Stroke continues to plague the United States, affecting 795,000 people annually. Although stroke mortality has decreased, the overall incidence of stroke appears essentially unchanged. With a population that is projected to increase in age and stroke risk over the next 10-15 years, this is concerning. Current stroke prevention education may not be adequately tailored to community learning needs. Analyzing existing demographic data within electronic medical records may allow healthcare systems to identify high-risk neighborhoods by geocoding stroke diagnoses and then completing a qualitative analysis within the target community of specific stroke knowledge deficits. That information may then inform stroke prevention education for that neighborhood. A descriptive, exploratory approach was used to identify a community with a high incidence of stroke using geocoded demographic data from patients coding out with a stroke diagnosis. Qualitative interviews conducted within the community yielded the following themes: fragmented knowledge of stroke causes and risk factors, unawareness of hypertension and diabetes as significant risk factors for stroke, knowing but experiencing challenges to engaging in healthy practices—specifically, diet and exercise, and financial barriers to healthcare resources. While most of the participants had adequate healthcare coverage and reported regular interactions with a primary healthcare provider, this community continued to experience a higher incidence of stroke than surrounding neighborhoods. The findings of this study highlighted specific challenges to stroke prevention that may inform future stroke prevention initiatives. Future research in other communities using this approach may provide additional insights into the specific knowledge deficits unique to communities, as well as revealing patterns and trends in stroke prevention knowledge. Approaching stroke prevention education using only data obtained from large registries may provide a broad overview of knowledge deficits, but lack the specificity necessary to effectively address stroke knowledge needs at the community level. Recognizing the challenges inherent with behavior modification for implementing lifestyle changes should also be considered when designing future stroke education. Harnessing technology in the form of web applications, text messaging, and email for maintaining communication with patients may improve effectiveness of stroke prevention interventions. Implementing a comprehensive health promotion program that addresses specific community needs with tailored health education and behavioral support may lead to decreased incidence of cerebrovascular disease in this community and provide a model for managing other preventable diseases. / Includes bibliography. / Dissertation (Ph.D.)--Florida Atlantic University, 2019. / FAU Electronic Theses and Dissertations Collection

Although the International Drinking Water Supply and Sanitation Decade has generated great interest from foreign aid donors, its impact. in terms of increased service levels has been poor. These disappointing results have been explained by the UN and other donors in terms of inadequate funding and lack of cost recovery, poor operations and maintenance, lack of personnel, unacceptable technology, poor logistics and non involvement of the beneficiaries. However, an alternative explanation revolves around factors contributing to poor project design. These include the lack of understanding of the development process, donor bias and self interest, and poor coordination and commitment by the recipient government. A review of the development and trends of contemporary aid philosophy and its translation in to rural development and water and sanitation projects, which led to the launch of the IDWSSD, provides a number of lessons that can be used to formulate a hybrid model for project design and the sector development process, that defines the relative roles of donors, recipient governments and people themselves. The model is based on coordinated development, community participation, and sector growth from pilot projects to large scale programmes. The developments in the rural water and sanitation sector that took place in Zimbabwe from 1974 to 1987, provide a unique opportunity to test this model using a systems analysis approach. After gaining Independence in 1980, Zimbabwe's development assistance funding grew tenfold with the influx of foreign donors, and major commitments were made by the new Government to rural development and the goals of the IDWSSD. However, the large investments in water and sanitation which included the preparation of a national master plan with external technical assistance, had both positive and negative impacts on the continuing development of the sector, the start of which can be traced back, well before Independence, to small pilot projects sponsored by non government organizations that used appropriate technology developed by the Rhodesian Government. This development process and the changing approach to project design is illustrated by a series of case studies of projects supported by multilateral and bilateral donors, and non government organizations, that were milestones during this period. Finally the project and sector development model is modified based on the practical lessons from Zimbabwe and recommendations for future practice are made together with suggestions for areas of further research.

The SCANS report issued in 1990 brought national attention to concerns about lagging competencies of US workers and their lack of preparedness for the high-performance workplace. Since the SCANS report, several national and statewide efforts have attempted to identify skill sets appropriate for success in the changing workplace. Recent discussion has included skill sets appropriate for college graduates. This study was designed to determine perceptions of Maryland community college chief academic officers and department chairs toward one such skill set, the Maryland Skills for Success, and whether they are appropriate learning expectations for associate degree completers. The Maryland Skills for Success (MSS) are comprised of five skill goals: (1) learning skills, (2) thinking skills, (3) communication skills, (4) technology skills, and (5) interpersonal skills. Three to five 'learning expectations' elaborate what students should be able to accomplish under each skill goal to be successful in future work and learning. The study involved a survey of 293 chief academic officers and department chairs at the 18 community colleges across Maryland. A 75 percent response rate was achieved. The survey assessed the extent to which respondents agreed that: (a) the Maryland Skills for Success are appropriate expectations for associate degree completers, (b) students currently achieve MSS expectations, (c) respondent's courses and programs contain specific learning objectives that require students to learn and perform such skills, (d) all Maryland community colleges should teach and assess a common set of higher-order knowledge application skills. Respondent ratings indicated that the Maryland Skills for Success represent valid learning expectations for associate degree completers. Deans were more favorable toward the MSS than were department chairs, and were more confident that students were required to learn and perform learning expectations similar to those listed in the MSS. The department chairs were also divided into groups to determine attitudinal differences by disciplines. The department chairs were more likely than the deans to agree that students currently achieve the MSS learning expectations. Most chair groups somewhat disagreed their courses and programs contained specific learning objectives requiring students to learn and perform the skills represented in the MSS. Of the chair groups, the English/fine arts/humanities, and the technologies/health care groups tended to produce significantly higher ratings than other chairs and supported the notion of Maryland community Colleges teaching and assessing a common higher-order knowledge application skill set. Based on respondent ratings, the communication, thinking and interpersonal skill sets in the MSS have the best chance of gaining acceptance by colleges interested in integration of purposeful teaching and assessment of a higher-order skill set across the curricula. Respondent ratings also indicated that it is unlikely that the colleges would undertake a common initiative to teach and assess a common skill set like the MSS without intervention from the state. Respondents expressed distrust of bureaucratic intervention, were somewhat concerned about the difficulty of teaching and assessing the entire skill set, and felt that the skill sets were too broad to be feasibly taught. Recommendations include the need for extensive faculty development and the provision of incentives from the state educational agencies to provide support for colleges interested in teaching and assessing a common higher-order knowledge application skill set. / Ed. D.