model LMIC. Based on previous studies in this lab, high rates of hypertension are present in the region of Kasigau, Kenya. Kasigau is a small region within Taita-Taveta County, Kenya. Traditional risk factors are not necessarily predictive of hypertension in all regions of Kenya. This study aims to address the lack of tested risk factors for hypertension in Kenya and …

Addressing Substance Use Disorder In Rural Appalachia: Improving Access And Treatment Outcomes For Justice-Involved Individuals, Jessica Muldowney

Electronic Theses and Dissertations

Background: Opioid use disorder (OUD) represents a critical public health crisis disproportionately affecting justice-involved (JI) populations, with approximately 65% of incarcerated individuals having substance use disorders (James & Beatty, 2006). Rural Appalachian communities face compounded challenges due to limited healthcare access, provider shortages, and cultural stigma surrounding addiction treatment. Despite evidence demonstrating that medication-assisted treatment (MAT) reduces recidivism and overdose deaths, only 20% of correctional facilities offer these services (Klein & Seppala, 2019).

Objective: This mixed-methods study evaluated organizational readiness and infrastructure capacity for implementing evidence-based OUD interventions, specifically MAT programs across three rural counties in northwestern North Carolina.

Methods: …

Improving Glp-1 Ra Initiation In Primary Care Through A Paper-Based Clinical Decision Support Tool, Carissa R. Bowery, Karen Carver

Epsilon Sigma at-Large Research Conference

Title: Improving GLP-1 RA Initiation in Primary Care Through a Paper-Based Clinical Decision Support Tool

Authors: Carissa R. Bowery, MSN, FNP-C; East Tennessee State University College of Nursing. Karen M. Carver, PhD, APRN, FNP-C; East Tennessee State University College of Nursing

This quality improvement project focuses on improving evidence-based pharmacologic management of adults with type 2 diabetes mellitus (T2DM) and obesity through implementation of a paper-based clinical decision support (CDS) tool in primary care. The aim is to increase initiation of glucagon-like peptide-1 receptor agonists (GLP-1 RAs) among eligible patients and improve provider adherence to current clinical guidelines.

Processes: This …

Medication Nonadherence And Social Participation For African American Adults With Low Vision, Shakeda Mcghee, Mary Jan Greer Phd, Otr, Jaimee Fielder

Spring 2026 OTD Capstone Symposium

The concept of this capstone is to analyze how quality of life (social participation, health management) is affected in adults ages 18-55 with low vision/blindness with conditions to include diabetic retinopathy, glaucoma, and cataracts.

Facilitators And Barriers To Mobile Health Unit Implementation: A Qualitative-Dominant Mixed Methods Study Exploring Staff Perspectives And Service Outreach, Kelsey Hardin

MUSC Theses and Dissertations

Background: Health disparities are linked to rising healthcare costs in the United States, particularly related to healthcare accessibility. Mobile Health Units (MHUs) have proven to be an effective intervention in reducing barriers to healthcare services, for example, providing early access to prenatal care, thus reducing infant mortality rates. This study focused on the facilitators and barriers to implementing an MHU program, based on staff perspectives and service outreach, to improve maternal and infant health outcomes.

Methods: This study employed a qualitative-dominant mixed-methods research design. Data was collected through interviews to assess staff perspectives. Secondary data analysis of quantitative data was …

Healthcare Systems & Policy Implications For The Impact Of State Medicaid Reimbursement Rates On Access To Primary Care Services In Rural Communities: Turning Knowledge Into Action, Miriam Martinez

Posters - 2026

• Where a child lives can determine whether they receive care or go without it. • Access to primary care is essential for prevention, early diagnosis, and treatment, but rural areas face persistent challenges such as provider shortages and geographic isolation. • Medicaid serves as the primary source of health coverage for low-income children; however, reimbursement rates vary by state and are often lower than other forms of insurance. • This study examines how Medicaid reimbursement policy contributes to disparities in access to care for rural children and reflects broader structural inequalities within the healthcare system.

Rural Health In Pike County: A Richard & Magnolia Community Health Needs Assessment, Victoria Bracey

Honors Theses

Rural communities across the United States suffer from poor health outcomes due to lack of resources and other compounding factors that make access to quality healthcare difficult. Mississippi is a predominantly rural state, and in the southwestern region of Mississippi lies the community of Magnolia and the community of Richard within Pike County. To better understand the health needs of Pike County, a community health needs assessment was conducted. This study aimed to assess the needs of Pike County in southwest Mississippi through the use of a community health needs assessment using focus groups. Two focus groups, with a total …

Overcoming Challenges With Rural-Related Health Data: Lessons Learned From Published Studies, Casey P. Balio, Margaret M. Francisco, Nicole Galler, Olivia A. Sullivan, Kate E. Beatty, Michael E. Meit, Chyanne Morrison, Christiana Keinath, Stephanie M. Mathis

ETSU/NORC Rural Health Research Center Policy Briefs

No abstract provided.

Victimization, Health, And Help Seeking In North Dakota: How Interpersonal Violence Shapes Physical And Mental Health, Tahmid Hassan Jeeshan

Graduate Research Achievement Day Posters

Interpersonal violence extends beyond physical assault to include psychological and/or emotional abuse that can produce substantial physical and mental health consequences. This study examines how multiple forms of interpersonal violence relate to health outcomes among North Dakotan women, focusing on differences between rural and non rural residents. We compare victimization patterns, physical and mental health status, and treatment seeking behaviors. We anticipate that rural victims will report more severe or chronic victimization yet face reduced access to and use of healthcare and victim services. By jointly considering violence type, rural versus non-rural status, health outcomes, and treatment seeking, this project …

Key Predictors Of Postpartum Depression And Anxiety Symptoms Among Mothers In Kilifi, Kenya: A Machine Learning Approach, Faith Benson, Rachel Odhiambo, Willie Brink, Anthony Ngugi, Akbar Waljee, Eileen Weinheimer-Haus, Cheryl Moyer, Ji Zhu, Amina Abubakar

Institute for Human Development, East Africa

Background:

The burden of maternal postpartum depression and anxiety is disproportionately high in sub-Saharan Africa (SSA), yet the use of advanced analytical methods to capture the complex interplay of variables influencing these conditions remains underexplored.

Objective:

To apply machine learning (ML) methods to predict depressive and anxiety symptoms in postpartum mothers and to identify key and actionable predictors.

Methods:

This cross-sectional study included 1,995 biological mothers of singleton infants aged 0–6 months, using survey data collected between March 2023 and March 2024 in Kaloleni and Rabai sub-counties, Kilifi County, Kenya, within the Kaloleni–Rabai Health and Demographic Surveillance …

Examining Rural Population Characteristics And Access To Care In 2022: A Study Of Health Professional Shortage Areas (Hpsas) And Medically Underserved Areas (Muas), Craig Holden, Shena Popat, Rachel Van Vleet, Shalanda Henderson, Carina Hoyer, Alana Knudson

ETSU/NORC Rural Health Research Center Policy Briefs

No abstract provided.

An Examination Of All-Payer Inpatient Rural Hospital Bypass, Craig D. Holden, Shena Popat, Alana Knudson, Marilyn G. Klug

ETSU/NORC Rural Health Research Center Policy Briefs

No abstract provided.

Social, Environmental And Policy Contexts Affecting The Feasibility And Acceptability Of Improving Household Flooring For Better Health In Rural Kenya, Ulrike Fillinger, Victoria Ochwal, Hugo Legge, Sharon Muli, Karisa Kazungu, Carlos Mcharo, Jacinta Mwongeli, Charles Mwandawiro, Katherine Halliday, Doris Njomo

Institute for Human Development, East Africa

Background Homes with unimproved floors (earth, sand, or clay) are associated with increased risks of soil-transmitted parasites and enteric infections, leading to higher morbidity and reduced quality of life. This study explored the enablers and barriers to adopting improved flooring (sealed, washable, and durable) in three culturally diverse regions of Kenya - Narok, Bungoma, and Kwale - to mitigate disease burdens.

Methods Between August 2021 and July 2022, we conducted 24 focus group discussions with homeowners, stratified by age, gender, and floor type. Additionally, 28 key informant interviews with local government officials, microfinance representatives, and masonry trainers in Kwale and …

Sexually Transmitted Infections And Screening: An Educational, Evidence-Based, Quality Improvement Bundle, Misty D. White

Doctor of Nursing Practice (DNP) Scholarly Projects - Archive

Background: With sexually transmitted diseases on the rise in central Texas, advance practice providers were not following evidence-based practice recommendations for sexually transmitted infection screening, treatment, and follow-up. Screening for sexually transmitted diseases occurred at a rate of less than one patient every 7.75 days.

Objective: The objective of this project was to develop and implement an advanced practice provider training tool to educate the clinic providers on sexually transmitted infections, collect pre- and post-data for the educational sexually transmitted infection bundle, and collect sexually transmitted infection screening, identification, treatment, and follow-up data generated by the clinic advanced practice providers …

Child Poverty And Nutritional Health In Rural And Non-Rural Ohio Counties, Viraj Chegu, Macy Puthoff

Scholarship in Medicine - All Papers

Child poverty is an ongoing issue in the United States, placing children at a risk of nutritional deficits. While community interventions and reduced price school lunch programs have improved food insecurity outcomes for children, there is limited knowledge of how these programs can alleviate potential health problems in rural versus urban areas. Thus, this project aims to compare various variables such as food environment index, food insecurity, and enrollment in reduced price school lunch among counties in Ohio of different poverty levels as well as whether the counties are rural or nonrural. Methods: Factors such as food insecurity, food environment …

Purchasing A Healthier Future: A Nutrition-Focused, Community-Centered Approach To Reduce Obesity And Diabetes In Graves County, Kentucky, Marissa Stephens

Theses and Dissertations--Public Health (M.P.H. & Dr.P.H.)

Obesity and type 2 diabetes are among the most significant public health challenges in the United States, with Kentucky consistently ranking among the states with the highest prevalence of both conditions. Together, these conditions contribute to reduced quality of life, rising healthcare costs, and increased morbidity and mortality, underscoring the need for targeted, community-centered interventions. The disease burden of obesity and diabetes is particularly pronounced in rural areas, including the state’s westernmost region, the Jackson Purchase. Among rural populations, chronic disease risk is driven by a combination of factors, including low socioeconomic status, limited access to healthcare/supermarket options, and food …

Feeding Missoula: Food Insecurity In Rural Children And Youth, Chani Brammer, Braelee Cheeks, Jordin Holland, Rayne Mccollough, Laurel Palmer, Therese Solomon

Undergraduate Theses, Professional Papers, and Capstone Artifacts

In Montana, approximately one in seven children live in a food-insecure household, with rural Montanans in particular facing significant barriers. Existing needs-based food assistance programs, such as SNAP and WIC, have structural weaknesses: SNAP benefits are often not sufficient to last through the month, and those eligible for these programs face a confusing application process, shame and stigma, and logistical hurdles, such as limited transportation.

“Feeding Missoula” began with an evaluation of how current food assistance programs met or failed to meet the needs of rural youth. Our methodology integrated a comprehensive review of existing literature and structured interviews with …

Investigating The Relationship Between Drug Overdose Deaths, Excessive Alcohol Drinking, And Adult Smoking In Urban And Rural Ohio Counties In 2025, Sumin Byoun, Anne Griffin

Scholarship in Medicine - All Papers

Deaths from drug overdoses have been increasing each year. Ohio ranks among states with the highest number of drug overdose deaths per year. There is a gap in the literature regarding discussions of how excessive alcohol drinking and cigarette smoking rates may predict drug overdose death rates in a community. First, this study investigates differences in excessive drinking, adult smoking, and drug overdose deaths between urban and rural counties in Ohio. Second, this study explores whether excessive drinking and smoking behaviors can predict drug overdose death rates in urban and rural Ohio counties. Data exclusive to Ohio counties was obtained …

Understanding The Impacts Of Food Insecurity On Education Outcomes In Ohio, Maria El Biri, Sreya Tummalapalli

Scholarship in Medicine - All Papers

Background: Food insecurity has been a growing concern in the United States, and prior research has shown how food insecurity in youth can correspond to negative psychosocial outcomes. Additionally, there are known disparities with access to food based on living in rural or urban counties. Objective: The goal of this study was to determine how differences in food security can impact youth educational outcomes in Ohio. Methods: Data from County Health Rankings & Roadmaps were obtained on variables such as access to healthy foods, food insecurity, high school graduation rates, average grade performance, and percentage of the population living in …