Advances in surgical technique and medical management have led to fundamental changes in surgical care allowing for a paradigm shift from inpatient to outpatient surgery. Enhanced recovery pathways have moved surgical recovery from inpatient to outpatient settings requiring informal caregiver support. The purpose of this study was to determine the prevalence of caregiver burden in this patient population and to explore whether caregiver burden contributes to preventable use of emergency room services. The conceptual framework supporting this retrospective cross-sectional study was Andersen's behavioral model of health services utilization. Data collected from 28 urologic patient/caregiver pairs were analyzed using descriptive statistics and linear and logistic regression. Findings indicated measurable caregiver burden in 2 of the 5 Caregiver Reaction Assessment (CRA) subscales: impact on schedule and impact on health. Findings also indicated a measurable protective effect of high socioeconomic status of caregivers and the CRA subscale of impact on finances, and a possible protective effect of caregiver self-esteem as measured by the CRA subscale and emergency room utilization within the first 30 days after enhanced recovery surgery. Social change implications include improving the surgical experience of patients and caregivers and enhancing the use of health care resources.

The role of hospitals as partners in community health improvement is changing, especially for nonprofit hospitals receiving tax exemptions in exchange for providing benefits to the community. There are examples of reported health improvement activities funded through hospitals' charitable donations, but there's a gap in the literature on the effect of policy and legislation on hospitals' investments in community building activities that address the social determinants of health. Grounded in eco-social theory, this quantitative, correlational study compared secondary data from CA's nonprofit hospitals' annual 2009 and 2012 reports to determine what, if any, changes have occurred in the hospitals' investments in community building since the 2010 implementation of the IRS' new community benefit standard. Matched-pair t test and chi-square goodness of fit tests were used to determine if there is a relationship between IRS regulations and how hospitals distribute their charitable dollars. Independent sample t test and ANOVA were run to determine if the characteristics of the hospitals studied were predictive of the changes found. Aside from a shift in the distribution of community building investments by types of activities, this study found no significant change in the use of nonprofit hospitals' community benefit funds to address the social determinants of health. Analysis did not indicate that current public policy supports hospitals' shift from sick-care institutions to institutions that promote population health. Rather, it revealed that CA's hospitals currently make only small financial contributions to activities that address the social determinants of health missing opportunities to leverage their resources to more effectively impact multi-sector efforts to improve population health and reduce health inequities.

The increase in new human immunodeficiency virus (HIV) infections among heterosexual couples in Africa may reverse the gains made by HIV prevention programs. HIV screening among such couples remains low and understudied.This qualitative study focused on the motivations for HIV screening among heterosexual couples. The primary research goal was to examine the lived experiences of heterosexual couples who were screened for HIV and received their results in Nakuru-Kenya. The health belief model (HBM) served as the theoretical framework and as a basis for the secondary questions which sought to explore the participants' perceptions on HIV based on the constructs of the HBM. Semi-structured interviews were conducted with a purposively selected sample of 14 heterosexual couples. Data were collected through face-to-face audio-recorded interviews, which were coded and analyzed using Moustakas's phenomenological data analysis method. Six major themes emerged from the clustered responses of the participants. Couples recognized that they may be susceptible to HIV infection because HIV is transmitted primarily through sexual contact. Some couples perceived HIV as a severe, life-threatening condition in their lives; others perceived HIV as chronic disease that could be managed through treatment and good health care. The fear of negative consequences was cited as a barrier to couples' willingness to receive HIV counselling and testing. Couples perceived HIV testing as having multiple benefits, including freedom from worries and as a motivation to plan their lives. Health messages and partner dialogue were major cues that encouraged couples to undergo HIV testing. Testimonials from other couples who had been tested and chose to talk about their experiences contributed to a strong feeling of self-efficacy. These study findings may help to improve HIV prevention interventions for heterosexual couples.

Childhood obesity has increased due to factors such as more television time, less outside play, parents' lack of education about nutritious meals, and eating more fast food versus home cooked meals. Research has been performed on many school-aged children; however, there is a gap in research as it pertains to preschool children. Preschool age learning is when children are most receptive to habit-forming activities. The purpose of this transcendental phenomenological study was to assess the parental perceptions of 11 preschool parents in rural Northeastern North Carolina of 4-year-old children who have been told by a health care professional that their children are overweight or obese. This qualitative study used the health belief model as its theoretical foundation. Responses were manually transcribed and uploaded into NVivo 10 software. The researcher performed horizonalization of the data to determine the themes and subthemes used for data analysis. Participants revealed that they recognized childhood obesity and overweight as an issue in their child and were knowledgeable on how to combat their child's diagnosis. As a result of this research, parents revealed that working and a lack of affordable resources played viable roles in why childhood obesity and overweight exists in their children. Parents shared that they felt safe in their neighborhoods, but acknowledged that affordability of healthy foods and other family members' impact on their child's eating habits play a role in their child's weight concerns. This study will lead to positive social change by providing local public health workers with an increased understanding of the experiences of parents of overweight and obese preschool-aged children, which may assist in stronger program development for the targeted population.

Although licensed registered nurses (RNs) comprise a significant percentage of the U.S. health care workforce, there is a lack of qualified nurses to meet patient needs. This shortage is expected to intensify as practicing nurses leave the profession. The problem that prompted this study was that an attrition-reduction program implemented in the nursing program at a U.S. midwestern community college did not show a reduction in the average attrition rate. The academic integration construct of Tinto's theory of student departure was used to examine archival academic performance records of 145 students enrolled in the local program from 2010 to 2012. The central research question focused on the correlations between academic progression requirements to student attrition rates in 1st-semester associate degree in nursing (ADN) courses. The correlation was computed using the point-biserial calculation. Findings from the data analysis indicated a statistically significant correlation between 2nd-semester licensed practical nurse (LPN) courses and success in 1st-semester ADN courses, but at a higher benchmark than the current requirement. There was no statistically significant correlation between the standardized exit examination and success in 1st-semester ADN courses. The resulting project was a white paper policy recommendation for the institutional and community stakeholders. The project was evaluated with an outcomes-based evaluation method to measure the effectiveness of the revised progression requirements by measuring attrition rates in the 1st cohort of nursing students who were held to the revised progression requirements. The project contributes to positive social change by providing recommendations to decrease student attrition rates, which, in turn, may help to reduce the global nursing shortage.

Obesity continues to be a growing problem across the United States. Chiropractors have made claims of providing health promotion services within their treatment protocol; however, there is a lack of empirical research regarding a need for the chiropractic profession to train chiropractors to address Healthy People 2020 public health initiatives. The purpose of this qualitative study was to examine the perceptions of Mississippi Delta Region chiropractors regarding their role in obesity management as nonmedical practitioners that implement public health objectives in their practice. The research questions aimed at addressing possible barriers and limitations that influenced chiropractors' perceptions regarding their role in obesity prevention. The health promotion model which recognizes the vital role of the practitioner to the patient relationship in health outcomes, guided this study. Purposeful sampling was used to recruit 11 eligible board-certified chiropractors in the Mississippi Delta. The participants encountered a 1-time session with open-ended interview questions influenced by the hermeneutic tradition. Interview data were analyzed using thematic analysis. The findings indicated that chiropractors could treat obese patients and provide some services that are mostly provided and billed by other health care practitioners. Chiropractors, however, encounter legislative and insurance challenges. Outreach programs and collaboration with other health care practitioners would improve chiropractors' role in obesity management. The study can contribute to social change by increasing understanding of the chiropractic profession and how they may offer health promotion services to improve patient management of obesity and obesity-related illnesses.

Malaria causes high morbidity and mortality, especially among the most vulnerable populations, including pregnant women. Malaria in pregnancy (MiP) can be prevented by compliance with the 3 core measures: sleeping under insecticide-treated nets (ITNs), 3 doses of sulfadoxine-pyrimethamine as intermittent preventive treatment (IPTp-SP), and effective case management of malaria and anemia. The purpose of this cross-sectional household survey was to examine the composite risk behaviors that enhance the transmission of MiP. Stratified and multistage sampling methods were used to select a sample of 300 pregnant women in Abuja, Nigeria. Bivariate and multivariate analysis were conducted. According to study findings, participants' mean age was 28.6 years, many (117 or 68.0% of the participants) used an ITN the night before the survey, and some (113 or 38.0%) had used SP for IPTp. Many participants (183 or 61.0%) were of high malaria risk status (MRS). The predictors of MRS were knowledge, OR 3.282, 95% CI [1.091, 9.873], p=0.03; number of pregnancy, OR=5.589, 95% CI [1.465, 21.316], p=0.01; attendance at antenatal clinic, OR= 3.777, 95% CI [1.119, 12.746], p=0.03; level of education, OR=0.050, 95 CI [0.013, 0.197], p=0.000; perceived barriers of ITN, OR=0.308, 95% CI [0.165, 0.575], p=0.000; and perceived benefits of SP for IPTp, OR=3.156, 95% CI [1.879, 5.301], p=0.000 . Perceived seriousness, perceived severity of malaria, age, and religion were not significantly related to MRS. This study leads to positive social change by providing information for policy makers to review MiP-related policies and programs to ensure quality messages, providers, and products are accessible and affordable across rural and urban settings where the target population live and work.

Since the 1990s, homelessness has increased in Canada. The existing strategies of the government and public health service providers to manage the situation have had limited success. Researchers have noted the lack of including those experiencing homelessness to better understand and find a solution to homelessness. The purpose of this phenomenological study, driven by the social cognitive theory, was to understand homelessness from the perspectives of people who do not have homes. Data were collected from open-ended interviews with a purposeful sample of 15 individuals who are homeless. Summarizing and analyzing the interviews, several themes emerged after interview data were transcribed via hand coding and analyzed using cognitive data analysis. The prominent themes were: lack namely, money, home, privacy, and support; discrimination of all kinds; mental illness and addiction; the need for a review of housing policy that specifically addresses rent, mortgage qualification criteria and house tax, and to create awareness of government support systems and the services that they provide. Public health service providers and designated authorities can use the findings of this study to understand the phenomenon from the perspective of people who are experiencing homelessness, and in turn can use that understanding to influence improved homelessness reduction strategies that could improve the lives of those experiencing homelessness and their communities. Since homelessness is a public health issue, effectively bringing it under control could create a positive impact on the health and safety of the public.

Abstract Healthcare policies are complex health promotion strategies used by healthcare policy designers to create awareness, educate, and develop the capacity of sustainable health promotion practices in rural communities. The purpose of this phenomenological study was to investigate an occurrence being experience by rural residents in the NWR of Cameroon where residents lacked nearby healthcare clinics where they can seek medical treatment and to determine if there were any funding policy requirements for the construction of new rural community clinics at the NW Regional Delegation of Public Health. Using Wright's conceptual framework on policy analysis and evaluation and Coleman's rational action theory, data were collected through in-depth interviews from a sample of 10 participants composed of healthcare policy designers and rural community residents. The data were analyzed using Colaizzi's 7-step method for analyzing phenomenological data. Findings indicated that the lack of primary health care clinics in rural communities imposed five main challenges which limit access to rural healthcare: the non-availability of healthcare facilities in rural settings, inaccessibility to rural communities, the unaffordability of healthcare in rural communities and lack of healthcare insurance, unacceptability due to lack of health education and social stigma, as well as lack of accommodation for new clinics. Furthermore, the Minister of Public Health use existing healthcare funding policy requirements at the NW regional delegation to make final policy decisions. The results of this study may be used to create positive social change by establishing nonbiased health policy intervention strategies and will also help the Government of Cameroon to establish health promotion policy guidelines and policy adjustments that address the lack of clinics in rural NWR of Cameroon.

There are more than 2 million end stage renal disease (ESRD) patients in the world. ESRD is becoming more manageable with the advent of competent therapies such as peritoneal dialysis (PD) and hemodialysis (HD). While recent evidence suggests that switching from PD to HD may preserve residual renal function longer than either PD or HD alone as an alternative approach, little is known about the optimal timing and the long-term efficacy of switching dialysis modes. The purpose of this quantitative retrospective study, based on the bio-psychosocial model, was to investigate the optimal timing and determinants of the effectiveness of switching dialysis modes from PD to HD. Data were extracted from a national database of ESRD dialysis patients. The Kaplan-Meier survival curve and the log-rank test were used to determine the effect of optimal dialysis time for switching from PD to HD on ESRD patient's survival and mortality. The results showed the optimal duration for switching dialysis modalities was 9 months where patients had a 90% survival rate after switching. ESRD patients taking more than 24 months to switch modes had the highest loss of renal function. Also, patients between 40 and 80 years of age were at a significantly higher hazard of renal function loss than patients younger than 40 years of age. It was concluded that timely switching of dialysis mode from PD to HD increases survival in ESRD patients. Younger patients have better survival rates in peritoneal dialysis modality than older patients. Moreover, females switching from PD to HD have better survival rates than males. The positive social change implications of this study may help raise awareness to the importance of optimal timing when switching dialysis modalities for improved survival and quality of life.