Pay-for-performance (P4P) programs improve the effectiveness, quality, and overall value of healthcare. In today's world of advanced technology and changing trends, physician organizations hesitate to adopt P4P program methodology. A gap in the literature was identified, as there were no guides found that explained how to implement P4P initiatives that improved quality of care. The purpose of this study was to gain a better understand-ing of P4P, and the phenomenology of practice theory was applied to obtain different perspectives about P4P programs and how incorporating technology improved quality of health provisions. Basic qualitative methodology was used, and semistructured telephone interviews served as the instruments to collect valuable data. E-mail invitations were sent to participants identified by the P4P Team Director, with interview questions to use as talking points during the telephone interview sessions. Post interview summaries were sent to the participants to review, approve or edit prior to inclusion into the study. Pat-terns were identified and showcased in a qualitative data coding analysis spreadsheet and a semistructured interview coding graph revealed that technology stood out amongst all key words. The results of the study confirmed that merging technology with P4P pro-grams produced positive patient outcomes. The use of the phenomenology of practice theory was justified as different responses were provided by the participants. From a so-cial change perspective, when technology and preventive healthcare initiatives are merged, P4P programs improve the quality of care. Inpatient bed days are reduced, and public reporting of physician organizations and health plans performances encouraged the onboarding of new physician organizations using the study site's measure sets to improve their quality of care efforts, thus resulting in better patient outcomes.

Physical activity is associated with many health benefits to include weight management, lower risk for chronic diseases, and improved mental health and self esteem. The built environment has been linked to lower physical activity levels and overweight and obesity in children living in low income communities but the exact causes need further investigation. The purpose of this quantitative, cross sectional study was to examine the association between parents' perception of safety and body mass index (BMI) percentile and children's physical activity/ inactivity levels and children's BMI as measured by the National Survey of Children's Health (2011/12 NSCH). The sample consisted of low income African American and Hispanic parents and their children between the ages of 6 to 17 (n=109) who live in Pennsylvania. The study used social ecological theory as the theoretical framework. Data analysis included descriptive analysis and Chi square analysis of variables related to safety, physical activity and children's BMI percentile. The results indicated a strong negative correlation of Hispanic parent's perception of safety and their children's BMI percentile, and a moderately negative correlation of African American parents' perception of safety and their children. In addition, a strong negative correlation of Hispanic parent's perception of vandalism and their children's BMI percentile was found. The study contributes to social change by increasing awareness of public health policy makers and officials that parental concerns for safety and vandalism should be considered in the creation of policies geared at reducing unsafe aspects of the community, the design of educational programs for parents and children, and alterations within communities to improve health.

Women face great risks in pregnancy and childbirth, especially in developing countries where there are very few skilled birth attendants and negligible government investments in maternal health programs. As a result, obstetric fistula (OF), a potentially fatal but preventable and treatable condition, affects some 3 million women and girls globally. In Sierra Leone, the prevalence of OF is extremely high, but the absence of quality data to inform decision-making, both on prevalence and risk factors, is a barrier to creating an environment for OF prevention and care. The purpose of this phenomenological study was to explore and document the barriers to medical care, and the perceptions of patients and medical personnel concerning the complexities of OF. In-depth interviews were performed over a 2-month period with 12 patients and 8 medical personnel at the Aberdeen Women's Center in Freetown, Sierra Leone. Results showed that patients face multiple medical barriers including high costs, fear of hospital treatment, severely inadequate treatment, and severe physical sequelae including paralysis and foot dragging. Multiple emotional, social, and financial harms related to OF were also reported, including stigmatization, abandonment by family, embitterment, depression, and job loss. Most patients expressed a preference for traditional birth assistants over medical personnel. However, many also benefitted from the intervention of friends or other good Samaritans. The results and recommendations from this study should be helpful in informing the general public and policy-makers about OF as a major public health problem, and in the design and delivery of programs to eradicate or alleviate the problem of OF in Sierra Leone.

The incidence and knowledge of the risk factors of stroke across ethnic groups in the United States have been examined in multiple studies. However, it is not well known if the foreign-born African immigrants who constitute about 4% of the U.S. immigrant population are at a higher risk of the incidence of stroke than are other nonimmigrant population in the U. S. This ethnographic study explored the perceptions of Anglophone African male immigrants residing in San Diego on the risk factors of stroke. The theoretical framework for this study included the health belief model and the health promotion model. Data were collected through unstructured, in-depth interviews with 8 male participants. Interview transcripts were analyzed using Nvivo 10 computer software and reviewed manually. A key finding was that most of the participants reported a lack or limited knowledge of stroke disease and no knowledge of the warning signs of stroke prior to migrating to the United States, but that they acquired some knowledge after integrating into mainstream U.S. society. Other findings were that using preventive services such as engaging in periodic medical check-ups and screening for high blood pressure, diabetes, and high cholesterol were not common practices in the home countries of the participants; that the participants considered women as resource persons on health issues; and that the participants struggled with negative attributes associated with sickness and hospitals. Results of this study might encourage changes in the health behaviors and beliefs of the African-born male adults by raising their knowledge and awareness of the prevalence of stroke and preventive measures available to them in the community.

Multiple studies have indicated a higher burden of overweight/obesity and exposure to environmental toxins, such as alcohol and tobacco smoke, in association with higher prevalence of cardiovascular disease (CVD) in the African American population. Thus, the purpose of this research was to determine if there was a significant difference in the use of lifestyle adjustments such as moderating alcohol consumption, weight loss, and smoking cessation on the prevalence of CVD in the African American population. The theoretical foundation was social cognitive theory and the social ecological model that posits the interplay of individual, social, and environmental factors. This cross-sectional quantitative study was designed to assess the effects of lifestyle adjustments of weight loss, moderating alcohol consumption, and smoking cessation in the prevalence of CVD in African Americans between 40 and 60 years of age. Analysis of secondary data from the National Health and Nutrition Examination survey for the years 2013-2014 was conducted using binary logistic regression. The findings showed no significant difference in the use of weight loss, moderating alcohol consumption, and smoking cessation in the prevalence of CVD in African Americans between 40 and 60 years of age. However, the odds of moderate alcohol consumption and weight loss were greater than 1. Thus, this study may have a small potential impact on CVD in African Americans by encouraging lifestyle adjustments, and may contribute to positive social change by increasing life expectancy, improving quality of life, and reducing the burden of certain chronic diseases and reduction of healthcare cost.

Female genital cutting (FGC) is the partial, or total excision of the female outer genitalia, or different forms of lacerations to the female genital organs for nonmedical reasons such as social, cultural, religious, or other nonmedical intentions. Many girls and women around the globe who have gone through FGC or are at the risk of being forced into it. The purpose of this qualitative case study was to explore the place of culture, religion, social beliefs, and men's views, attitudes, and knowledge regarding the FGC within the Nigerian immigrant community in the northwest US. The social convention theory served as the framework for the study. Data were gathered from 22 adults, 18 years old and above, who have lived in the Portland, OR area for at least 2 years. Fourteen open-ended questions with subheading were used to carry out a face-to-face interview. The data were analyzed manually. The participants (parents with daughter[s]) in this study supported the possible eradication of FGC in all manner; using sound education and legislation. Even though FGC is filled with so much pain and in some cases, lifetime scares, people still carry it out because it is a traditional rite which has been passed down from generation to generation. Possible implications for positive social change include education of young parents and everyone else regarding the dangers that are associated with FGC, especially in the rural areas where FGC is believed to still thrive. If men were to speak up and stress their dissatisfaction with FGC and show sympathy to those who may have gone through FGC, they may shield their daughters from the practices. The eradication of FGC would enhance the lives of young women and girls and reduce the morbidity and mortality connected to this practice.

More than 49,081 people were diagnosed with HIV in the United States in 2011. Of those 49,081 HIV-infected persons, 1 in 6 was not aware of being HIV positive. In 2011, Georgia had the 5th highest number of HIV diagnoses among the 50 U.S. states. This phenomenological study aimed to understand the lived experiences of HIV-infected adults, ages 30 to 49 years in Atlanta, Georgia, by understanding their perceptions of risk prior to contracting HIV. The health belief model was used to guide this study because it explains and predicts health-related behaviors and it has been used in previous studies to identify preventive behaviors specific to sexual behaviors. Purposive sampling was used to obtain 12 HIV-positive persons ages 30 to 49 years who lived in the metropolitan Atlanta area at the time of the study, were knowledgeable about HIV perceptions, and were able to discuss their lived experiences. Interviews were conducted to collect the data. The data analysis procedures included creating codes and categorizing the data, checking the validity of the codes, identifying patterns and themes, interpreting the data, and conducting member checks. Results showed that most participants did not perceive themselves to be at risk of HIV. Participants also experienced stigmatization and had challenges maintaining social relationships after their HIV positive diagnosis. Future priorities should focus on identifying best practices relevant to individual, familial, organizational, societal, environmental, economic, and policy factors to reduce the risk of HIV. This study is important for public health and social change because the findings might be used by healthcare professionals to identify and allocate the resources necessary to strengthen HIV/AIDS care and services to the populations who need them the most.

In the Republic of Chad, primary care physicians play a central role in the detection and control of outbreaks and are critical actors in the integrated disease surveillance system through mandatory reporting. Feedback on such surveillance must reveal the needs and perceptions of these physicians. These needs and perceptions were examined using a questionnaire survey distributed to a sampling of 20 physicians in Chad. The purpose of this qualitative study was to investigate the role of primary care providers in the integrated disease surveillance to identify factors that impact complete, quality, and timely reporting. The theory of planned behavior was used for the theoretical framework. Interview data collected from the physicians via a purposive sampling strategy were analyzed. The questionnaire used a standardized, validated tool to assess the role and factors that impact complete, quality, and timely reporting related to the integrated disease surveillance system among primary care physicians. Demographics and descriptive analysis of the frequency of responses was performed. Key findings were positive for the importance of the provider's role in case detection and case reporting. These findings offer an understanding of factors that affect the complete, quality, and timely reporting and give insight into how the integrated disease surveillance system might be improved. The data show the physicians understood how to conduct disease reporting, and provide solutions for enhancing the integrated disease surveillance system. These findings support social change by informing the important practice of early detection and reporting of infectious diseases to detect and control future outbreaks.

Methicillin-resistant Staphylococcus aureus (MRSA) strains have spread in Saudi Arabia, increasing morbidity, mortality, and financial burdens. Recent studies have suggested the phenotyping methods typically used to classify MRSA as either health care MRSA (HA-MRSA) or community-associated MRSA (CA-MRSA) cases are unreliable, because they lack concordance with the results of genotyping. Yet the expense associated with genotyping precludes its use in the Saudi Aramco population in Saudi Arabia. The absence of a standardized and affordable method to classify MRSA into CA-MRSA and HA-MRSA has been a challenge for infection control programs in Saudi Arabia. The objective of this quantitative, secondary data analysis was to determine the most reliable phenotyping approach to strain identification using John Hopkins Aramco hospital data. The ecological and antibiotics selection pressure theories framed this research. The results of concordance, and sensitivity and specificity tests, suggested hospital admission profiles and susceptibility pattern were the most reliable phenotypic predictors of genotype-based classifications. Multiple logistic regression for susceptibility pattern (OR = 15.47, p < .001) and hospital admission profile (OR = 2.87, p = .008) confirmed those results, whereas all other variables were not found to be statistically significant. These results can be used to clarify the epidemiological and molecular factors that affect the transition of MRSA from health care facilities to the Saudi Aramco community. Implications for positive social change include faster and more reliable classification of MRSA to aid in disease surveillance and the selection of appropriate treatments to reduce MRSA-related morbidity and mortality.

African Americans are disproportionately affected by diabetes mellitus (DM) and complications that include diabetic retinopathy and its disease and socioeconomic burdens. This study examined the relationships between diabetic retinopathy and health care utilization factors, such as gender, DM comorbidities of hypertension and hyperlipidemia, and health care access, among sampled African Americans with DM in the United States. The Andersen health care utilization model was the framework for the study. In this correlational cross-sectional study, data from the 2011-2016 National Health and Nutrition Examination Survey datasets were analyzed. Results of complex samples logistic regression showed that there were no significant associations between diabetic retinopathy and DM comorbidities of hypertension and hyperlipidemia, gender, and health care access, after controlling for hemoglobin A1C level, urine albumin-to-creatinine ratio (UACR), marital status, education level, and annual household income. UACR, annual household income, and adult education level were significantly associated with diabetic retinopathy (p <.005). Researchers might use findings from this study for further studies to establish cause-and-effect relationships between diabetic retinopathy and the related health utilization factors in this population. Positive social change might be effected by using results from the study in planning and developing effective public health interventions targeting specific African American populations, which might result in a reduction of the associated physical and socioeconomic burdens on these populations.