The United States healthcare system cares for and supports a diverse patient population. Patients come from various ethnic backgrounds, speak different languages, hold distinct religious affiliations, and more. These differences can create a chasm in the patient-provider relationship, impacting the quality of care or health outcomes. Specifically, language-discordance can affect patient-provider communication; however, technological interventions, such as access to electronic medical record tools and digital translators, can facilitate this dyadic communication. This scoping review examines the literature present on the use of digital tools to facilitate multilingual patient-provider communication. The initial search in PubMed with MeSH terms resulted in 531 studies. After studies were screened for the inclusion criteria in abstract and full-text screening, seven studies remained for data extraction. Results revealed no strong patterns regarding either type of digital technology studied, medical specialization, or clinical setting. Only one randomized controlled trial was identified. Findings highlight the need for more research in this field to determine more specific impact of the usage of technology in healthcare communication.

Recently, the Centers for Medicare and Medicaid Services (CMS) ranked all hospitals based on Medicare readmission rates for heart attacks, heart failure, and pneumonia. CMS offered subsidies to hospitals ranked in the 4th quartile to develop community support services to reduce the problem of potentially preventable readmissions (PPRs). CMS cited 4 of the 5 hospitals in Prince George's County in the 4th quartile. The purpose of this quantitative research study was to investigate the relationship between community support services and the reduction of PPRs in Prince George's County. The Evans and Stoddart field model of health and well-being guided this study with support from Bertalannffy's general systems theory. This study sought to relate community support services to PPRs in Prince George's County in contrast to other Maryland counties. To evaluate relationships between community support services and the reduction of PPAs, secondary data were provided by CMS in conjunction with the Robert Wood Johnson Foundation and the University of Wisconsin. The data included 26 behavioral community support factors from 53,229 Medicare paid claims in Maryland residents from July 1, 2008 to June 30, 2011. Lack of diabetes screening is a community support factor within quality of care. Using multiple regressions, there was a statistically significant relationship found between diabetic screenings and pneumonia readmission rate. The implication for social change is that reimbursement of key screening recommendations to CMS, local government, and hospitals in Prince George's County may reduce readmission rates, thereby positively affecting patients, improving community health, and decreasing health care costs in Prince George's County.

Even with access to well-known breast cancer treatment centers, older African American women continue to have higher breast cancer mortality compared to their European American counterparts. Researchers have theorized relationships among diagnostic delay, socioeconomic status (SES) factors, beliefs, culture, and breast cancer mortality in African American women ages 40 to 64, but these same relationships among African American women ages 65 to 80 have not been investigated. The purpose of this qualitative study was to describe older African American women's experiences with abnormal mammograms. The quality-caring model and critical race theory were used through narration to show the association of structure and process within the context of race. Purposeful, criterion-based sampling was used to select and interview 12 African American women ages 65 to 80 who had an abnormal mammogram result after breast cancer screening (BCS) within the previous 2 years. Through narrative analysis with triangulation it was demonstrated that clinical and social systems within the process of BCS affected the women's perceptions of providers and outcome. Their independence, motivation, health outlook, and spiritualistic beliefs kept them adherent to BCS and longterm follow-up. Health promotion activities were supported by family, friends, and spirituality. Variations in mammography practices and poor provider communication were obstacles to health maintenance. Positive social change is supported through health care providers' understanding of the barriers that impede older African American women's follow-up of abnormal mammogram results. Removing these barriers may assist in the reduction of breast cancer mortality.

Cultural beliefs on healthcare in the 21st century by the African immigrants in the United States have contributed to the severity of illnesses in their communities. The results of this research identified the healthcare barriers experienced by members of the Bronx Ghanaian Immigrant Muslim Community (BGIMC) in New York City. The purpose of this research was to investigate the influence of education, immigration status, health insurance status, and cultural beliefs on the BGIMC members' perceived access and willingness to use healthcare services for various ailments. A sample of 156 male and female members of the BGIMC completed the survey questionnaire. The study was grounded in the conceptual frameworks of critical theory and complexity theory. The results of logistic and linear multiple regressions indicated that those with insurance were 9 times more likely to report that they had access to healthcare than those who did not have insurance. Additionally, those with health insurance were almost 7 times more likely to report using healthcare services in the past 12 months. Results of the multiple linear regressions indicated that immigration status, health insurance status, and education levels did not predict willingness to use healthcare when an arm was broken, nor did they predict willingness to use healthcare for a severe fever. However, immigration status, health insurance status, and education levels did predict willingness to use healthcare when experiencing dizziness. Understanding the social and cultural factors related to use of health care services will lead to tailored health insurance and access initiatives for the BGIMC; this increased understanding will also promote positive social change in their community and serve as a model for other African communities in the United States.

Work-related musculoskeletal disorders (WRMSD), specifically physical and muscular discomfort in the upper arm, lower arm, thigh, lower leg, wrist, shoulders, back, or neck, are among the most frequently reported workplace injuries in the United States. The dearth of knowledge about the types of workloads that may contribute to the development of WRMSD was the impetus of this research. The study aimed to identify antecedents of WRMSD among warehouse workers in order to reduce WRMSDs and increase productivity as expressed in a systems perspective on industrial health. The research questions examined the prevalence of specific WRMSDs, the relationship of high-risk tasks of warehouse personnel with WRMSD incidence, and the relationship of job category and workload with WRMSD incidence. The sample included 82 warehouse workers, stockroom clerks, and forklift drivers. MANOVA was used as the data analysis technique. The results showed that WRMSD was the most prevalent in the upper back, lower back, knees, and lower legs. Various high-risk tasks were linked to WRMSD incidence including repeatedly bending to lift objects was associated with discomfort in the lower back, shoulders, and lower legs. Furthermore, the use of pallets led to reduced discomfort and work interference in the hips and buttocks, upper arms, and knees. Proper lifting form may reduce WRMSD in the shoulders, forearms, lower back, and wrists in particular. The social change implications of this study stem from the notion that increasing the employers' WRMSD prevention awareness will lead to an increase in safety attentiveness and decrease workers' injuries.

Bariatric surgery is not the panacea it was once thought to be for weight loss. Due to patient noncompliance issues, many weight loss surgery patients are relapsing and regaining the significant amounts of weight that bariatric surgery had initially helped them to lose. This failure is costly monetarily, psychologically, and medically to both the patient and to society. Using the narratives of 32 post-weight loss surgery patients, this narrative study explored: (a) whether Erikson's psychosocial stages of development occur after weight loss surgery, (b) whether successful patients (defined as those who are able to maintain their weight loss long term) have successfully navigated Erikson's stages, and (c) whether these patients formed new identities in the process. Recursive analysis and text analysis revealed noticeable trends toward developmental progress among participants after weight loss surgery, with regard to all stages in Erikson's psychosocial developmental theory. This trend suggests that participants are experiencing developmental changes after surgery and that participants who have successfully navigated psychosocial stages are at least beginning to build new identities. These findings may indicate the need for social changes in the way clinicians guide patients through the weight loss surgery process; these findings may also inspire the creation of programs that address developmental milestones, which may increase successes after weight loss surgery.

Low health literacy impacts an individual's ability to comprehend communication from healthcare providers, reduces access to healthcare, and contributes to increased mortality. The purpose of this study was to evaluate the impact of learning style on adult health literacy education. The health belief model, protection motivation theory, the transtheoretical model, and social cognitive theory were used to analyze the data in this study, and to further develop effective health literacy education. The research questions addressed the effectiveness of educational intervention adjusted to their appropriate learning style in comparison to a standardized health literacy intervention and potential difference, according to type of learning style, in the amount of changed performance between pretest and posttest. A sample of 80 adults in an urban community was recruited through organizations serving low-income individuals. The participants were assessed for baseline health literacy level, followed by identification of learning style, educational intervention, and posttest assessment, which led to determination by t test that changes between pretest and posttest scores were statistically significant between the control group and the study groups. This finding suggests that health education should be delivered to patients according to individual learning style in order for patients to comprehend and retain information provided. Social change implications include healthcare professionals appropriately addressing health literacy so that patients may participate more actively in their personal healthcare decisions to improve healthcare quality outcomes, decrease long-term costs of delivering healthcare services, and improve the general health of the community.

<p>This thesis examines the performance of non-impaired Tamil-English speaking bilinguals on the Tamil-English version of the Bilingual Aphasia Test (BAT) (Paradis and Libben, 1987). The test was administered to 25 participants, 15 women and 10 men. The results show that, on average, participants achieved an overall score of 97%. However, participants did not do well on two subtests on the English version, specifically sections on derivational morphology and morphological opposites. Also, a more detailed analysis indicates that years of education significantly correlates with performance, even though it is claimed that years of education should not affect performance on this test. This study makes suggestions for how to improve the Tamil-English version, in view of the findings from this study, and provides a cautionary note on the role played by years of education in test performance. If the latter factor is not taken into account, the test could possibly lead to an inaccurate assessment of a patient’s language abilities, and could potentially result in misdiagnosis. In an effort to increase the test’s validity and reliability, this study recommends a series of modifications to the Tamil-English version of the BAT, based both on participants’ comments and on statistical analyses.</p> / Master of Science (MSc)

<p><strong>Purpose: </strong>Current cancer programs in Canada manage adolescents (15-18 years) under a pediatric model of care, and young adults (19-25 years) under a disease-centered model of care. Key issues arise because neither of these models adequately meets the needs of adolescents and young adults (AYA). The aim of this study is to identify health and supportive care (HSC) needs of AYA survivors with cancer. <strong>Method: </strong>A concurrent nested mixed-method design was employed. Qualitative description and a systematic literature review (SLR) were used. Medline, Cochrane Central, PubMed, PsycInfo CINAHL and EMBASE were searched from their date of inception to October 2011. A comprehensive search strategy was developed. 
A purposive sample of AYA survivors with cancer, aged 15-25 years were recruited. Face-to-face qualitative interviews were digitally recorded and transcribed verbatim. Line-by-line coding was used to establish codes and categories. 
<strong>Result: </strong>Our SLR retrieved 760 citations. Among them, 12 were relevant. Qualitative findings are based on 20 interviews. Twelve diagnosed during adolescence and eight in young adulthood. Participants described several HSC needs that we categorized into 7 broad themes (e.g., social health) and 29 sub-themes (e.g., social support). Among the most commonly reported HSC needs for AYA survivors with cancer from both studies, were social wellbeing, information-sharing and communication and service provision. <strong>Conclusion: </strong>This study has identified a comprehensive set of HSC needs of AYA survivors with cancer. Study results will be used to inform the potential development of a new healthcare program for AYA patients in the Hamilton Health Sciences.</p> / Master of Science (MSc)

For several decades, the cost of medical care in the United States has increased exponentially. Congress enacted the Patient Protection and Affordable Care Act (PPACA) of 2010 to ensure affordable healthcare to the citizens of the United States. The purpose of this case study was to explore physicians' perspectives regarding physician-centric business models evolving under the requirements of PPACA legislation. Complex adaptive systems formed the conceptual framework for this study. Data were gathered through face-to-face, semistructured interviews and e-mail questionnaires with a purposeful sample of 20 participants across 14 medical specialties within Northeast Texas. Participant perceptions were elicited regarding opinions of PPACA legislation and the viability of business models under the PPACA. In addition, a word cloud was used to identify 3 prevalent or universal themes that emerged from participant interviews and questionnaires, including (a) use of mid-level practitioners, (b) changes to provider practices, and (c) lack of business education. The implications for positive social change include the potential to develop innovative models for the delivery of medical care that will improve the health of the aggregate population. Healthcare leaders may use the findings to advance the evolution of physician business models that meet the needs of healthcare stakeholders. These findings may also inform healthcare leaders of the need to develop cost-effective and innovative organizational models that are distinct to individual patient populations.