The United States has experienced an increase in older workers as individuals born between 1946 and 1964 have remained in the labor force. Preventive health screening education, such as an immunization flyer, is necessary to avert preventable illness among older workers. Based on previous research, there is a gap regarding age-specific methods for educating the older worker about preventive health. Therefore, the purpose of this study was to explore the relationship between various media providing preventive health screening information and the assessed health literacy of the older worker. Based on the health belief model, a quantitative, cross-sectional method was used. A population of older workers (n = 159), starting at age 45, of diverse racial groups and job types, was surveyed to determine their health literacy, preventive health screening knowledge, and frequency of exposure to diverse types of media that facilitate preventive health education. Analysis of variance was used to evaluate the relationship between the various media providing preventive health screening used by the older worker and the health literacy of the older worker. According to the study, the 45-54 age group had the lowest health literacy scores, and all age groups possessed comparable knowledge of preventive health screening education. Finally, 2 types of media 'television and radio' were effective in improving health literacy by exposure, and 4 types of media 'television, radio, newspaper, and Internet' were perceived effective in providing preventive health education. Implications for positive social change included age-specific methods for educating the older worker about preventive health, which could, in turn, reduce morbidity and mortality caused by preventable diseases such as cancer and heart disease.

African American (AA) men in the state of Alabama are affected by colorectal cancer (CRC) more than all other races. The purpose of this phenomenological study was to gain understanding of colorectal cancer screening health benefits in AA men in Mobile, Alabama. The health beliefs model (HBM) developed by Hochum, Rosemstock, and Kegels was used to to explore the barriers and facilitators to CRC screening in AA men with health insurance in Mobile, Alabama. The research questions explored knowledge, perceptions, and facilitators to CRC screening among AA men age 40 to 75. Participants were selected using purposive sampling and data were collected through face-to-face individual interviews with 13 participants living in Mobile, Al. Data were inductively coded and subjected to a thematic analysis procedure. The study findings revealed that participants had a general knowledge of cancer but a low awareness of CRC screening. Findings also revealed a perceived gap in CRC screening education from participants' doctors. Few reported understanding or remembering a conversation about the need for CRC screening during their last doctor's visit. There was no indication that age or level of education played a meaningful role in participants' knowledge or perception of CRC screening requirements. Positive social change implications stemming from this study include recommendations to Alabama public health officials and policy makers to invest in the development of intervention and education efforts to increase CRC screening among AA men, which in turn, may reduce CRC related morbidity and mortality.

It is well established in the literature that the morbidity and mortality rates due to chronic diseases such as cardiovascular disease, cancer, hypertension, and diabetes in the U.S are alarmingly high. Likewise, there is ample data which demonstrates that participating in physical activity can help prevent and control many types of chronic diseases. Though the benefits outweigh the risks of participation in physical activity, the risks must be acknowledged. Published standards and guidelines in the health fitness field have been established to address operational practices of fitness facilities, increase safety of participants and mitigate these risks. The present study was a national investigation conducted to determine adherence to published standards and guidelines for self- and professionally-guided pre-activity health screening procedures (PHSP) across various settings (i.e., Hospital/Clinical, Community, Commercial, Corporate, University, Government). Additionally, this study obtained perspectives from study participants regarding familiarity with, importance of adherence to and legal liability associated with published standards and guidelines. As the American College of Sports Medicine (ACSM) is considered the gold standard in health and fitness, only ACSM's published standards and guidelines, specifically those related to pre-activity health screening, were included in the present study. A survey instrument was developed and validated to obtain the data for this study. The link for the web-based survey was sent from the ACSM's Certification Department to all ACSM Health Fitness Specialists (HFS) who lived in the US (n=9,433); a total of 1,246 (13.2%) responded to the survey. The survey instrument consisted of 54 questions including 14 participant related (i.e., Q1, Q3, Q34-Q45), 32 facility related (i.e., Q2, Q4-Q33, Q46), seven demographic related (Q47-Q53), and one open-ended question (Q54). Exclusion criteria removed any HFS who was not currently working part- or full-time in a fitness facility, which left 677 usable responses for data analysis. Special measures were taken to remove duplicate responses for any given facility which resulted in a lower number of usable responses (n=656) for those 32 questions. As hypothesized, the Hospital/Clinical setting had significantly (p<.006) higher percentages of fitness facilities (93%) which require new participants to complete a pre-activity screening device than all other settings (i.e., University (56%), Community (54%), Commercial(40%), and Government (67%)). Additionally, the Hospital/Clinical setting was also found to be significantly higher than Corporate relative to this same variable. Regarding the second research hypothesis, the Corporate setting was found to have significantly (p<.006) higher percentages (78%) of fitness facilities which require new participants to complete a pre-activity screening device than the Community setting. Twenty-six percent of respondents indicated they their facility conducted self-guided, 43% professionally guided, and 31% offered both self- and professionally-guided PHSP. High percentages of fitness facilities (73%) required new participants to complete a pre-activity screening device with 47% and 87% of these facilities requiring medical clearance for at-risk new participants for self- and professionally-guided screening procedures, respectively. At-risk was defined in the study as someone with known disease (e.g., cardiac, pulmonary or metabolic) or with signs/symptoms and/or risk factors associated with cardiac, pulmonary, or metabolic disease. Also, participants with other medical conditions (e.g., pregnancy, orthopedic injury) may be considered at- risk. The majority (86%) of facilities offered personal training and nearly all of these (99.6%) required clients of personal trainers to complete a pre-activity screening device. Additionally, 84% of these facilities required medical clearance for at-risk clients. Data regarding other aspects of PHSP for facilities were also obtained such as frequency of completion for participants, privacy, confidentiality, and security of information obtained, participant refusal to complete, and waivers for guests. Regarding their familiarity, 69% of respondents indicated that they were very familiar with the ACSM's Guidelines for Exercise Testing and Prescription (ACSM's GETP); however only 52% indicated they used the ACSM's GETP for development and implementation of their facility's PHSP. Of these facilities, the results regarding the inclusion of the GETP criteria on their screening device were: (a) 96%, 91%, 87% for known CV, pulmonary and metabolic disease, respectively, (b) 44-95% for each of the nine signs/symptoms with dizziness/syncope the highest (95%) and intermittent claudication the lowest (44%), and (c) 64%- 99% for each of the nine CV risk factors with smoking the highest (99%) and high-density lipoprotein the lowest (64%). Although 52% of respondents reported more than adequate academic preparation, 70% reported being very confident in conducting professionally-guided pre-activity health screening procedures and that adherence to published standards and guidelines was very important. However, only 28% of respondents reported more than adequate academic preparation regarding legal implications involving PHSP. Other data from the HFSs regarding PHSP were also obtained such as their perspectives of the importance to management to adhere to and familiarity with published standards and guidelines as well as their knowledge of legal issues related to PHSP. In the open-ended question, respondents provided comments and challenges (n=509) that they encountered while conducting PHSP. These data were analyzed, coded and then categorized into three major themes: 1) medical clearance related issues, 2) administrative/procedural related issues, 3) member related issues. Compared to previous research, adherence to published standards and guidelines, as evidenced by the percentage of facilities which require new participants and clients of personal trainers to complete a pre-activity screening device, seems to be generally increasing. Additionally, relative to the requirement of medical clearance for personal training clients also seems to demonstrate an upward trend. However, the requirement of medical clearance for at-risk new participants remains about the same as previous studies (ranging from 49%-82% of the facilities) and the current study (47% for self-guided and 87% for professionally-guided). For facilities that were not conducting PHSP (27%), the major reasons why were reinforced by the comments to the open-ended question and were similar to those found in a previous study that investigated the same. The findings from this study indicated that there are areas that may need to be addressed within the profession to help increase adherence to published standards and guidelines especially in Community, Commercial, University, and Government settings. For example, these facilities might need a more simplified approach and additional guidance from the ACSM for more effectively and efficiently conducting PHSP. Additionally, academic programs could contribute by more comprehensively integrating PHSP into courses and practical learning opportunities for students. Given the importance of conducting PHSP, future research in PHSP focused on issues specific to individual settings may help establish the framework and provide direction for stakeholders to address this relevant issue in the field.

Objective: This thesis aimed to advance the study of sustainability through the exploratory use of a conceptual framework for the investigation of a collaborative project. Methods: A qualitative case study design, utilizing document analysis and key informant interviews, was used to conduct a three-year follow-up of a collaborative mental health project. The study design and directed content analysis were informed by the Scheirer and Dearing (2011) conceptual framework. Results: The sustained outcomes identified by the six participating agencies included: institutionalized project components, maintained client benefits, continued collaboration and sustained attention to the issue. The sustainability of project components was associated with complex interactions between the innovation, organization, and community factors investigated. Conclusions: The study illustrated the importance of evaluating multiple aspects of sustainability to fully capture a project’s long-term effect. Complex systems theory was proposed to describe the interactions observed and as a direction for further development of the conceptual framework.

Objective: This thesis aimed to advance the study of sustainability through the exploratory use of a conceptual framework for the investigation of a collaborative project. Methods: A qualitative case study design, utilizing document analysis and key informant interviews, was used to conduct a three-year follow-up of a collaborative mental health project. The study design and directed content analysis were informed by the Scheirer and Dearing (2011) conceptual framework. Results: The sustained outcomes identified by the six participating agencies included: institutionalized project components, maintained client benefits, continued collaboration and sustained attention to the issue. The sustainability of project components was associated with complex interactions between the innovation, organization, and community factors investigated. Conclusions: The study illustrated the importance of evaluating multiple aspects of sustainability to fully capture a project’s long-term effect. Complex systems theory was proposed to describe the interactions observed and as a direction for further development of the conceptual framework.

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No description available.

The purpose of the study was to explore the understanding and implementation of the guidelines by nurses to detect mental disorders in Human Immunodeficiency Virus (HIV) management in the Limpopo Province, South Africa. The study aimed to recommend measures to strengthen implementation practices. Qualitative, exploratory and descriptive approach was conducted. Non-probability purposive sampling was used to select primary health professional nurses trained in HIV programme at primary health care facilities in Capricorn District. Data were collected through focus groups and in-depth individual interviews approach using the interview guide. The interviews started with focus group discussions as primary method and in-depth individual interviews as follow-up. Interviews were tape recorded and transcribed. Data were analysed using Creswell’s data analysis steps. Four themes emerged from data: understanding of HIV management guidelines; implementation of the guidelines; strengthening of mental health screening and competencies required for mental health screening. The study revealed that the nurses who did not have psychiatric nursing as an additional qualification lacked confidence and skills to conduct mental health screening in HIV positive infected individuals. However, they used their background nursing knowledge to manage clients. They all experienced challenges with information provided in the guidelines to screen for mental health in HIV management. Based on the results of this study, it was recommended that there should be integration of mental health and HIV and development of practical assessment tools for mental health screening. The study acknowledges the importance of equipping nurses with adequate skills to diagnose altered mental health states among HIV infected individuals. / Health Studies / M.A. (Nursing Science)