Older adults with infectious and chronic diseases, such as cardiovascular disease and human immunodeficiency virus (HIV), are at high risk for associated chronic comorbidities, which are associated with increased medical expenditures to cover treatment costs. The purpose of this study was to investigate (a) whether adults 65 or older with either HIV or cardiovascular disease were predisposed to increased medical expenditures versus adults 64 and younger, and (b) the impact of race and type of health service used on total direct medical expenditures incurred among adults with HIV or cardiovascular disease. A quantitative, deductive, retrospective cross-sectional design was used, and the behavioral model of health services use and the socioecological model were chosen as the study’s theoretical foundations. Analyses were conducted using binary logistic regression. Controlling for confounding variables of education and region of residence, the key findings were that adults ≥ 65 years had higher odds of incurring higher expenditures overall. White patients had higher odds of incurring higher expenditures for medication (OR 1.251), office-based visits (OR 1.433), inpatient visits (OR 1.245), and outpatient visits (OR 1.451) when compared to other races. Older adults with HIV had higher expenditures for medication and home health (OR 1.850); and older adults with cardiovascular disease had higher outpatient (OR 1.235), inpatient (OR 2.142), and emergency room expenditures (OR 1.063). These findings might promote social change because assessing the influences of cost disparities on infectious and chronic diseases can help address variations in health care costs and can initiate the development of tailored evidence-based practice guidelines that can help older adults.

There is a high prevalence of hypertension in Nigeria. Limited knowledge of hypertension, how to prevent it, its outcomes, rapid urbanization, and the adoption of Western eating habits are implicated. Hypertension is an important issue because chronic disease places economic, social, and disease burdens on society. The purpose of this mixed-methods study was to investigate lifestyle practices, knowledge, and attitudes on risks and prevention of hypertension among residents of Ogun State, Nigeria (N = 79). The conceptual framework for this study focused on how knowledge, attitudes, and practices influence the dietary habits, behaviors, and ultimately blood pressure . The PEN-3 model was also used as the theoretical framework for research. The general linear regression model with sums of squares and Pearson's product correlation were used in quantitative analysis of diet, blood pressures, educational attainment, height, physical exercise, and weight to determine the factors that were predictive of hypertension. The main predictors of hypertension were age (p < 0.03), BMI (p <.024), and educational attainment (p < 0.02). Deductive analysis of qualitative data from focus group discussions revealed mothers are a primary source of health knowledge. Also, Babcock University has made a major impact on community health by providing free health lectures. This study contributes to social change by extending the PEN-3 model with two new domains, support for health behavior, and power to change health behavior. This information can be used to help focus government health outreach programs for improved support of individual and community change.

Breast cancer patients undergoing radiotherapy often experience severe levels of anxiety and depression. There is a gap in the research literature from Africa, particularly from Ghana, with few studies focusing on the assessment of anxiety and depression among breast cancer patients undergoing radiation treatment. A better understanding was essential to promote efforts to help breast cancer patients cope with their diagnosis and treatment and increase their overall quality of life. This mixed method study examined breast cancer patients in Ghana undergoing radiotherapy and their responses related to anxiety and depression through a concurrent triangulation involving an interview with selected professional participants and a detailed patient survey. Patients completed 2 modified scales, the Patient Health Questionnaire and Depression Anxiety Stress Scale. The sample consisted of 100 patients between the ages of 20-89. Individual interviews were held with 6 professionals with a minimum of 5 years of work experience. Themes were generated through open coding of the interview data, while multiple regression was performed to determine the relationship between depression and anxiety with the independent variables . Findings of this study indicated the need intervene through counseling and education on behalf of patients in Ghana as they undergo breast cancer treatment. Age and monthly income of patients were statistically significant in predicting the anxiety and depression among the patients. The study's implications will lead to positive change when all stakeholders take on the responsibility of implementing measures to promote coping strategies for breast cancer patients in Ghana.

From 2004 to 2015, the health sector in Nigeria was substantially underfunded despite the existence of a federal health policy committing 15% of the national budget to health care financing. The purpose of this narrative and phenomenological study was to explore the nature and significance of economic claims made in this policy. The central research question examined the extent to which these economic claims were perceived to be realistic, attainable, and successful in meeting their intended policy objectives and impact. The study's conceptual framework combined Kingdon's ambiguity and multiple streams theory, Roe's narrative policy analysis, and Skocpol's policy feedback theory. Seventeen major health policy documents and transcripts from key informant interviews with a convenience sample of 15 representative health policy experts, were imported into a data software. Twenty-six nodes were identified and then manually organized into 3 themes to generate the findings. Policy experts perceived the 147 economic claims in the policy documents as marginally realistic, and a majority of these experts assessed the claims as unattainable and with limited chance of succeeding in addressing the underfunding of Nigeria's health sector. The study opened a new area of research inquiry in health policy and health care financing by linking the veracity of economic claims made in the national health policy with the actual financing of health care. Health policy experts can use study results to promote the formulation and use of evidence-based economic claims in future health policies. Increased use of specific, measurable, attainable, realistic, and time-bound economic claims will enhance future health policy contributions to human wellbeing and positive social change.

Collective efficacy, time urgency, and health literacy have been a focus of research since the 1970s. Researchers have demonstrated that these factors influence health and decision making. However, researchers have yet to establish how these factors may be connected to the achievement of policy aims that impact holistic or environmental health. This study utilized the health belief model, social cognitive theory, time urgency theory, health education and promotion theory, Bronfenbrenner's ecological systems theory, and the Meikirch model. The purpose of this quantitative study was to determine if the factors of collective efficacy, perceived time urgency, perceived health literacy, ethnicity, age, gender, perceived financial strain, and/or educational level are associated with the perception of the likelihood of reaching 100% renewable energy in North Hawaii County (Hawaii Island) by the year 2045, referred to as REHI45. A sample of 136 residents of North Hawaii County completed a survey to measure these factors. A multiple linear regression analysis was run to test relationships among the variables. Results revealed that collective efficacy, perceived time urgency, and perceived health literacy were significantly associated with the perceived likelihood of REHI45. These findings may inform the design of intervention programs and/or preventative measures to promote overall long-term health and positive social change in North Hawaii County. Individuals, organizations, institutions, cultures, and societies may benefit from the results of this study through its ability to raise awareness of factors that influence the perceived likelihood of achieving REHI45.

The food decisions, dietary patterns, physical activity, and weight-related convictions of African American mothers are affected by their self-perceptions and views of body weight. The gap in the literature regarding the impact of these perceptions on children's food choices, eating habits, and body image is significant. Using the health belief model as the theoretical foundation and a cross-sectional survey as the research design, this study assessed the potential relationship between mothers' and children's eating habits and whether mothers' perceptions of their children's body image were reliable indicators of childhood obesity. Eighty-six mothers provided demographic information and completed the Child Feeding Questionnaire (CFQ) and the Figure Rating Scale (FRS); 86 children completed the FRS. All 172 participants self-reported weight and height. No other measurements were taken. Logistic regression and correlation analysis were used to answer the research questions. Correlation analysis showed a significant relationship between the mothers' perceptions of their children's body image and the children's self-perceptions of their body image. The results of regression analyses indicated that the mothers' perceptions of their weight as children influenced food choices for their children as well as their children's self-perception of body image. Positive social change in the African American community may occur by having community and health care professionals offer awareness programs to African American mothers.

Management of chronic disease requires a different service delivery model from that of acute illness. The uninsured population experience poorer health status and increased incidence of chronic disease than do the insured population. The purpose of this study was to identify the supports and barriers present in providing chronic disease management to patients at Ohio free clinics. Wagner's theory of chronic disease management served as the theoretical lens. The sequential, exploratory mixed methods study collected data from 13 free clinics belonging to the Ohio Association of Free Clinics (OAFC). Quantitative questions focused on processes in clinics with high and low fidelity to the chronic care model (CCM) determined by the Assessment of Chronic Illness Care (ACIC) survey. A backwards stepwise logistic regression was used. The quantitative analysis determined the 3 highest and lowest scoring clinics on the ACIC survey who then participated in a 2 tiered multi-case study series. Qualitative questions examined supports present in high fidelity clinics and barriers present in clinics with low fidelity. Qualitative findings identified 5 support areas that centered on progressive vision and patient-centered care themes that existed in high fidelity clinics. Four barriers were identified in low fidelity clinics that focused on the theme of capacity building. These findings provide evidence to guide the OAFC's work in improving adherence to the CCM constructs, thereby elevating the quality of care to the uninsured with chronic disease to the level of those providers governed by accrediting organizations. Changes in quality of care may result in an improvement to the health status of the individual and the communities in which they live.

The Centers for Medicare and Medicaid Services wanted to ensure that electronic health records were used in a meaningful manner to improve coordination and quality of patient care. In 2011, the federal government began offering monetary incentives to help healthcare facilities and providers adopt technology that supported patient access and increased their ability to manage their own health. The hospital where this project took place encouraged patients’ involvement in their health by providing a patient portal, yet the public has underutilized it. The purpose of this project was to develop an evidence-based strategy for future implementation at the hospital that will increase patients’ use of the hospital’s portal. Education will be provided through an interaction between patients and a designated staff member. An informative video describing the functionality and benefits of the portal will be shown to patients to see if individualized education increases portal enrollment and participation in the portal. Adult learning theory informed this quality improvement project. In addition, the logic model served as the framework for the development of an evaluation strategy that the organization will use post implementation. The project targets social change through patient engagement. Ideally, patient portal education will increase portal enrollment, which will increase patients’ knowledge of their health information. Evidence indicates access to one’s own health information is a first step in improving and strengthening self-care and achieving better clinical outcomes.

Diabetes is an epidemic that has started to capture political attention in the United States because of the devastating health care costs associated with the disease. Researchers in other studies have concluded that additional education face-to-face (FTF) and FTF with alternative forms of diabetes communication (FTF plus) have been beneficial. However, there is very little information on the comparison of the two groups as mentioned above when comparing chronic limitations, self-perception, health status, and healthcare satisfaction as circumscribed by specific demographic population. This study was an investigation of the above variables and explored how specific demographic characteristics (age, gender, educational level, and race/ethnic background) may have an identifiable association with each diabetes education type, either FTF or FTF plus. This research involved the use of the social cognitive theory and the health belief model to help explain self-care behavior changes. This quantitative, cross-sectional study used secondary data from the 2016 National Health Interview Survey for analysis. A simple linear regression was used to understand health status and healthcare satisfaction. A logistical regression was used for chronic limitations, while controlling for demographics for all the variables. The study revealed FTF plus had an association with chronic limitations with race and education level, but age was not significant. After controlling for demographics, a person who has FTF plus has decreased odds of having chronic limitations, in comparison to someone who receives only FTF. The results from this study may aid formulation of future healthcare policies that focus on how to refer patients to multiple forums of diabetes education, while reducing healthcare costs.

The street food sector continues to grow in Nigeria in a largely unregulated environment. The lack of regulation poses a significant public health risk for consuming unsafe street foods such as suya. Quantitative research has revealed high levels of microbiological contamination of suya, despite qualitative findings that suggest that food handlers are knowledgeable about safe food handling practices. This discrepancy reveals a gap in understanding about what influences safe food handling practices besides knowledge. This qualitative study was therefore designed to gain a deeper understanding of the beliefs and attitudes that influence hygienic practices among suya producers. Guided by the social cognitive theory, a phenomenological design was used to investigate and describe the hygiene phenomenon. Ten suya operators were recruited in Abuja, the Federal Capital Territory of Nigeria, to participate in the study. Data were collected from interviews and observation of participants. Semistructured, open-ended questionnaires were used in face-to-face interviews to elicit participants' views on hygiene. Hygiene practices among participants were also observed. Information gathered was recorded, stored, transcribed, and analyzed using the NVivo software and based on emerging themes. The findings revealed that participants' understanding of hygiene was related to popular culture rather than science. Furthermore, findings also revealed that family, religious, and cultural beliefs, as well as environmental factors such as consumer attitude influenced their hygiene practices. These findings may provide evidence-based guidance for public health interventions for safer suya production processes with positive social change implications for improved consumer health.