The purpose of this qualitative study was to investigate whether there were differences between the preconceived notions of emergency medical technicians and paramedics prior to entering the profession and their notions of the vocation after facing the realities of the job. The contribution of alignment or misalignment to job satisfaction and the intention to leave the profession was also further investigated. This research is important as there currently is a gap in the literature pertaining to the factors affecting career longevity of emergency medical service (EMS) professionals. The degree of fit between individual and occupational characteristics guided this phenomenological study according to Lowman's theoretical model of career assessment and counseling. Study participants (n = 10) were recruited from organizations providing EMS training courses and ambulance service providers in New York State. Data were collected from semistructured interviews and the information was coded into themes. Key findings indicated aligned expectations and experiences of altruism led to satisfaction, physical challenges not considered prior to employment were associated with intent to leave the profession, and a perception of EMS as a transient career. This study's implications for positive social change are that its results will likely aid organizations in developing strategies to retain prehospital service workers, resulting in improved responses to the medical emergencies of communities and improvements in the care provided to society's sick and injured.

African Americans are adversely affected by health disparities due to the complexities of the patient-provider relationship. The behavioral model of health services was used as the theoretical framework to understand how individuals make healthcare utilization decisions. The purpose of the research was to evaluate how the patient-provider relationship influences inconsistent doctor visits by African American patients despite the prevalence of chronic conditions. 45 African Americans located in Shelby County, Tennessee were included in this study. A cross-sectional quantitative design was used to collect the data via an online survey. The 45 collected responses were analyzed by performing multiple linear regression, Pearson correlation, and Cronbach's ï?¡. Results of the analyses were statistically significant in proving that education level, income, gender of African Americans, and having health insurance affect the patient-provider relationship. It was determined by the statistically significant results that the patient-provider relationship had an effect on African American patients' decision to seek healthcare services and medication compliance and follow-up medical care. This information may guide the conversation within the Shelby County, Tennessee African American community regarding what role the patient-provider relationship has when addressing health disparities among African Americans.

The purpose of this phenomenological study was to explore the experience of older homeless females who have type 2 diabetes mellitus. Women who have stable housing often find it difficult to manage their diabetes; for those who are homeless, managing the disease is even more difficult. This chronic disease has impacted people all over the world and decreased their quality of life. However, people who are homeless may be at a higher risk of this stressful illness. Managing glycemic levels is a crucial factor in decreasing the adverse results in type 2 diabetes. In this study, face-to-face interviews were conducted with flyers from 15 participants between the age of 55 and 64 years who have type 2 diabetes. The participants shared their experiences of how they managed and monitored type 2 diabetes. The qualitative analytics in this study showed that the implementation of a secure storage area for diabetic medications is needed in shelter environments. The administration of insulin injection is essential, and needles should be allowed and stored appropriately in a locked cupboard or cabinet at the shelter. The 15-participants reported that the lack of a permanent address reduces their chance to access health insurance and other social benefits. The implementation of an emergency mailing program and modified interventions could meet the needs of older homeless women with diabetes and lead to a positive social change that would improve long-term care for these women. Therefore, the findings of this study show the need for new knowledge and social change that benefits the participants, the entire community, neighboring communities, and anyone who is struggling with type 2 diabetes.

Many companies have used perceptions of their employees to understand how sleep disorders affect their working environment. Sleep disorders have had an undesirable effect on employee performance and often result in employee modifications to accommodate their condition in the workplace. Though information is available concerning employees' experiences pertinent to working with sleep disorders, research focusing on how employees with narcolepsy perceive their work environment appears to be missing from the literature. The purpose of this study was to gain understanding of perceptions of employees with narcolepsy about their work environment and strategies that may influence others to promote positive health maintenance of narcolepsy in the workplace. The repair and restoration theory of sleep and the disability theory guided this study. Fifteen employees with narcolepsy participated in this descriptive phenomenological study by sharing experiences of their working contributions to become or remain employed. Giorgi's data analysis strategy revealed thematic employee reports of declines in work performance as a factor for being employed with narcolepsy. Study findings established that participants believed sleep attacks and inability to multitask were barriers in the workplace. Scheduling naps and changing work tasks offset barriers to help the participants remain successfully employed. The results of this study may benefit the health services industry as it relates to knowledge and understanding about productivity, schedules, and tools of the work environment for employees with narcolepsy. Positive social change implications include improved work environments and accommodations for employees with narcolepsy.

Teenage pregnancy is both a social and a public health problem in the United States, with approximately 750,000 young women between the ages of 15 and 19 becoming pregnant each year. In addition, teen pregnancy is more prevalent in the African American (15%) and Hispanic (14%) communities than it is in White communities (5%). The purpose of this study was to identify risk factors contributing to teen pregnancy among racially diverse teenagers 15 to 19 years of age living in the rural south. This study, guided by social cognitive theory, used a quantitative, cross-sectional research design to determine whether living environment, educational resources, and access to healthcare impact risk of teenage pregnancy. A quantitative survey assessed factors such as sex-related attitudes, parent/peer communication, living environment, and educational attainment. Two primary research questions and 8 related hypotheses were formulated for investigation. Using binary logistic regression, the data in this study revealed that an increase in positive environmental factors (household income and parental education) and an increase in positive personal factors (parental/peer communication, teen's academic achievement, and attitudes toward sex) decreased negative behaviors (risks of teen pregnancy). This study may promote positive social change by providing information on relevant social and educational factors to those responsible for the design of comprehensive pregnancy prevention programs that target at-risk teenagers. Provision of comprehensive social and health services to teenage parents and their children may help to reduce rates of first-time and repeat teenage pregnancies and thus prevent the negative social consequences of these pregnancies.

The oral health and hygiene of incarcerated populations, both in the United States and globally, is known to be poorer than that of the general population. This study examined the prevalence of dental caries and periodontal disease and the relationships between oral health status and the oral health knowledge, attitudes, and practices of jail inmates housed in a large metropolitan jail located in the midwestern United States. This cross-sectional study collected data from 100 inmates using a 21-item closed-ended questionnaire in addition to oral examinations conducted by the jail's dentist to determine the extent of dental caries and periodontal disease (DMFT and CPI scores) in this population. Neither oral health and hygiene studies nor studies of oral health knowledge, attitudes, and practices have been examined in U.S. jails. The conceptual frameworks of this study were the health belief model and social cognitive theory. The data were analyzed with the use of bivariate correlation tests, as well as binary logistic analyses. The results of this study revealed that the total number of correct answers on the oral health attitudes (OHA) questionnaire appeared to be the strongest predictor of high DMFT, with significance of 0.05 and an odds ratio of 1.522 (95% CI [1.000, 2.334]). In the analysis that included the total number of correct answers for the OHA questionnaire, years incarcerated was the strongest predictor of high CPI (p = 0.027), with an odds ratio of 0.340 (95% CI [0.131, 0.883]). This study advances social change by aiding in understanding the oral health status and oral health knowledge, attitudes, and practices of inmates - an underserved population. Results from this study can be used to assist jail administrators in understanding the types of dental care that is needed in correctional facilities.

Breast cancer (BC) is a significant condition that can result in devastating outcomes without treatment. The purpose of this phenomenological study was to explore barriers to health care disparities among young African American females. The findings of this study may help to address gaps in knowledge, obtain insights in treatments, and comprehend lived experiences with BC. The theoretical framework for this study was Bronfenbrenner's social ecological theory. Data were collected from face-to-face interviews with 10 African American women ages 20 to 40. Data were then transcribed and coded. The findings of the study indicated that women required treatment plans, informative resources enhancing comprehension of procedures, and assurance. The results of this research might motivate health care professionals to promote awareness in preventing delayed diagnosis of BC in African American women between the ages of 20 and 40 years. The findings in this study may increase health care providers' awareness and bring about social change in BC screening implementation.

This study focused on factors that influenced clinician embryo disposition decision-making in in vitro fertilization (IVF). Evidence-based medicine (EBM) should be built on the premise of shared decision-making. This paradigm is often skewed, resulting in clinician stress, a higher probability of errors, reduced productivity, or ineffective decisions. Guided by the theory of planned behavior and the self-perception theory, this study assessed the independent variables' religiosity, ethnicity, level of burnout, gender, age, years of experience, and clinical role in relationship to the dependent variable "decision-making" as measured by the Lyerly Frozen Embryo Survey, Maslach Burnout Inventory, and the Areas of Worklife Survey. IVF clinicians throughout the United States and Europe (n = 151) completed an online survey via a nonrandom, cross-sectional methodology. Study results indicated the factors were not significant. A vast majority of participants identified as: White, (84%), and female (75%), and that religion was very important (73%). The bulk of participants had a moderate level of burnout (85%), which showed that the multitude of participants were not experiencing overly high levels of emotional exhaustion, were not emotionally detached from their patients' needs, and felt a high degree of personal accomplishment. Recommendations included using a larger sample size, different variables, or developing a new survey as the decision making process may have been more multifaceted than anticipated. There are more areas to be studied around factors and decision making to fully understand these concepts. The positive social change implications include an increased awareness of factors that have the potential for impacting clinician decision-making as a reminder of the importance to be cognizant and sensitive of the needs of patients.

The relationship between suspected predictors of current HIV risk, i.e. self-efficacy, social norms, expectancies, alcohol use, past HIV risk, past history sexual abuse, social support, and behavioral intention was investigated in a sample of Latino migrant workers living and working in the United States (N=270) using baseline data from a previous study. A series of multiple regression analyses were performed by adjusting for socio-demographic characteristics such as age, gender, marital status, educational attainment, and length of stay. Zero-inflated Poisson regression analysis showed that self-efficacy was associated with behavioral intention (β= 0.03, p= 0.04) and expectancies was associated with behavioral intention (β= -0.01, p = 0.04). Binary logistic regression analysis showed that past HIV risk was associated with the dependent variable, current HIV risk (β = 0.11, p= 0.01), while behavioral intention was associated with current HIV risk (β= -0.16, p= 0.02). Bayesian path analyses showed behavioral intention to partially mediate the relationship between self-efficacy and current HIV risk (β= 0.24, 95% CI: 0.10, 0.38) and to fully mediate the relationship between AOD use and HIV risk (β= 0.11, 95% CI: -0.05, 0.26). In summary, two socio-psychological factors emerged as significant predictors of HIV risk. Lower levels of behavioral intention and higher levels of past HIV risk were associated with higher current HIV risk. These findings are relevant for informing future studies on Latino migrant workers or similar populations and for planning interventions designed to prevent and/or reduce HIV risk.

The focus of this study was to provide a comparison of data collected from seventh grade students on food safety knowledge who have been through USDA’s National Integrated Food Safety Initiative program with those seventh grade students who have had no formal school instruction on this topic. Middle school students were specifically targeted because they are more likely to synthesize this information in a way that will lead to the development of new behaviors. The population consisted of seventh grade students at Burchfield, Fairview, Huntsville and Oneida Middle Schools. Burchfield and Huntsville were the two schools used as the comparison group. The following conclusions were based on findings of this study: 1. There were some substantive increases in post-test scores for the treatment group. 2. The treatment group increased in all areas from pre-test to post-test. The areas included: Science Knowledge, Language Arts Knowledge, Math Knowledge, Social Studies Knowledge, Food Handling Skills Knowledge and Food Handling Behaviors Knowledge. 3. The data suggests this interdisciplinary food safety curriculum has made a positive impact on the treatment group. The scores after the program record higher overall than the comparison group scores. 4. The data showed that the treatment group had retained the knowledge, skills and behaviors six weeks after the treatment was administered. 5. Data revealed that the overall mean score for the treatment group pre-test was higher (+7.24) than the post-test score of the comparison group. 6. There was some evidence to suggest that the treatment group had more knowledge than the comparison group before the treatment, except in science, however the gain score afterwards shows the program successful. 7. A comparison of the treatment group and comparison group, revealed an overall increase in the mean score increase of 10.04 points for the treatment group, as an impact of this interdisciplinary food safety program. 8. After going through a one week food safety program, the student’s knowledge, skills and behaviors increased, thus strengthening the evidence that the program had a positive impact on the students.