Low Human Immunodeficiency Virus [HIV] test uptake and multiple partnerships among men in Nigeria are contributing factors to HIV transmission. The purpose of this quantitative cross-sectional study was to examine the relationship between HIV test uptake, sociodemographic characteristics, HIV knowledge, attitude, and multiple sexual partnerships. The health belief model provided the framework for the study. Data were collected from the 2013 Nigerian National Demographic Health Survey, which surveyed 17,359 Nigerian men ages 15-49 years. Chi-square and binary logistic regression analysis showed that sociodemographic variables (age, residence, marital status, religion, wealth status, ethnicity, and educational level), HIV test uptake, HIV knowledge, and attitudes toward negotiating safer sex are significantly associated with multiple sexual partnerships. Findings showed that multiple sexual partnerships were higher among middle-aged men (25-39 years) in Nigeria and lower among Hausa Muslims. Findings showed that HIV testing is a significant predictor of multiple sexual partnerships, those that have been tested are more likely to be engaged in multiple sexual partnerships than those never tested. A well-tailored intervention that will promote follow up with men after HIV test uptake is essential to reduce the practice of multiple sexual partners among them. This may result in positive social change by presenting public health experts, donor agencies, and health teachers with valuable information about how multiple sexual partners and HIV testing can influence sexual risk behaviors among men. This may advance HIV prevention and control practices among men in Nigeria.

Approximately 35% of women in the United States experience intimate partner violence (IPV). IPV could be linked to symptoms of posttraumatic stress disorder (PTSD) that result in long-term mental health issues. Public health professionals, college counselors, and educators require information to assist in identifying college-age women who may be affected by IPV. The purpose of the study was to explore the association between the occurrence of symptoms of PTSD and IPV among college-aged women. The socioecological model was the theoretical framework for the study. A total of 199 cases were selected from National Intimate Partner & Sexual Violence Survey dataset for analysis. Data were analyzed using chi-square analysis and Welch's t test. The results of the study indicated significant association in the relationships between PTSD symptoms and IPV, which displayed p < .001, and significant association between PTSD symptoms and socioeconomic status, which displayed p = .026. The results also indicated that age (p = .313), ethnicity (p = .178), social support, and education (p = .079). have no significant relationship with PTSD symptoms and IPV among college-aged women. The potential positive social impact of this study is that findings show predictive factors that may have influenced a type of behavior as it relates to IPV, which could create and improve IPV prevention programs for college women, college educators, college counselors, local authorities, and health care workers. Providing focused attention on the education of these individuals could assist in early detection, which could reduce the potential for IPV/PTSD symptoms to occur among college-aged women.

The purpose of this study was to investigate the behavioral impact of knowledge regarding the relationship between breast cancer, vitamin D supplementation, and sunlight exposure considering levels of self-efficacy and response-efficacy. The study was based on protection motivation theory, which attributes behavior change to cognitive processes related to perceived threats and has demonstrated efficacy in promoting breast cancer risk-reducing behaviors. The study employed a quasi-experimental research design based on a survey using SurveyMonkey. Participants were New York City-residing women ranging in age from 25 to 74 who were recruited via an invitation from SurveyMonkey. Correlation analysis and linear regression analysis were performed on the data extracted from the survey in order to better understand the relationship of the variables in this study, and to test if any of the independent variables were significant predictors of vitamin D intake through supplementation and sunlight exposure. The results of this analysis showed that knowledge regarding the reduction in risk of breast cancer from sunlight exposure and through vitamin D supplementation was not related to changes in behavior involving increases in sunlight exposure and vitamin D intake through supplementation. Further, the results showed that those participants with higher levels of self-efficacy and response-efficacy regarding sunlight exposure and vitamin D supplementation had an increased amounts of vitamin D intake through supplementation on a daily basis. The results of this study can be used to help medical professionals understand the complexity involved in how their clients may or may not take action to reduce the potential for reducing the risk of breast cancer.

Breastfeeding is associated with numerous health and social benefits. Although support for breastfeeding is promoted globally, disparities in breastfeeding rates and support continue. African American mothers have lower breastfeeding rates than do Hispanic and Caucasian mothers. Several researchers have focused on the benefits of breastfeeding support, but no available research has explained any specific ethnic group perceptions of breastfeeding. This study explored 10 first-time African American mothers' perceptions of the breastfeeding support they received from physicians, nurses, midwives, and lactation consultants. The purposeful criterion sampling strategy was used to recruit participants, and data were collected through semistructured telephone interviews. The phenomenological research strategy, the social constructivist philosophical framework, and the breastfeeding self-efficacy theory guided the research process and helped in understanding the lived experiences of the participants. Data were analyzed thematically, revealing motivating factors for breastfeeding, experiences in getting breastfeeding support, types of breastfeeding support groups, and overall breastfeeding experiences. All participants felt it was important to breastfeed for their children's health. Their main concern was a lack of adequate professional support after they gave birth. The findings from this study can contribute to positive social change by increasing awareness related to first-time African American mothers' breastfeeding experiences and perceptions. Such awareness can assist in creating culturally sensitive programs to assist more first-time African American mothers increase their self-efficacy and promote successful breastfeeding.

Malaria is a mosquito transmitted tropical disease that accounts for more cases and deaths in Nigeria than in any other country worldwide. Globally malaria accounts for 300,000 deaths among young children and pregnant women annually. The promotion of the use of insecticide treated nets (ITNs) to reduce pregnant women's contact with mosquitoes has been the focus of malaria prevention efforts in Nigeria. However, the use of ITNs during pregnancy has been inexplicably low in Nigeria. A quantitative cross-sectional study was conducted to examine barriers to the utilization of ITNs among pregnant women in rural Nigeria. The social ecological model was utilized to analyze secondary data from a 2015 survey conducted in Nigeria in which 4,834 pregnant women between 15 to 49 years of age participated. The relationship between the use of ITNs and the knowledge of ITNs, traditional medicine, education, and family income was examined using multiple logistic regression modeling. Results showed that there was a significant relationship between the knowledge of ITN (p = 0.000), family income (p = 0.000), education of pregnant women (p = 0.000) and the use of ITN among pregnant women in rural Nigeria. However, there was no relationship between the use of traditional medicine (p = >0.5), and the use of ITN, perhaps because most of the women surveyed did not respond to the question about use of traditional medicine. Results of the study have important implications for positive social changes among pregnant women in Nigeria. These findings will inform strategies to increase the uptake of ITNs during pregnancy in Nigeria, improving birth outcomes, increasing maternal and child survival, and decreasing the economic burden due to malaria morbidity and mortality in rural Nigeria.

African Americans disproportionately develop cardiovascular disease risk factors including high blood pressure and high cholesterol levels in comparison to European Americans. The purpose of this study was to examine the associations of diet quality and physical activity with blood pressure levels and cholesterol levels among African Americans. The social ecological model was the theoretical foundation for the study. Research questions were designed to examine the extent to which diet quality and physical activity predict blood pressure levels and cholesterol levels. The research design was quantitative cross-sectional secondary analysis of 959 participants. After controlling for demographic factors, body mass index, and energy intake, there was a potential nonlinear association between the dietary approaches to stop hypertension (DASH) diet and blood pressure levels. Multivariable-adjusted logistic regression analysis showed that a fourth-quintile DASH score significantly predicted blood pressure (OR: 0.57; 95% CI [0.35, 0.93]). There was no association between the DASH diet and cholesterol levels. Physical activity was not significantly associated with blood pressure levels or cholesterol levels. Researchers can use these findings to replicate large prospective studies. In addition, findings may be used to promote positive social change by healthcare professionals including dieticians and clinicains, as well as health promotion advocates and other institutions or individuals with public health interest.

Postpartum depression (PPD) is internationally recognized as one of the most prevalent and severe but neglected maternal mental health complications of childbirth. Previous studies have indicated that there is a high burden of disease associated with PPD in both developed and developing countries. However, there remain gaps in the current literature regarding the recognition and management of PPD in remote parts of the developing world. Therefore, the purpose of this study was to understand the perceptions, attitudes, and beliefs of health professionals towards PPD and examine the factors that either facilitated or hindered its recognition and management in a remote setting in Nigeria. The pen-3 cultural model was the conceptual framework used in this study. The study focused specifically on professionals with regard to the recognition and management of PPD in a rural hospital in Nigeria. Ten semi structured qualitative interviews were conducted with doctors and nurses from a rural hospital in Nigeria. Data were analyzed via phenomenological interpretative analysis. Results from the study revealed that health professionals in a remote setting in Nigeria have a working knowledge of PPD and perceived the condition as a serious public health concern, but were faced with numerous barriers from the institutional, organizational, and community level that hindered their ability to recognize and manage PPD in a timely manner. These results make an important contribution to the existing literature and can enhance social change initiatives through the enhancement of awareness of PPD, and the need for improvement of policies on comprehensive maternal mental health in remote parts of Nigeria.

Chronic illness is an increasing concern in the United States as the CDC reports that about 50% of adults have at least 1 chronic illness. When individuals must adjust to chronic illness they may experience uncertainty regarding the illness, prognosis, and symptoms. The purpose of this qualitative, phenomenological study was to explore the lived experiences of individuals living with uncertainty in chronic illnesses. A Merle Mishel's uncertainty in illness theory was the framework used to explore the lives of individuals diagnosed and living with chronic illness. In-depth interviews were conducted with 8 individuals who have chronic disease; data were audio-recorded and transcribed. The data were analyzed using thematic coding, and stored in NVivo and categorized for commonality in results. Results revealed themes that individuals with chronic illness do experience uncertainty and that it impacts almost all aspects of their lives. The individuals expressed changes in daily activities, the need to plan ahead, altering plans based on symptoms, and retraining their minds to accept their new normal. Individuals diagnosed with chronic illness face daily challenges. Obtaining a better understanding of alternate ways to cope and manage uncertainty can greatly impact the individuals quality of life. The information produced from this study will help contribute to positive social change to enable healthcare providers to address the uncertainty at diagnoses and offer ways for individuals to cope and manage the additional stressor. Recommended areas for further research include repeating the study with a larger, more diverse sample, conducting interviews during different times of the year, and investigating the use of a multidisciplinary team approach for chronic illness treatment.

Malaria is a life-threatening parasitic disease spread to humans through bites of an infected mosquito. In rural Cameroon, malaria is one of the major causes of morbidity and mortality. Several studies have examined the use of various malaria preventive tools; however, there is insufficient literature available on use of an integrated approach to prevent and control malaria in rural Cameroon. The aim of this study was to provide information necessary for bridging the gap in understanding the proper use of insecticide treated nets (ITNs) and antimalarial drugs and the roles of education and socioeconomic status in malaria prevention and control efforts in rural Cameroon. This quantitative cross-sectional study was guided by the socioecological framework. Secondary data from the 2011 Cameroon Demographic and Health Survey (sample size of 216) was used in this study. The Chi-Square, binary logistic, and multinomial logistic regressions were used to analyze the data. The result revealed that there was a significant association (p < 0.05) between proper use of ITNs and malaria prevalence among children under 5 years old, education and proper use of antimalarial drugs, and socioeconomic status and health seeking behavior. There was also a significant association between healthcare preference and malaria treatment outcomes among children under 5 and pregnant women. These findings may contribute to social change by helping public health officials in Cameron to continue to prioritize local needs and enforce the proper use of available malaria tools in rural communities through an integrated approach to prevent and control malaria in rural Cameroon, especially for children under 5 years old and pregnant women, which would lead to improved quality of life.

Schools and healthcare organizations face questions of validation in leadership and investment in human capital, which raises important public policy questions. External forces such as economics, pressure groups, and oversight organizations as well as worker availability are at issue. Unlike education, segments of the healthcare industry are doing very little long-range planning concerning human capital development. A new paradigm must be developed for the healthcare industry if it is to face the challenges of a shrinking, less prepared workforce, in an aging nation. This case study uses the home health care and supplemental staffing industry to focus on an emerging public policy issue--requiring criminal background checks of healthcare workers. The study looks at the development of the National Healthcare Clearinghouse, critically analyzing the plan to determine how original goals shifted and affected its actualization. The primary and continued concern was on a negative aspect of hiring workers for the industry--that is to "screen-out" persons with an unacceptable criminal record. To assess attitudes among healthcare organizations, 3273 surveys were sent out to agency directors, with 28% responding. Subsequently and through research of the literature and follow-up interviews, a positive agenda emerged related to staff development through firm-specific and industry recognition of a career lattice. This recognition leads to potentially improved employment practices. The negative agenda raises issues such as privacy rights, due process and consumer protection. The positive agenda could reduce turnover, better protect clients and improve competency and salaries. Many significant steps to improve service work are closely linked to political processes and those legislative steps are poorly suited to achieve effective and efficient solutions. An industry based clearinghouse should be a proactive and positive corporate solution to a public concern that has advantages, especially in terms of costs, but may not survive a major financial crisis. This project was no exception. The survey results indicate that current criminal background checks are not effective. An accompanying survey of human resource needs provides a wealth of information to evaluate the current employment environment, and develop collaborative solutions. Recommendations are made to bring the project, although abandoned by a trade association, to fruition.