<p> Sickle cell disease is a disabling chronic autosomal recessive blood disease characterized by abnormal hemoglobin, pain crises, and frequent emergency department visits. Adherence to hydroxyurea therapy has been shown to improve these patient outcomes. Guided by the theory of comfort, the purpose of this project was to determine if an educational intervention would increase adherence to hydroxyurea therapy in pediatric patients between 2 and 17 years of age recruited from an urban university hospital hematology clinic. The RE-AIM model was used to support the translation of evidence and the change process. An educational video produced by AFLAC was viewed by patients&rsquo; parents 4 weeks after enrollment into this pretest/posttest design project. A total of 22 African-American parent participants completed the 8-item Morisky Medication Adherence Scale at baseline and again at 8 weeks to assess hydroxyurea adherence. The Short Test of Functional Health Literacy in Adults tool was used to assess parents&rsquo; health learning needs; all parents met the adequate literacy level at baseline. Using <i>t</i> test statistics, no statistically significant differences were found pretest to posttest on the Morisky Medication Adherence Scale scores, mean corpuscular hemoglobin, and fetal hemoglobin percentages. Wilcoxon Signed Rank tests showed no significant differences in emergency room visits nor number of pain crisis. Although no significant changes emerged in short-term hematologic findings, emergency room visits, and pain crises, social change in the health care setting was promoted by confirming parents were able to understand education and a high level of hydroxyurea adherence was maintained; literature indicated that long-term adherence to hydroxyurea limits severe attacks.</p>

<p> Women and men&rsquo;s preferences for delivery services in rural Ethiopia Nancy Beam Aims: This study aims to determine the combination of facility-based delivery care attributes preferred by women and men; if gender differences exist in attribute preferences; and key demographic factors associated with attribute preferences. </p><p> <b>Background:</b> Despite programs to promote facility-based delivery, which has been shown to decrease maternal and neonatal mortality, 80% of women in rural Ethiopia deliver at home without a skilled birth attendant. </p><p> A review of the Ethiopian literature on factors associated with delivery location revealed several weaknesses in research methods that need to be addressed. First, research participants were almost exclusively women, although male partners often make decisions about delivery location. Second, most quantitative study designs are similar in content to the Ethiopian Demographic Health Survey, limiting the generation of new knowledge. Third, cultural practices identified in qualitative studies as barriers to facility-based delivery have not been included in quantitative studies. This study addressed these weaknesses by using discrete choice experiment methodology to elicit preferences for delivery service attributes, including support persons in the delivery room, staff training and attitude, cost, distance and transportation availability. </p><p> <b>Methods:</b> A cross-sectional, discrete choice experiment was conducted in 109 randomly selected households in rural Ethiopia in September-October 2015. Women, who were pregnant or who had a child &lt; 2 years old, and their male partners were interviewed. After completing a demographic questionnaire, male and female respondents were asked separately to choose between facility-based scenarios that reflected various attributes for delivering their next baby. Data were analyzed using a multilevel mixed-effects logistic regression model. </p><p> <b>Results:</b> Both women and men preferred health facilities where medications and supplies were available, a support person was allowed in the delivery room, cost was low, and doctors performed the delivery. Women also valued free ambulance service, while men favored nearby facilities with friendly providers. Men are disproportionately involved in making household decisions, including decisions about whether their wives seek health care. Yet, men are often unaware of their partners&rsquo; prenatal care attendance. </p><p> <b>Implications:</b> The Ethiopian government and health facilities could increase facility births in rural areas by responding to families&rsquo; delivery service preferences.</p>

<p> Adolescent pregnancy and parenthood have been identified as national public health problems and are topics of intense debate in the United States because of their impact on maternal and child health and on the social and economic well-being of the nation. While many types of parenting programs are available to the adolescent mother, not one approach has emerged as the most effective to decrease subsequent pregnancies and to improve mother and child health. Using Husserl's Phenomenology as a philosophical underpinning, what it means to be a pregnant adolescent living in a group home was explored. Data were collected from volunteers who had lived in two group homes in a suburban county in the Mid-Atlantic area of the U.S. In-depth, one-on-one interviews using a semi-structured guide were completed with eight participants. Giorgi's steps for analysis of the verbatim transcripts were used to develop <i> essences and the essential structure</i> about the phenomenon understudy. The participants' ages when they lived in the group home ranged from 13-17 years; the time they lived in the group home was between one to two years and some adolescents, after delivery, lived in the group home from six months to two years. Three themes emerged, each with subthemes, describing the participants' experiences: <i>The environment with its rules and structure was experienced as either supportive or not in day-to-day living; Balancing adolescent expectations and needs impacted pregnancy and parenting; and Defining motherhood focused on the basics and was influenced by the participants' own mothering</i>. The study's fmdings were compared and contrasted with well-known nursing, individual development, and parenting theories and relevant research findings. Nurses who care for adolescents throughout their pregnancy and the postpartum period are uniquely positioned to influence their development as mothers. </p>

<p> Human trafficking is a global problem and a multi-billion dollar industry. Most victims are women and girls and more than half are children. In the United States, many at risk youth continue to attend school with school nurses on the frontlines. Using the Peace and Power Conceptual Model, a mixed methods study was conducted to explore their awareness, attitudes, and role perceptions in prevention of commercial sexual exploitation of children (CSEC). Two factors related to increased awareness, and positive attitudes and role perceptions to prevent of CSEC included prior exposure to working with vulnerable students, and prior education about CSEC. Two factors that inhibited identification of CSEC included an uncertainty in identifying CSEC, and a lack of collaboration with colleagues in schools. Four sub-themes were identified; &lsquo;exposure/knowledge, &lsquo;collaboration&rsquo;, &lsquo;role boundaries&rsquo;, and &lsquo;creating respite space&rsquo;. Future research should target the multidisciplinary school team. Simultaneous policy efforts should focus on improving practice conditions for school nurses to support their role in identification and intervention to prevent CSEC among at risk youth.</p>

<p> HIV infection is a leading cause of morbidity and mortality in our country today with nearly 1.2 million Americans living with HIV infection. Early recognition of infection is imperative for appropriate initiation of treatment to prevent comorbidities. Additionally, identification of infection can serve as a primary preventative measure to reduce spread of the disease. National organizations have supported the initiation of routine screening policies for HIV in health care settings. Primary care providers are uniquely positioned to be able to offer HIV screenings and identify infected persons very early in the course of the disease. Despite support for routine testing in the literature and by national evidence-based guidelines, testing is still not offered routinely in the primary care setting. The purpose of this project was to explore if a clinical reminder improves the frequency of HIV screening offered in a rural primary care clinic (PCC) located in Central Louisiana. Results of the project did show a statistically significant increase in the frequency of HIV screening offered following implementation of the clinical reminder system.</p>

<p> Over the last half a century, the frequency and intensity of tornados, floods, and other severe weather events have underscored the need for disaster preparedness, particularly for older adults. Functional limitations, cognitive decline, and medical comorbidities such as heart disease and diabetes create additional vulnerabilities, regardless of the type of disaster. Still, elders are capable of self-identifying needs and can be empowered to prepare communication plans, assemble disaster kits, and learn how to respond to threats posed by specific disasters. By increasing the level of disaster preparedness through training, many of the health problems faced by elders during a disaster could be alleviated and their overall response improved. Yet despite their abilities and the known benefits of disaster preparedness, disaster education and planning for elders has not been widely implemented.</p><p> The purpose of the Geriatric Passport Project was to increase the level of disaster preparedness through implementation of a disaster education program among community-dwelling older adults over the age of 55. Recruitment strategies included media, engaging key staff from program sites, and word of mouth. </p><p> The project used a pre-post reflexive control design. Knowledge about the elements to include in a disaster communication plan increased as did knowledge about items to include in a disaster kit. Notably, self-rated level of stress associated with evacuation to a shelter remained unchanged. Most importantly, the perceived level of disaster preparedness increased, suggesting that those who participated in the Geriatric Passport Project felt more prepared to respond to a disaster as a result of having attended the disaster education program.</p><p> The Geriatric Passport Project appears to have beneficial effects and the success of the pilot project supports exploring the feasibility of expanding the program to a wider geographic region and conducting a more rigorous evaluation of program effectiveness, efficacy, and efficiency.</p>

<p> This dissertation, composed of three manuscripts, provides a foundation for sleep disorders screening in primary care. The first manuscript presents a concept analysis of sleep to guide nurses&rsquo; understanding of how sleep impacts patients. The first manuscript is currently under review in the Nursing Forum journal. A framework for sleep disorders screening in primary care is presented, and followed by a systematic review of the literature to identify questionnaires that might be suitable to screen for sleep disorders in primary care. Several candidate questionnaires are identified, but none of those meet both thoroughness and brevity criteria postulated as necessary for use in primary care practices. The second manuscript is currently under review in Sleep Medicine Reviews. The third manuscript introduces the sleep disorders screening checklist (SDS-CL), previously used for research. The SDS-CL meets both thoroughness and brevity criteria but has not yet been validated for primary care application. Psychometric properties of the SDS-CL are evaluated with data from a sample of n=694 adults representative of the primary care population. Psychometric properties of the SDS-CL are favorable for primary care application. The third manuscript is currently being prepared for submission to a journal focusing on primary or preventive care medicine. Finally, future studies are recommended.</p>

<p> Colorectal cancer is one of the most common cancers in the United States and confronting its challenges has remained a problem to the United States health sector, especially among outpatient clinics. Guided by health belief model, the purpose of this needs assessment was to identify patients age 50 and older in outpatient clinic located in a large metropolitan city in Texas who should receive information on the need for colorectal cancer screening based on their risk for developing colorectal cancer as outlined by American Cancer Society. A sample of 70 charts of patients age 50-75 years was randomly selected and audited using descriptive statistics. Among the patients aged 50-75 years attending the outpatient clinic, 25.7% were African Americans, 71.4% were Hispanic, and 2.9% were Caucasians; 42.9% were male and 57.1% were female. The rate of colorectal cancer screening was 12.9%, a rate that is lower than the rate for all Texans, which was 54.1% - 59.2%. CRC screening was ordered for 62.9% of all patients; 24.2% of clinic patients were identified as being at high risk for colorectal cancer. The low rate of screening may hamper early detection of colorectal cancer in outpatient clinics setting. It is recommended that the outpatient clinic develop intensive campaign to increase patient awareness about the need for and benefits of colorectal cancer screening, especially for those at high risk for developing colorectal cancer. The findings of this study may raise awareness on the chasm in quality of health care availability and provide insight on colorectal cancer and its prevention.</p>

<p> Primary care providers have not customarily provided oral assessments or offered anticipatory guidance about oral health care; dentists manage that task. Myths and access-to-care issues often result in limited or no dental care during pregnancy. Improving the oral health of pregnant women has a positive correlation with fewer dental caries in their children. Currently, evidence-based practice (EBP) oral health guidelines exist for pregnant women and children. While health care providers (HCPs) want to implement best practices, they find practice change challenging.</p><p> This project utilizes a planned change theory to guide the implementation of oral health guidelines with a methodical approach. Retrospective and prospective chart audits evaluate HCP behavior change. The chart audits reveal HCPs change behaviors after a practice intervention with a Primary Care Oral Assessment Tool (PCOAT), and again after introduction of EBP guidelines. Some changes in provider behavior were statistically and clinically significant.</p><p> <i>Keywords:</i> pregnancy, pregnant, prenatal, antenatal, dental care, oral health, and practice guidelines</p>

<p> Problem: Adolescent obesity has reached epidemic proportions globally. Motivational interviewing (MI) is an emerging intervention for adolescent health risk behavior that has promise. Despite its potential fit in primary health care contexts, primary care providers tend to express reticence in learning or adopting MI practices. This program evaluation project assessed the usefulness of Motivational Interviewing (MI) by primary care providers with adolescents in school based health centers that was implemented by a large randomized clinical trial (RCT) in southwest United States high schools. </p><p> Methods: As part of the RCT, the primary care providers were required to do MI sessions with 66, 45, 25, and 91 youth participants respectively at their School-based site. It was anticipated that providers would be increasingly comfortable with MI between their first and final participant and that youth would be increasingly satisfied as provider comfort increased. To evaluate this, as part of the RCT, a set of primary care providers working with youth in school based health centers were trained through didactic sessions, homework, and role-play. School-based providers were provided an introductory training in MI, MI reading materials, a study manual, and were required to participate in bimonthly tele-coaching to ensure treatment integrity and fidelity. Primary care provider and adolescent participant survey data from session 1 of the RCT was analyzed to determine provider comfort with MI and adolescent satisfaction with MI.</p><p> Summary of findings: Despite the standard training practices, providers showed a range of interest in comfort with the intervention. However, as anticipated, overall primary care providers became significantly more comfortable with MI on the final day of the MI sessions with increased use (p &lt; 0.01). Adolescent participants overall were highly satisfied with MI regardless of time with no significant differences over time.</p><p> Implications for Practice: Primary care providers have not embraced MI as it is perceived as time consuming and challenging, yet over time the primary care providers in this project became significantly more comfortable with MI while youth were highly satisfied independent of provider comfort. Integrating MI into clinical practice has promising implications to get more effective treatment to high-need and underserved youth.</p>