There is a growing body of evidence on the positive association between diabetes and tuberculosis (TB), especially in populations with low socioeconomic status. According to the CDC and the WHO, diabetes is increasingly seen as a global epidemic, one that poses a threat to global TB control. The goal of this DNP project was to develop a program to educate clinical staff on the importance of early identification of diabetic and TB patients. The logic model was chosen as the framework for this project because it allows the planner to rationally observe each stage of a project's development. The program design consisted of several steps: (a) assembling the planners and stakeholders, (b) conducting relevant literature review, (c) gathering educational materials, (d) creating education modules, (e) developing an evaluation method, (f) presenting the results to the organization, and (g) standardizing the modules to be implemented in each of the organization's clinics. Ten participants including nurses, physicians, educators, and administrators reviewed the program in a formative (n = 5) and summative (n = 5) round to evaluate the ease of use and content. During the summative review, participants demonstrated 92.3% agreement using the AGREE II instrument. This tool supported the stakeholders' understanding and support for the developed modules. Overall, the program serves as an important tool to educate clinical staff to better manage and decrease the spread of tuberculosis among diabetic patients, and also as a comprehensive guide for developing similar projects in community clinical settings. The resulting educational program, which could be implemented by health care providers and clinical administrators, could serve as a catalyst for improved community health outcomes.

A public health workforce must be trained to react quickly, especially in the case of terrorist attack. Political leaders and emergency management experts have often cited inadequate emergency training as a contributing factor in the public health system's failed preparations for a bioterrorist event. As a result of these failures, billions of dollars have been allocated towards correcting infrastructure deficiencies including training for public health nurses (PHNs), who are critical to a communitywide medical response. This quantitative study used Pearson's correlation and a multivariate regression analysis to evaluate the most effective modality of bioterrorism training (BTT) for PHNs working in rural communities in North Carolina. Using a conceptual framework created by Handler, Issel, and Turnock, this study compared 3 modalities of instruction (MOI) to seek the best predictor of success in retaining learned bioterrorism skills. The research question focused on whether MOI for BTT/all-hazards training courses significantly predicted the degree of retention of emergency knowledge/skills for PHNs working in public health agencies in North Carolina. A multiple choice survey was used to test 103 PHNs' level of knowledge retention on a bioterrorism quiz. The results of this study were ultimately inconclusive in that no MOI was found to be a statistically significant predictor of retention. Factors such as age were found to be successful predictors of knowledge retention. The readiness issues identified in this study have a potential for positive social change if community decision makers use this information to prioritize future funding for public health professionals or enhance communitywide emergency preparedness education programs.

In the United States, over two-thirds of adults are overweight or obese, and the number of children and adolescents who are overweight is increasing. Obesity is a significant issue as obesity-related chronic diseases can result in diminished quality or life, high morbidity and mortality, and substantial healthcare costs. The purpose of this study was to examine neighborhood social capital and how it relates to adolescent obesity. The socio-ecological model was used as the theoretical framework of this study to examine how the environment and social contexts influence health behaviors. Utilizing a quantitative cross-sectional research design, bivariate and multivariate analyses were conducted on 43864 10 to 17 year-olds using secondary data from the 2011-2012 National Survey of Children's Health. Controlling for age, gender, race, and overall health status, logistic regression analysis indicated that supportive environments predict the odds of adolescent overweight and obesity, while safer communities did not significantly predict the odds of adolescent overweight or obesity. The results of this study showed that there was a significant association between living in a supportive neighborhood and a decreased likelihood of an adolescent being overweight or obese (OR = 0.797). Associations were also found in demographic variables such as race, gender, and age. Positive social change implications from this study may include use of the findings by public health practitioners to better understand the factors that influence adolescent obesity in general, and the role of the social neighborhood environment in particular. In turn, public health workers can use this improved understanding to improve the quality of interventions, programs, and policies, resulting in positive social change among adolescents.

African American women living in rural Ohio have a history of low mammogram screening rates and a high incidence of breast cancer identification in the late stage of the disease, leading to mortality rates exceeding those of Caucasian women. The purpose of this doctoral project was to establish a breast health educational program for health providers in a local mammography center that did not provide such a program specifically targeted for African American women. Three theoretical frameworks, the health belief model, Knowles's learning theory, and the PEN-3 model, guided the development of a staff education program based on cultural appropriateness. The practice-focused question was whether or not the educational program would enable health care providers and staff to use an evidence-based approach to promote the message of breast cancer prevention in a population at high risk for breast cancer. A radiology specialist, nurse navigator and radiology supervisor reviewed the educational plan and the Komen Toolkit materials and graded the program as strongly supporting a cultural competency program. The education and experience of the three panel experts in mammography enabled them to serve as evaluators for this research project. The strategy to use faith-based leaders' as representatives of the African American patient population collaborating with providers supported cultural competency in health care. Mammography centers and faith-based organizations benefit from this project because of its focus on culture at the center of its development. Cultural competency supports positive social change in health care for an at-risk population.

The prevalence and incidence of breast cancer is an important issue that is affecting all women, but African American women have the lowest survival rates after breast cancer diagnosis. Historically, the Black church and faith leaders have been essential in promoting health in the African American community. Moreover, faith-based interventions have become more common within the African American community in addressing factors that affect survival rates such as early detection, cultural barriers, and education. Currently, there is not clear information on the perspectives faith leaders have on their experiences with implementing breast health interventions in their places of worship. This phenomenological study used interpretivism as the conceptual framework to understand the experiences of the faith leaders of African American congregations who participated in Worship in Pink, a faith-based breast health program implemented among congregations in metropolitan Atlanta. The research questions sought to answer what faith leaders' experiences were with participating in this intervention and what situations or contexts may have influenced their experiences. In depth, semistructured interviews were administered to a sample of 5 faith leaders who participated in Worship in Pink. There were 3 themes and 1 subtheme that emerged because of the study. The themes included partnership with Komen Atlanta, increased awareness, impact on the community, and resources. The positive social change implications include knowledge useful for faith leaders, program developers, health policy makers, health educators, and other researchers who are seeking to understand experiences of faith leaders in order to improve breast health and awareness of African American women.

The Hispanic population has a higher incidence of diabetes and poorer health outcomes compared to other populations in the United States. Although previous research has reported that cultural and ethnic beliefs play a role in poorer diabetes self-management by Hispanic individuals, limited studies have been focused on the barriers to self-management from the perspectives of Hispanic immigrants. The purpose of this qualitative study was to gain an understanding, through oral history narrative, of the experiences of Hispanic immigrants living with diabetes. In this study, the influence of cultural and ethnic beliefs on diabetes self-management in Hispanic immigrants in the Bronx in New York was explored. Semistructured interviews were conducted with 7 Hispanic immigrants who narrated their lived experiences regarding how they self-manage their conditions. The theory of reasoned action/theory of planned behavior guided this research. Data from in-depth interviews were coded and analyzed for themes. Six themes emerged from these interviews: knowledge of diabetes, diabetes self-management, strong cultural beliefs, social support, lifestyle changes, and strong cultural influence on diabetes management. The results from this study can lead to social change by providing information to health care providers and policy makers who need to deliver culturally sensitive education to both diabetic individuals and their families, which can help in the self-management of the disease.

Acute bacterial skin and skin structure infections (ABSSSI) are common infections within the local community, and they result in higher morbidity and health care costs. While risk factors for skin and soft tissue infections have been previously evaluated, risk factors associated with secondary bloodstream infections (BSI) has not been investigated, especially in an intercity patient population with limited health care resources. In this case control investigation, 392 patients consisting of 196 cases (ABSSSI + BSI) and 196 controls (ABSSSI) were investigated to determine risk for BSI. Both sociodemographic and underlying conditions were evaluated. According to bivariate analysis of cases and controls, individuals with ABSSSI + BSI were significantly older (p < 0.001), more often male (p = 0.008), and had a higher percentage of abnormal symptoms, such as elevated temperature, white blood cell count, and acute renal failure on hospital admission (p < 0.001). Individuals with ABSSSI + BSI also had a higher percentage of chronic renal failure (p = 0.002), diabetes (p = 0.005), congestive heart failure (p = 0.012), intravenous drug use (p =0.012), and a history of prior hospitalization (p < 0.001). Several of these factors remained statistically significant by logistic regression analysis, such as male gender aOR of 1.85, 95% CI 1.11-3.66; acute renal failure aOR 2.08, 95% CI 1.18-3.67; intravenous drug use aOR 4.38, 2.22-8.62; and prior hospitalization aOR 2.41, 95% CI 1.24-4.93. This study contributes to positive social change by identifying patient characteristics that are associated with ABSSSI-related BSI, thus providing health care providers the ability to improve patient outcomes in this underserved patient population.

Diabetes is a disease that affects the Hispanic population in disproportionate numbers. With larger numbers of immigrants coming to the United States who are of Hispanic origin, the individual risk and health burden of this disease will have a major impact on the quality of life and the health care system. Research into the influence of the timing of changes in lifestyle suggested an association between specific levels of socioecological exposures and certain health conditions. This study examined that possibility. The use of the National Health Interview Survey, 2005-2011, provided adequate data for examining whether age at migration was associated with self-reported diabetes; if there was a relationship between age at migration, diabetes, and obesity; and, if the age at migration-diabetes relationship differed depending on the Hispanic subgroup. It was a quantitative, cross-sectional study using a logistic regression. The outcomes indicated that migration early in life influenced diabetes diagnosis in later life and, with the addition of obesity to the model, the relationship between age at migration and diabetes persisted. This research can be a catalyst for social change in allowing for the identification of individuals most at risk, the timeframes for that increased risk, and a better understanding of the factors that predispose individual to diabetes. Public policy initiatives to target specific time periods can provide avenues for social change among this population with preventive measures to reduce long-term negative consequences of diabetes, thus improving quality of life and providing a more effective use of the health care system.

Low-income populations in the United States consume less healthful diets than higher-income populations, specifically relating to fruit and vegetable consumption. The supplemental nutrition program Women, Infants, and Children (WIC) is intended to bridge this gap by providing nutrition education and vouchers for nutritious foods. The purpose of this study was to determine if the 2009 WIC food package revisions impacted fruit and green vegetable consumption in 18 to 24-year-old females in California. Using the social ecological model as a guide, a population of WIC (N = 115) and non-WIC (N = 276) participants from the California Behavioral Risk Factor Surveillance System survey were analyzed for trends on daily fruit and green vegetable consumption over the period of years 2009, 2011, 2013, and 2015. ANCOVA analysis showed that WIC and non-WIC populations did not consume significantly different amounts of green vegetables, but did consume significantly different amounts of fruits, p = .120 and p = .028 respectively. Additionally, WIC participant fruit consumption did not significantly increase over the years, p = .376. However, a decrease of .031 (95%CI [.019,.584], p = .037) was identified in green vegetable consumption between 2009 and 2015. Due to mean differences between samples and years it is evident that there are influencing factors driving fruit and vegetable consumption outside of income barriers, such as possible social or environmental factors. This study adds to the literature regarding the WIC food package revisions and may promote positive social change by encouraging future researchers to identify barriers to healthful diets in WIC populations and determine if additional food package revisions may be needed to increase healthful diets in low-income populations.

One in every 4 people living with the Human Immunodeficiency Virus (HIV) are women. The leading cause of infection is heterosexual contact. The purpose of this quantitative, correlational study was to examine the relationship between gender ratio perception and masculine ideology and a woman's decision to use condoms during her sexual activity. The theory of gender and power and the theory of planned behavior served as the theoretical frameworks for this study. The perceptions of gender ratios, as measured by the Gender Ratio Imbalance Beliefs and Behaviors Scale (GRIBBS) subscale, GRIBeliefs, and masculine ideologies, as measured by the Gender Role Beliefs Scale (GRBS), served as independent variables, while condom use behaviors, as measured by the Gender Ratio Imbalance Beliefs and Behaviors Scale (GRIBBS) subscale, GRIBehaviors, served as the dependent variable. Covariates included demographic factors, as well as behavioral factors. A purposeful, convenience sample (n=55) via the Walden University research pool was utilized, enabling researchers to use readily available data that represented college educated women. Descriptive statistics, independent t-tests, correlational analysis, as well as multiple linear regression were used to examine the aforementioned perceptions of study participants. Correlation analyses and multiple regression indicated no statistically significant correlations between gender ratio imbalance, masculine ideology, and condom use, while controlling for race, employment status, religion, religious devoutness, sexual orientation, relationship status, STD history (self), and partner STD history. Social change is indicated via the results illustrating the possible empowerment of women regarding their sexual health.