Lyme disease (LD) is emerging as one of the major global health challenges of the 21st century. Although data on the diagnosis and treatment of LD is available, research focusing on people's perceptions of LD appears to be limited. Because individual perceptions can significantly affect compliance with preventative measures, such data are critical for the design and successful implementation of interventions to control the disease. The purpose of this qualitative phenomenological study was to explore risk perceptions and knowledge of LD among residents of a county in the U.S. state of New Jersey where the disease is prevalent. The health belief model and the social ecological model served as the theoretical foundation for the study. Research questions centered on the perceptions of the study participants regarding their risk of contracting LD and the factors that may influence or interfere with preventive behaviors against ticks. A convenience sample of 11 individuals, aged 18–55 years, participated in a focus group discussion. Data were analyzed using thematic analysis and participant responses revealed that information dissemination methods regarding LD were ineffective. Participants believed that lack of knowledge on LD was the main barrier to protective behaviors. Participants who perceived no risk from LD reported that they were not taking preventive measures against tick bites. Dissemination of study results through presentations to public health departments and LD organizations in New Jersey may benefit the public health sector by furthering understanding of the public's risk perceptions and knowledge about LD. Positive social change implications include increased awareness of LD and improved risk communications of the disease.

The aim of this project was to implement and evaluate the effectiveness of the Clear Minds protocol for early detection and prevention of delirium in hospitalized, elderly patients. The protocol was used to monitor for delirium and improve sleep quality by reducing sleep disturbances caused by environmental factors in hospital settings. Due to the risk of delirium for patients in late adulthood, implementation of a delirium-prevention protocol was needed. Upon admission, patients 60 years and older or patients that screened positive for the Brief Confusion Assessment Method (bCAM) were placed on the Clear Minds protocol. The protocol consisted of establishing healthy habits including structured eating, toileting, and sleeping times. Patients were oriented, exposed to light during the day, and had orders to not disturb during the night unless medically necessary. A convenience sample of 100 patients were reassessed using the bCAM every shift. Sleep patterns, morbidity, mortality, and length of hospital stay of patients were examined pre- and post- implementation of the protocol through surveys and aggregate data pulled from the electronic medical record. Results from a 2-sample t-test indicated no difference between the pre- and post- implementation groups, although there was a positive relationship between the use of the protocol by clinical staff nurses and the length and quality of sleep for patients, suggesting that nurses can have a positive impact on sleep patterns of hospitalized patients. The potential for a positive social change will result from nurses using a standardized approach with a validated tool in clinical practice to assess for delirium; intervene with patients predisposed to sleep disturbances; and thereby decrease morbidity, mortality, length of stay, and readmissions.

Postpartum depression affects many postpartum mothers. When postpartum depression is not timely assessed, identified, and treated, it can lead to problems with mother child bonding and cause family problems, negligence, and infant death. The purpose of this phenomenological study was to understand Imo State women's lived experiences and perception on sufficiency of the assessment and treatment received for their postpartum depression. The conceptual theory for this study was the empowerment theory. In-depth, face-to-face interviews were conducted to examine 10 Imo State postpartum mothers' lived experiences of assessment processes and to understand if their psychological desires were addressed. The interviews were audio recorded and notes were taken; the recordings were transcribed, and the transcripts were imported into NVivo9 for the data to be examined. The inductive coding method was used in data coding. The text was used as the source for coding, and the dominant themes were isolated and a range of themes were defined. The themes that appeared from the participants' responses were tearful and anxiety during and after pregnancy, inadequate assessment, stress, lack of knowledge, coping mechanisms, herbalist, and prayer. The participants stated that feelings of unhappiness and sadness increased after delivery of their babies, which were misinterpreted by family and friends. Participants stated that they sought recovery through prayer and herbs. The findings from this study can be used to promote positive social change by enhancing Imo State women's awareness on postpartum depression and also to support health care providers in designing relevant assessments and providing care for women with postpartum depression.

Asthma is the most common chronic disease in childhood. Education directed toward asthma self-management is vital and emphasizes patient participation in symptom monitoring and control. The practice problem addressed in this quality improvement project was the lack of an asthma management plan in the pediatric setting for which the project was developed. The purpose of the project was to develop an evidence-based asthma initiative consisting of a staff education curriculum with a pretest/posttest and a patient self-management component. Using a team approach, Rosswurm and Larrabee's conceptual model served as the practice framework to guide the development of the project. Two content experts evaluated the curriculum plan using a 9-item dichotomous rating. Results of their evaluation showed that the content met the objectives of the curriculum. The content experts also conducted content validation for each of the 17 pretest/posttest items using a 4-point Likert scale ranging from1 ('not relevant') to 4 ('highly relevant'), that resulted in a content validation index of 1.00 revealing that the test items reflected the content of the curriculum and the intent of the objectives. This project promotes positive social change by providing patients and families with the ability to recognize and handle asthma symptoms. This change can prevent exacerbation of symptoms resulting in avoidable emergency department visits ultimately impacting healthcare costs and the well-being of patients and families.

Cervical cancer is the second leading cause of cancer deaths among women of all age groups in Zimbabwe, and mortality and incidence continue to increase. The purpose of this quantitative cross-sectional study was to assess the factors that influence the utilization of cervical cancer screening services by Zimbabwean women living in Harare, Zimbabwe. Because personal beliefs influence screening, this study was guided by the health belief model (HBM). A total of 394 women whose ages ranged from 18 to 65 years were recruited from a health care facility in Harare. A 40-item closed-ended questionnaire was used to assess participants' knowledge, attitudes, beliefs, and cervical screening practices. Descriptive analysis was used to characterize the sample, and logistic regression was used to explore the effects of the hypothesized predictor variables. Results indicated that the strongest predictors of screening were monthly income, marital status, and the HBM construct perceived barriers. The study may promote positive social change as findings may be used to formulate policies that may encourage women to adopt preventive screening practices, which may save lives and reduce costs associated with treating cervical cancer when diagnosed at an advanced stage.

This study surveyed healthcare professionals and rheumatic heart disease (RHD) female participants in two hospitals located in central Afghanistan to examine the effects of communication among healthcare professionals, ethnicity and socioeconomic status, and the health quality of life. The social ecological models (SEM) of health promotion was utilized in the individual (communication between healthcare professionals), community (health quality of life), and societal factors (ethnicity and socioeconomic status). Three research questions were explored in this study: the significance of RHD healthcare professional's education to their RHD female patients ages 16 to 45 years; a correlation between ethnicity and socioeconomic status among the targeted participants; and a correlation between health-related quality of life and RHD education among the targeted participants. This study was a cross-sectional quantitative survey design with 138 participants to determine the factors of RHD education, communication training, and beliefs of the targeted population in assessing RHD effects. McNamara's, Pearson's, and Chi test was used for determining correlation and relation of the research variables. The results of this study showed a correlation between healthcare professional communications and RHD but no correlations for ethnicity and socioeconomic status, and health quality of life and RHD. This study promotes positive social change through training healthcare professional to educate their female RHD patients about prevention and living with the disease. This research showed that the onset of healthcare professional education could reduce the effects of the disease. Moreover, the need for funding of the society would also control the RHD effected population.

As of the end of 2010, .9% (20,093) of the inmate population under the care of the U.S. Federal Bureau of Prisons and 1.7% (2,394) of the inmate population under the care of the Texas Department of Criminal Justice were living with HIV/AIDS. The purpose of this quantitative correlational study was to analyze the relationships between HIV/AIDS status and former inmate demographic characteristics, intravenous drug use (IDU), and social support networks. The behavior models of importation and deprivation formed the theoretical frameworks used to explore the relationship between HIV/AIDS and behavioral risk factors for released Texas prison inmates. Fifty former prison inmates in Texas were recruited through Prison Talk, an online prison and family support community, and asked to complete a 57-item web-based survey on demographic characteristics, IDU, and social support networks. Spearman correlation and multiple logistic regression analyses were used to test potential relationships between risk factors. A significant negative correlation was found between African American race and HIV infection (rs = -.31, p < .05). A significant positive correlation was found between IDU and HIV infection (rs = .49, p < .001). Logistic regression analysis confirmed IDU as a significant predictor of HIV infection (B = 3.99, OR = 54.33, p < .05); access to or a desire for social support were not found to be significant predictors of HIV infection. Decreasing IDU among former prison inmates was shown to be an important step in HIV/AIDS prevention. Findings from the study can provide policy makers, legislators, prison administrators, educators, and researchers with insight into the factors that contribute to the prevalence of HIV/AIDS, possibly leading to positive social change by reducing the prevalence of HIV/AIDS among former prison inmates and their partners.

The purpose of this study was to determine how autonomy is affected among individuals with spinal cord injuries by being able to drive again or for the first time, after participating in a driving rehabilitation program. Information was collected using a survey originally designed for the purpose of this study on driving-related autonomy. Fifty two surveys were included in this study and met the inclusive criteria. Analysis of the responses indicated that the majority of individuals in this study experienced a high level of autonomy after going through a driving rehabilitation program. The results showed that there was an increase in the number of subjects who did not drive before their injury, disability, or condition by 35.3%, after participating in a driving rehabilitation program. It was also found that 76.9% of the subjects perceived that driving had improved their life by 100% on a daily basis after completing a driving rehabilitation program. The participants perceived driving as being very important in allowing them to remain or become autonomous, by being able to drive themselves to needed and desired locations.

There are over 15.5 million cancer survivors in the U.S. currently, increasing to over 20 million by 2026. Long-term cancer survival has raised awareness for the issues that affect quality of life (QoL) after treatment. Fatigue and subjective cognitive dysfunction are common quality of life concerns for survivors but little is known regarding prevalence of these problems in daily life. The purpose of the current project is to examine these concerns after treatment using data from a 2 week daily diary study of breast cancer survivors up to 3 years post-treatment. Of importance is determining the factors that contribute to reporting decreased QoL. Taken together, our findings suggest that within-persons, survivors who reported worse mood and physical function tended to also report higher levels of fatigue. Similarly, subjective reporting of cognitive function is influenced by current mood and physical symptoms such as fatigue. Demographic characteristics and depressive symptoms prior to the study were unrelated to fatigue and subjective cognitive function. This dissertation advances the current understanding of daily QoL issues. These findings also highlight the importance of capturing these experiences in daily life.

This study examines the role of psycho-social factors in contributing to chronic illness, in particular Coronary Heart Disease (CHD) and cancer. Research conducted over the last 50 years indicates a modest role for psycho-social factors as risk factors for these conditions. The research suggests that in combination with other modest risk factors, psycho-social factors play an equally important role. Grossarth-Maticek & Eysenck (1990) gained notoriety by reporting research results which seriously question current wisdom. Grossarth-Maticek & Eysenck (1990) conducted what must be considered the largest long term prospective psychological health study. They followed around 20,000 probands for 15 years in order to determine the relative contributions to health outcomes (primarily cancer and CHD) of standard medical and psycho-social risk factors. They reported an 81% accuracy of prediction of death by cancer or CHD with the use of a psychometric test. Further, answers to the test were reported to be six times more predictive of cancer or CHD than were any of the standard medical risk factors, either taken on their own or together. Being far in excess of claims made by any other researchers, the treatment/prevention implications of Grossarth-Maticek’s study are far reaching. It is an important endeavor to examine possible influencing factors in these results. While scientific fraud can never be excluded, in the absence of any incriminating evidence, this assertion is considered to be non-empirical. Amelang (1991) wonders whether unknown, favourable and non replicable conditions were present in Grossarth-Maticek’s samples or methodology which influenced the results. The current research program represents an attempt to ascertain what some of those factors may have been. It is suggested here that Grossarth-Maticek’s probands learnt of their cancer or CHD proneness in the course of the interview which formed the basis of the data collected in their study. Focusing on this aspect of Grossarth-Maticek’s data collection methodology, the possibility of a large scale treatment effect emerges. The most psychologically vulnerable of his probands, having been stimulated by the interview process, may have ruminated and ‘catastrophized’ over their health prospects during the ensuing years, thereby making themselves physiologically more vulnerable to the feared conditions. The possibility of probands being adversely influenced by the interview is tested in the current study with subjects being measured for changes in cancer/CHD risk perception and anxiety levels as a result of participation in the ‘Grossarth-Maticek interview’ format. In order to test this hypothesis, two studies were undertaken in which Grossarth-Maticek’s data collection method was replicated with 105 subjects. Subjects were assessed on a range of self report items prior to the ‘Grossarth-Maticek’ interview, and again post to this interview. They were assessed as to their beliefs about vulnerability to cancer and CHD; and their levels of anxiety in relation to contracting these conditions. Subject’s responses to learning of their ‘health prediction’ according to Grossarth-Maticek’s assessment tool were also measured via a heart rate monitor. Changes in subject’s self report measures and heart rate responses were noted and associations to the type of health prediction which they were given at the end of the interview was assessed. In the second study, the relative effects of family history, Neuroticism and time on disease risk perception and anxiety were studied via statistical analyses of self report measures. The results of this study do not support the notion of the interview having any adverse influence. Problems with the methodology and sample selection may have influenced the outcome. It is concluded that for these reasons, the current study did not represent a thorough test of the current hypothesis. Recommendations for a superior test of this hypothesis are made.