No description available.

Thesis (D.N.S.)--Boston University / PLEASE NOTE: Boston University Libraries did not receive an Authorization To Manage form for this thesis or dissertation. It is therefore not openly accessible, though it may be available by request. If you are the author or principal advisor of this work and would like to request open access for it, please contact us at open-help@bu.edu. Thank you. / This study investigated of the capacity of self-efficiency (SE) and the Health Belief Model (HBM) to predict diabetes self care. Research questions derived from Bandura's Social Cognitive Theory asked the associations between SE, HBM, and their interaction on reported self care (SC). / 2999-01-01

Despite strong evidence that screening for Colorectal cancer (CRC) can reduce cancer incidence and mortality, screening adherence remains low. Racial differences in CRC incidence and mortality are well documented in the literature. Racial differences in CRC screening use remain mixed with most studies using race as an independent variable and focusing on racial differences in CRC screening rates. Few studies have examined correlates of CRC screening use, stratifying by race. The purpose of this study was to determine if there are racial differences in correlates of CRC screening, using the Health Belief Model as the theoretical framework. Data analyzed in this study came from the 2003 Health Information National Trends Survey (HINTS) of the National Cancer Institute. White (n=1988) and non-white (562) respondents age ≥50 years, without a history of cancer were interviewed by phone. Multivariable logistic regression was used to identify correlates of FOBT and endoscopy adherence stratified by race and screening test. Independent variables included age, gender, education, income, insurance status, regular care visit frequency, perceived risk of CRC, family history of cancer, CRC knowledge, cancer worry, perceptions of screening benefits, and perceptions of expense as a barrier. Predictors of adherence to FOBT for whites included being older and having at least 1 regular car visit. Predictors of FOBT adherence for non-whites included having health insurance. Endoscopy adherence for whites was significantly associated with being older, being female, and agreeing with perceptions of benefits to CRC screening. Predictors of endoscopy adherence for non-whites included being older, and disagreeing with perceptions of benefits to CRC screening. Such differences, if confirmed in future studies, may inform race-specific interventions to increase CRC screening utilization.

Human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome (AIDS) are ailments that have a social and political impact in the U.S. Since their discovery more than three decades ago, there has been an intense focus on eradicating these deadly diseases. Although there has been a lot of progress in the fight against HIV and AIDS, there are communities still disproportionately affected by it. Based on data from the Center for Disease Control and Prevention (CDC), one such community is young adults age 20 to 24 (CDC, 2016a). These young adults are at the focal center of the HIV/AIDS epidemic for various reasons; yet, this group is often overlooked in HIV literature and prevention/intervention strategies. Additionally, this community is known for inconsistent condom use, although there have been countless public service announcements (PSAs) and interventions promoting the use of condoms as a means of preventing not only unwanted pregnancy but the contraction of sexual transmitted infections (STIs) including HIV/AIDS. The aim of the current study was to test a comprehensive moderated mediation model and assess factors associated with condom use among early young adults age 18 to 24 above and beyond known variables such as age, gender, and ethnicity/race. These variables included participants’ age of sexual debut, number of lifetime sexual partners, perceived threat of contracting STIs and HIV/AIDS, and exposure to cues to action as predictors of condom use. The decision to expand the study to assess condom use among early young adults (18 -24) as opposed to focusing exclusively on young adults (20 -24) was based on early young adults being less likely to be tested for HIV compared to other age groups (CDC, 2008). For the moderated mediation model, I drew on the health belief model (HBM) and tested whether 1) the relationship between sexual debut and condom use was mediated by number of lifetime sexual partnerships, and 2) the relationships between sexual debut and the mediator were moderated by perceived threat, and whether the relationships between the mediator and condom use was moderated by perceived threat and cues to action. The full model was not supported. The implication of this study is that more current research is needed to understand early young adults and their condom use, as they are a community that is most vulnerable to HIV/AIDS and a key component in the fight against this disease.

The purpose of this study was to compare the health profiles of women seeking residential treatment for substance abuse with women in the community. These 2 data sets consisted of a total of 621 participants. An additional aim of the present study was to examine whether these health profiles differ between the monosubstance abusing and polysubstance abusing women within the treatment group. There were a total of 257 participants in this group. All analyses controlled for the effects of age, insurance, marital status, employment and race/ethnicity. Binary logistic regressions were used to compare between and within the specified groups on the following variables: asthma, dyslipidemia, diabetes, Hepatitis B vaccination, HIV testing, hypertension, Pap smear testing, mental health problems, overweight/obesity and smoking. A follow-up analyses examined whether differences in the variables could be explained by the effects of specific control variables. Results suggested that differences in four outcomes might be explained by a single or smaller number of specific control variables. The overall results revealed that age was one of the strongest predictors of differences between the treatment and community group. When we controlled for age, marital status, low socioeconomic status (insurance, employment) and ethnicity we found that only two variables were significantly different. Women in residential showed significantly more smoking and mental health symptoms than were found in the community sample. There were no significant differences in the health profiles of polysubstance substance abusing than were found in monosubstance abusing women. The findings of the present study indicate that women seeking treatment are individuals with similar health disorders and health maintaining behaviors as the general population of women. However, women seeking treatment have significant increases in mental health disorders and smoking. Older age was related to increases in the odds of having dyslipidemia, diabetes, hypertension, and decreases in the odds of being immunized for Hepatitis B, tested for HIV, and having a Pap test in the last year. Due to anticipated-age related disorders, screening for dyslipidemia, diabetes, and hypertension should be provided for older women seeking admission to treatment. Substance abuse treatment centers for women should provide for mental health services and offer smoking cessation.

I Sverige genomförs årligen 35 000 - 40 000 aborter. Kvinnor i åldersgruppen 20-24 är de som utför allra flest och risktaganden i sexuella sammanhang är betydligt större än vad det tidigare har varit. Litteraturstudiens syfte var att beskriva unga kvinnor sexuella riskbeteenden och deras attityder till abort. Systematiska sökningar gjordes i Cinahl, PubMed och PsycINFO och artiklar som motsvarade syftet granskades kritiskt. Slutligen valdes 11 vetenskapliga artiklar som bearbetades och analyserades. Utifrån syftet delades resultatet upp i två delar. Under riskbeteenden framkom följande underteman: alkohol gör unga kvinnor mer riskbenägna, liberala attityder till sex, inkonsekvent användande av preventivmedel, upplevda nackdelar med preventivmedel samt brist på information om preventivmedel och sexualkunskap. Dessa teman beskriver på olika sätt de sexuella riskbeteenden som visat sig finnas hos unga kvinnor idag. Unga kvinnors attityder till abort delades upp i två underteman: abort som ett accepterat alternativ samt blandade känslor kring en oplanerad graviditet och beslut om abort. Abort sågs som en självklar rätt men även rädsla att ångra sitt beslut uttrycktes. Preventiva insatser vad gäller oönskade graviditeter är ett ansvar som åligger hälso- och sjukvården. Sjuksköterskan kan i sin profession använda sig av motiverande samtal. Det vilar också ett ansvar på hälso- och sjukvården att erbjuda en god abortvård samt möjlighet till återhämtning där sjuksköterskan spelar en viktig roll vid samtal och stöd. / Every year implements 35,000 to 40,000 abortions in Sweden. The most are performed by women aged 20-24 and risk-taking in sexual context is much more common than before. The aim of this study was to describe young women´s sexual risk behaviors and their attitudes toward abortion. Systematic searches were made in Cinahl, PubMed and PsycINFO and articles that corresponded the aim was critically reviewed. Finally 11 research articles were selected and after that they were processed and analyzed. Based on the purpose the result was divided in two parts. To risk behaviors following subthemes revealed: alcohol makes young women more willing to take risks, liberal attitudes to sex, inconsistently use of contraception, perceived disadvantages of contraception and lack of information about contraception and sex education. These themes describe the sexual risk behaviors that exist in young women today. About young women's attitudes to abortion two subthemes were emerged: abortion as accepted alternative and mixed feelings about an unplanned pregnancy and the decision on abortion. Abortions were seen as a natural right, but also fear of regretting their decision was expressed. Preventions of unwanted pregnancies are a responsibility of health and medical care. Nurses can in their profession use motivational interviewing. The health sector also has a responsibility to offer a good abortion care and allow for recovery. The nurse plays a particularly important role in the support.

Women smokers with heart disease (HD) are at increased risk for negative health effects. At the time of invasive cardiovascular (CV) interventions is a critical opportunity to make lifestyle changes to reduce future CV interventions. The purposes of this study guided by the Health Belief Model were to determine which factors predict smoking cessation (SC) in women following an invasive CV procedure and to explore assistance received with SC. A correlational, prospective design was used. Data were collected from women smokers at the time of an invasive CV intervention and three months later. Instruments measured commitment to stop smoking, perceived threat of HD and future interventions, cessation self efficacy, barriers to SC, benefits of SC, cues to action, and motivation. Analyses included Chi-square, t-tests, and multiple, hierarchical, and logistic regression. On average women (N = 76) were middle-aged (M = 55.9 ± 8.0 yrs), smoked M = 15.3 ± 9.8 daily cigarettes and smoked for M = 33.6 ± 10.2 years. At baseline, fewer perceived barriers to SC, high cessation self-efficacy, and being more autonomously motivated to quit smoking explained 67 % of variance in commitment to stop smoking, F (6, 67) = 19.37, p < .001. At 3 months, only 8 (n = 54) women had quit smoking. Women smoked fewer daily cigarettes (M = 10.6 ± SD = 8.5) at 3 months compared to time of procedure (M = 15.3 ± 9.8), t(51) = 3.43, p < .01. Higher baseline cessation self-efficacy and lower HD threat were predictors of SC at three months, X2 (4, N=54) = 18.67, p = .001. At the three month follow up, the most common barrier to SC was anxiety (24%) and cigarette cravings (24%). While women were highly committed and confident they could quit, they reported receiving little help from their health care provider (HCP) other than simple advice to quit smoking. Most women undergoing an invasive CV procedure were unable to quit smoking even with a high desire to do so. Referrals for assistance from HCP to decrease anxiety and nicotine dependence and to address ongoing challenges to SC are needed.

With regard to infectious diseases, the most economical, direct, and efficient way to prevent them is timely inoculation and a comprehensive policy of vaccination. Such steps not only reduce the overall mortality rate, but also lessen a patient¡¦s susceptibility to serious complications once infected, and therefore their length of hospital stay. It is the foundation of disease prevention in all countries, and should be the primary focus of every public health department. This survey is based on a health belief model and a self-constructed questionnaire. Its sample base are parents whose children have visited one of two local hospitals, each of which is in a different administrative region. A total of 350 questionnaires were distributed. Recoveries were 270, of which 237 were useable. The effective response rate, therefore, is 67.7%. The useable recoveries were analyzed by SPSS, 17th edition, and verified and assumed by mean, standard deviation, t-test, one-way ANOVA, Pearson correlation analysis and Logistic regression analysis. The most influential factors on parents¡¦ decision whether or not to accept streptococcus pneumoniae vaccination (SPV) were as follows: 1.The greater the understanding of SPV and its policy, the greater the number of vaccinations 2.The perceived importance of good health 3. Age variability 4. The interrelationship between the perception and the policy of vaccination, the benefits of - and barriers to ¡V action, and the virulence and severity of the disease The results of this research suggest the public perception of SPV is the most important factor governing its efficacy. It is recommended, therefore, that public health departments campaign for SPV in a variety of different ways,( e.g. in newspapers and magazines, on TV, at pediatric clinics, at health centers, etc.) in order to establish a free and open flow of information to the public at large. It is in the hope of reducing the current mortality rate, length and cost of hospital stay and the serious complications arising from infection, that we offer the following data as reference for future planning.

Methicillin Resistant Staphylococcus aureus (MRSA) is the most commonly isolated multi-drug resistant organism in the hospital setting. MRSA can result in death among people who have no identified risk factors for infection. One-third of MRSA infections are cross-transmitted as Healthcare-Associated Infections (HAIs). It is well known that the single most effective means for decreasing the risk of HAIs is hand hygiene (HH), yet poor performance among registered nurses persists. The theoretical framework used to guide the study was the Health Belief Model (HBM). The purposes of the study were to: explore the RNs’ self-reported HH performance rate; explore the RNs’ knowledge related to MRSA; identify relationships between MRSA knowledge and HBM constructs; explore the RNs’ barriers to HH performance; identify relationships between barriers and self-reported HH performance; explore relationships among HH behaviors and constructs in the HBM; explore predictors of ‘overall HH’ performance; and identify if certain demographic characteristics are related to MRSA knowledge, self-reported HH, and HBM constructs. A cross sectional descriptive study was conducted with a sample of RNs who were randomly selected. The questionnaire mailing, which included the survey, consent, and the return-stamped envelope were distributed to 684 RNs. Completed surveys (n=120) from RNs who met the sample inclusion criteria were returned within four weeks. Self-reported HH were highest during times of increased perceived susceptibility for infection. In addition, nurses were more likely to overcome barriers to HH during ‘moments’ associated with the highest perceived susceptibility. Although MRSA knowledge did not correlate with ‘overall HH’ performance, there was a significant relationship identified with self-efficacy (r=.27, p<.01), which may influence HH behaviors. The most commonly identified barriers to HH performance were system factors (e.g. ‘a high workload’). Self-efficacy and barriers represented 26% of the variability in the regression model when applying significant correlations among HBM constructs and ‘overall HH.’ The phenomenon of the RN’s HH decision making is not completely understood. More research is needed to explain predictors for HH among registered nurses. This understanding will allow researchers to plan interventions aimed at increasing knowledge and understanding about perceived susceptibility, which may in turn improve self-efficacy behaviors for HH, which could decrease HAI rates. / text

Cardiovascular disease (CVD) including coronary artery disease and stroke is a significant health problem in Japan regardless of well established health care and insurance system and various public campaigns and exhibitions in the contemporary Japanese society. Higher and increasing prevalence and incidence of well-known risk factor of CVD may contribute to increasing mortality and morbidity of CVD in the future. However, limited knowledge was available for understanding perceptions of risk for CVD among Japanese adults. This grounded theory study aimed to explore social psychological process in perception of risk for CVD among Japanese adults.There were a total of 26 individuals participated in this study. Participants consisted of 19 Japanese adults with at least one CVD risk factor and 7 Japanese health care providers residing or working in which a consistently high mortality rate of CVD in both men and women.The theory grounded from the data was a process to avoid serious physical, emotional, social, and financial suffering as a consequence of developing CVD or of leaving it untreated and a process to maintain a good relationship with risk for CVD among Japanese adults with CVD risk factors. This grounded theory was consisted of the central concept of perceived risk for CVD, which defined as fear, threats, sorrow, worries, and/or anxiety for possible adverse impacts on their life living with their family and suffering for loss of independence and quality of life consequent upon CVD. This central concept was followed by actions to avoid these adverse and excruciating consequences of CVD including changing behavior, taking measures to manage CVD risk, and continually evaluating their condition. Factors contributed to perception of risk for CVD among Japanese adults were seriousness and severity of consequences of CVD, susceptibility, proneness, and possibility to develop CVD, and Japanese specific contextual factors.This study may contribute to appropriately addressing perception of risk for CVD and behavior change among Japanese adults with risk factors for CVD within the unique social, cultural context of Japan. The results of this study could apply to better nursing practice for CVD risk management and health promotion in Japan.