A Magnet-recognized academic hospital system experienced an increase in patient falls and patient falls with injury after transitioning to a new electronic health record. The purpose of the project was to evaluate the effectiveness of a system-wide quality improvement practice change. The practice-focused question addressed a Magnet model implementation of a standardized, system-wide, evidence-based Hester Davis Scale (HDS) fall risk assessment and intervention tool and the impact on the nursing-sensitive indicators of patient fall rates and fall rates with injury. Successful implementation and sustained, correct use of the HDS fall risk assessment and targeted fall-prevention-intervention tools added to the evidence of multifactorial fall-intervention-prevention strategies designed to reduce patient falls and patient injury associated with falls. Two models were used to inform the project: the American Nurses Credentialing Center next-generation Magnet model and the Institute for Healthcare Improvement framework for spread. The primary source of evidence was the National Database of Nursing Quality Indicators. A run chart approach to process improvement was determined to be the best method to assess the effectiveness of the HDS Falls Prevention Program for 28 months post implementation. The run chart for patient fall rates and fall with injury rates demonstrated a reduction in falls and sustained improvement over 28 months. The decreases in falls and fall with injury rates of this project have implications for positive social change. Magnet recognition supports the implementation of the evidence-based HDS Fall Reduction Program, thereby improving the quality of life for patients and families and reducing the burden and cost of health care associated with falls.

Essay #1 - Parental Social Influence in Childhood Obesity Interventions: a Systematic Review The objective of this study is to understand the pathways through which social influence at the family level moderates childhood obesity interventions. We conducted a systematic review of obesity interventions in which parents' behaviors are targeted to change children's obesity outcomes, due to the potential social and environmental influence of parents on the nutrition and physical activity behaviors of children. Results for existing mechanisms that moderate parents' influence on children's behavior are discussed and a causal pathway diagram is developed to map out social influence mechanisms that affect childhood obesity. We provide health professionals and researchers with recommendations to leverage family-based social influence mechanisms for increasing the efficacy of the obesity intervention programs. Essay #2 - Dynamics of Obesity Interventions inside Organizations: a Case Study of Food Carry-Outs in Baltimore A large number of obesity prevention interventions, from upstream (policy and environmental) to downstream (individual level), have been put forward to curb the obesity trend; however, not all those interventions have been successful. Overall effectiveness of obesity prevention interventions relies not only on the average efficacy of a generic intervention, but also on the successful Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) of that intervention. In this study, we aim to understand how effectiveness of organizational level obesity prevention interventions depends on dynamics of AIM. We focus on an obesity prevention intervention, implemented in food carry-outs in low-income urban areas of Baltimore city, which aims to improve dietary behavior for adults through better food access to healthier foods and point-of-purchase prompts. Building on data from interviews and the literature we develop a dynamic model of the key processes of AIM. We first develop a contextualized map of causal relationships integral to the dynamics of AIM, and then quantify those mechanisms using a system dynamics simulation model. With simulation analysis, we show how as a result of several reinforcing loops that span stakeholder motivation, communications, and implementation quality and costs, small changes in the process of AIM can make a big difference in impact. We present how the dynamics surrounding communication, motivation, and depreciation of interventions can create tipping dynamics in AIM. Specifically, small changes in allocation of resources to an intervention could have a disproportionate long-term impact if those additional resources can turn stakeholders into allies of the intervention, reducing the depreciation rates and enhancing sustainability. We provide researchers with a set of recommendations to increase the sustainability of the interventions. Essay #3 - Dynamics of Implementation and Maintenance of Organizational Health Interventions: Case Studies of Obesity Interventions In this study, we present case studies to explore the dynamics of implementation and maintenance of obesity interventions. We analyze how specific obesity prevention interventions are built and eroded, how the building and erosion mechanisms are interconnected, and why we can see significantly different erosion rates across otherwise similar organizations. We use multiple comparative case studies to provide empirical information on the mechanisms of interest, and use qualitative systems modeling to integrate our evolving understanding into an internally consistent and transparent theory of the phenomenon. Our preliminary results identify reinforcing feedback mechanisms, including design of organizational processes, motivation of stakeholders, and communication among stakeholders, which influence implementation and maintenance of intervention components. Over time, these feedback mechanisms may drive a wedge between otherwise similar organizations, leading to distinct configurations of implementation and maintenance processes. / Ph. D.

Employee involvement and participation in HIV-prevention interventions at the workplace remains a barrier to effective programme implementation, which contributes significantly to programme failure and the consequent continued spread of HIV among employees at the workplace. This study explores employee involvement and participation in HIV-prevention interventions at a Bulawayo tyre manufacturing firm. It assesses factors affecting employee involvement and participation in these interventions, and examines the implications of these findings for programme implementation. I used a semi-standardised interview schedule to conduct in-depth, face-to-face qualitative interviews and a self-administered questionnaire to collect quantitative data. The responses showed the nature of employee involvement in HIV-prevention at the firm was at a co-option level, and the type of participation was mere token participation. I recommended that the firm should develop a clear understanding of the importance of stakeholder involvement in HIV-prevention programmes. / Sociology / M.A. (Social Behaviour Studies in HIV/AIDS)

Employee involvement and participation in HIV-prevention interventions at the workplace remains a barrier to effective programme implementation, which contributes significantly to programme failure and the consequent continued spread of HIV among employees at the workplace. This study explores employee involvement and participation in HIV-prevention interventions at a Bulawayo tyre manufacturing firm. It assesses factors affecting employee involvement and participation in these interventions, and examines the implications of these findings for programme implementation. I used a semi-standardised interview schedule to conduct in-depth, face-to-face qualitative interviews and a self-administered questionnaire to collect quantitative data. The responses showed the nature of employee involvement in HIV-prevention at the firm was at a co-option level, and the type of participation was mere token participation. I recommended that the firm should develop a clear understanding of the importance of stakeholder involvement in HIV-prevention programmes. / Sociology / M.A. (Social Behaviour Studies in HIV/AIDS)

Abstract in English, Xhosa and Afrikaans / The victimization of women and children represents one of the public health problems deserving urgent attention in Ethiopia, making the prevention of rape in all its forms a matter of vital importance. The purpose of the study was mainly to describe the extent of rape prevention interventions in Addis Ababa and examine efforts to assist rape survivors based on the perceptions of professionals working for organizations operating in this context. The study had a further purpose of identifying difficulties faced by government institutions and making suitable recommendations for the improvement of rape prevention interventions and programs in the future. A qualitative descriptive research approach was adopted mainly involving in-depth interviews for primary data collection. The study involved 14 research participants purposively selected from five government institutions. The study findings indicated Gandhi Memorial Hospital to be the only institution in Ethiopia implementing an integrated rape prevention intervention. Efforts were directed largely at secondary prevention, with little attention being paid to primary prevention. Recommendations included tackling the multiple factors influencing rape at different levels of the social-ecological model simultaneously through the implementation, strengthening, and intensification of well-designed, comprehensive rape prevention interventions and programs. / Ukuxhatshazwa kwabafazi nabantwana e-Ethiopia kufana nenye yeengxaki zempilo kwaye kudinga ukuthathelwa ingqalelo ngokungxamisekileyo. Oku kwenza ukuba ukuthintela ukudlwengulwa ngazo zonke iindlela kube ngumbandela obaluleke kakhulu. Injongo yesi sifundo ibikukucacisa iindlela zokuthintela ukudlwengulwa eAddis Ababa, nokuvavanya imizamo yokunceda abo bakhe badlwengulwa, ngokokubona kwabo basebenzela amaqumrhu aququzelela lo msebenzi. Enye injongo yesi sifundo ibikukuchonga ubunzima obufunyanwa ngamaziko aseburhulumenteni ajongene neli candelo ukuze kunikwe iingcebiso zokuphucula amacebo neenkqubo zokuthintela ukudlwengulwa. Kuqhutywe uhlobo lophando lomgangatho nolucacisayo, apho kuqokelelwe iinkcukacha zolwazi ngokwenza udliwano ndlebe olunzulu. Kusetyenzwe nabathathi nxaxheba abali-14 abakhethwe ngobuchule kumaziko aseburhulumenteni ama-5. Okufunyaniswe sesi sifundo kubonakalise ukuba isibhedlele esiyiGandhi Memorial siso sodwa esinenkqubo elungelelaniswe kakuhle yokuthintela ukudlwengulwa. Imigudu yokhukhusela ijoliswe ekuncedeni kwiziqhamo zodlwengulo nasekufundiseni ngodlwengulo (secondary prevention) hayi kudlwengulo ngqo (primary prevention). Amacebiso esifundo aquka ukulwa neemeko eziphembelela udlwengulo olwenzeka kumazinga ahlukeneyo oluntu, ngaxeshanye nokuqinisa ukusetyenziswa kweenkqubo eziqulunqwe kakuhle zokuthintela udlwengulo. / Die viktimisering van vroue en kinders is een van talle kwessies in die openbare gesondheid van Ethiopië wat dringend aandag vereis, aangesien die voorkoming van verkragting in enige vorm van die allergrootste belang is. Die doel van hierdie studie was om die omvang te bepaal van intervensies om verkragting in Addis Abeba te voorkom, en om die hulp wat aan verkragtingslagoffers verleen word, te ondersoek op grond van die belewenisse van beroepslui wat in hierdie verband vir organisasies werk. Hierdie studie het dit verder ten doel gehad om die probleme aan te toon waarmee staatsinstellings in hierdie opsig te kampe het, en om beter intervensies en programme vir die voorkoming van verkragting aan te beveel. ʼn Kwalitatiewe en deskriptiewe navorsingsbenadering is gevolg. Dit het omvattende onderhoude behels waartydens primêre data versamel is. Altesame 14 deelnemers by vyf staatsinstellings is vir hierdie doel gekies. Volgens die bevindings is die Gandhi Gedenkhospitaal die enigste instelling in Ethiopië wat ʼn geïntegreerde program vir die voorkoming van verkragting ingestel het. Sekondêre voorkoming geniet voorrang, terwyl primêre voorkoming min aandag geniet. Daar word aanbeveel dat tegelykertyd werk gemaak word van die veelvuldige faktore wat verkragting op verskillende vlakke van die sosiaal-ekologiese model beïnvloed. Dit moet gedoen word deur deeglik ontwerpte, omvattende intervensies en programme om verkragting te voorkom in werking te stel, uit te bou en te verskerp. / Sociology / M.A. (Sociology)