Care Coordination Home Telehealth (CCHT) maintains a positive impact on the delivery of patient care in the primary care clinic at the Department of Veterans Administration Medical Center (VAMC). This quality improvement initiative targets patients with chronic conditions such as diabetes, hypertension, heart failure, and chronic obstructive pulmonary disease. These patient are frequently seen in the emergency room, and are often admitted to the hospital, where they saturate the outpatient clinics' waiting room with multiple walk-ins. CCHT has, to some extent, reduced walk-ins, emergency room visits, and hospitalization while minimizing the strain on access to care at the VAMC. Sustaining self-management skills of veterans with chronic conditions at the VAMC continues to impose challenges. In this project, retrospective data from 95 randomly selected charts reviewed during a 2-year period were used to compare hospitalizations, emergency room visits, and primary care visits. The findings of the study indicate veterans enrolled in Home Telehealth show positive social change. The social change is evidenced by change in behavior patterns, such as maintaining a healthy diet, performing daily physical activity, and compliance with medication administration. Enrolled veterans had better outcomes regarding hospitalization, emergency room visits, and primary care visits. The data highlighted the need for incorporating disease-specific protocols guiding care coordinators at first point of contact with the veteran patient. Following these protocols may enhance communication style that matches the patient's stage of behavioral change with interventions.

Due to increased rates of childhood obesity since 2010, researchers have examined family environmental factors and family influences on children's consumption of healthy foods. While previous research has examined how factors such as food presentation and the food intake of other family members can predict a child's body mass index, there has been little research examining whether parent factors predict the amount of healthy foods children eat. This quantitative survey study examined whether certain parent factors, specifically parents' attitudes about food, parents' feeding styles, and parents' attachment styles, predicted the amount of fruits and vegetables children ate. Understanding the extent to which these factors predict children's actual consumption of healthy foods, rather than predicting their body mass index, will further inform the healthcare field about parents' role in their children's physical development. Family systems theory served as the theoretical foundation. Seventy-four parents of children ages 1 to 7 years completed an online survey containing items from the Caregiver Feeding Styles Questionnaire, the Relationship Structures Attachment Questionnaire, and the Parent Attitudes About Food Questionnaire. As well, they logged the amount of fruits and vegetables their child ate over a 1-week period. The results of the multiple regression analysis revealed an overall significance which suggested that the 3 parent factors together predicted the amount of fruits and vegetables that children ate; however, closer examination indicated that only parents' attachment style was a significant prediction of children's consumption of fruits and vegetables. The results of the study add to our understanding of the role that parents play in their children's eating habits and the influence of attachment on children's consumption of a nutrient-dense diet.

Teenage pregnancy is disproportionate between African American and Caucasian females. This disproportion is notable because African American teenagers are 3 times more likely to become pregnant than their Caucasian counterparts are. The purpose of this study was to determine whether a relationship exists among major life events, sexual behaviors, and resultant teenage pregnancy among African American females in the United States. The theoretical framework for this study was social learning theory. Three key research questions focused on relationships among (a) major life events and initial sexual behavior, (b) ethnicity, and (c) teenage pregnancy. Independent variables were life event and ethnicity, and dependent variables were teenage pregnancy and initial sexual behavior. The population sample included a total of 12,284 data observations of African American and Caucasian females. Hypotheses were tested using logistic regression and independent sample t tests. The study used public domain data from the Centers for Disease Control and Prevention's National Survey of Family Growth. Study results indicated that Research Question (RQ) 1 confirmed that life events are a statistically significant predictor of teen pregnancy. RQ2 confirmed that no significant relationship exists between Caucasian and African American adolescent females and the existence of teen pregnancy. RQ3 confirmed significant mean differences in the age of first sexual intercourse between Caucasians and African Americans. This study may contribute to positive social change by educating and empowering teenage African American women about teen pregnancy, enhancing their social competence, and potentially preventing unwanted pregnancy.

Research on obesity, weight loss, and food addiction (FA) suggested a strong relationship between use of food additives and the brain's addictive response to food. Previous researchers have examined (FA) and have identified certain food additives such as monosodium glutamate (MSG) and high fructose corn syrup (HFCS) as contributors to food addiction and overeating. Social cognitive theory (SCT) has also been effective in addressing addictive behaviors such as drug addiction, alcohol addiction, and smoking cessation (Bricker et al., 2010). However, researchers had not examined food addiction, social cognitive theory, and obesity in the same study. The purpose of this quantitative, quasi-experimental study was to compare the effects of SCT-based health information and non-SCT-based health information on FA among obese and overweight women. The Yale Food Addiction Scale (YFAS) was used to measure changes in FA and food addiction symptoms among 84 obese and overweight women who received SCT-based health information and non-SCT-based health information. Total scores from pretests and posttests were analyzed using analysis of covariance. Between-group differences on the symptom count posttest scores of the YFAS were analyzed using analysis of variance. Scores were used to determine the difference in FA and FA symptoms between nonrandomized groups. Although the results were not statistically significant, almost 60% (n = 50) of participants experienced a favorable decrease in FA symptoms and experienced weight loss. Findings may provide a basis for determining additional options for health professionals to address obesity and FA patterns.

Developing countries like Nigeria continue to have HIV epidemic challenge due to the scarcity of evidence-based information and lack of resources to boost HIV education. The study population, Owerri, is one of the states in Nigeria with a high incidence rate of HIV. The purpose of this phenomenological study was to explore the experiences of people living with HIV/AIDS regarding the effects of nonadherence to HIV/AIDS drugs. The integrated theory of health behavior model provided the framework for the study. I collected, transcribed, and analyzed interview data to identify clusters and themes. Results showed that various factors influenced and (e.g., free drugs, fear, culture, medication side effects, discrimination, relationship/support system, poverty, belief, easy access) contributed to adherence behavior among respondents. People living with HIV/AIDS may be encouraged to adhere to drug treatments because of these research findings. This study contributed to a positive social change in that respondents were excited and open about sharing their fears, challenges, struggles and hope with the anticipation to influence others to be open about their HIV disease.

The Navajo tribe reports extraordinarily high number of cases of sexually transmitted diseases (STDs), such as gonorrhea, chlamydia, and human immunodeficiency virus (HIV) among men who have sex with men (MSM) and heterosexual populations. The purpose of this qualitative study was to explore the cultural value of adil' idli (self-respect) and how this cultural practice might influence health behaviors in sexual activity, condoms use, and acquiring of STDs among Navajo men. The Health Belief Model (HBM) was the theoretical foundation for providing a deeper understanding of the social, environmental, and cultural factors of condom use among Navajo men. Research questions focus on understanding whether condoms affected sexual activity, its protective role against STDs/HIV, and acceptability concerns pertaining to adil' idli (self-respect). A purposeful criterion-based sampling was used to select and interview 20 Navajo men ages 20 to 39 who lived in or near Shiprock, New Mexico and Gallup, New Mexico. I used a grounded approach and categorizing strategy to code and analyze the transcripts. Key findings revealed that the positive components of adil' idli (self-respect) have influenced Navajo men to protect themselves by wearing condoms. Recommendations include identifying strategies to address condom errors and failures and to develop tactful approaches to promote correct condom use in order to decrease the rates of STDs and HIV among Navajo men. The positive social change implications include health professionals' use of findings to improve STD and condom use prevention behavior among Navajo men by integrating the cultural beliefs of adil' idli (self-respect), specifically emphasizing the positive aspects of staying healthy in health messages.

In Ethiopia, 17% of pregnant women ages 18-49 are malnourished and have low awareness of prenatal nutrition, which may relate to increasingly high rates of maternal and infant mortality. The purpose of this mixed methods research study was to determine the effects of a community-based prenatal nutrition education intervention program on maternal nutrition knowledge and attitudes in the Alaje district of Ethiopia. The theoretical framework was Sen's capability theory of poverty, in which opportunities can lead to well-being and promote economic development. Research questions focused on the relationships among 8 independent variables-age, income source, degree of program implementation, marital status, education, number of pregnancies, number of children, and occupation-with respect to maternal nutrition knowledge and attitudes. Health workers recruited 135 pregnant and non-pregnant women in each of 2 villages: Dejen (control village) and Takha (experimental village), totaling 270 participants. The community intervention program was an add-on to the Ethiopian government's nutrition program and provided information on portion sizes, the importance of eating an extra meal each day, and obtaining adequate rest during pregnancy. Data from customized pretest and posttest focus groups and surveys were collected. Focus groups were analyzed manually and surveys were analyzed using 1-way ANOVAs and descriptive statistical analyses. The key findings were that the women in Takha had significantly greater knowledge of the importance of prenatal health requirements. The implications for positive social change include recommendations for policy makers about proper dietary practices in order to improve pregnancy outcomes related to maternal malnutrition.

The Centers for Medicare and Medicaid Services (CMS) report thousands of falls in hospitals each year. The CMS does not reimburse hospitals for fall related injuries, costing the hospital system organization for which this DNP project was designed millions of dollars each year. Framed within the Iowa model of evidence-based practice and using a team approach, the purpose of this project was to develop an evidence-based (EB) fall safety bundle for use by nursing staff and a curriculum to educate staff on prevention strategies. The components of the EB fall bundle kit were approved by the stakeholder committee. Evaluation of the curriculum and the pretest/posttest items was completed by three content experts. The curriculum was evaluated related to the objectives using a 'met' (2) and a 'not met' (1) response. All responses were 'met' for an average score of 2 showing the content met the objectives. Validation of the pretest/post items was conducted using a 10-item, Likert scale, ranging from 1- 'is not relevant' to 4- 'is highly relevant'. The content validation index was 1.0, showing that the test items met the objectives and content of the course. Recommendations included providing a consistent methodology to disseminate the fall safety bundle and educational curriculum across the entire healthcare system as well as adding the fall safety bundle tool kit to the hospital's intranet page for ease of access for all staff. Social change will be achieved by facilitating prevention of fall related injuries and avoiding the financial impact on the facility.

Chronic Obstructive Pulmonary Disease (COPD) and Congestive Heart Failure (CHF) are conditions that represent significant and ongoing medical costs, including frequent emergency department (ED) visits, hospitalizations, work absences, and disability. This retrospective cross-sectional study, examined the effects of the frequent ED visits due to COPD and CHF on the beneficiaries of Medicare and Medicaid in Maryland. The goal was to identify the factors that led these patients to visit the ED, the impact of these visits on Medicare utilization and costs across Maryland, and preventative intervention strategies to control this population's costs of care. Secondary data were analyzed from 2010-2012 using the Administrative Claims Data in Chronic Condition Warehouse (CCW). The results for the first research question revealed that an increase in the number of primary care physicians was correlated with a decrease in ED visits; thus, persons living in areas with higher PCPs also had lower ED visits therefore the first null hypothesis was rejected (Ï?2 = 3.85, p=.05) . The results for the second research question revealed that ED visits had no significant relationship with death in a given year; thus, patients may be diverted to less expensive care sites to minimize cost and ED overcrowding, therefore the second null hypothesis was not rejected (Ï?2 = 0, p=.98). In both cases, the confounding variables of gender, age, and race had significant effects upon the relationship. Health Professionals and policy makers may use the findings to develop strategies to increase supply of PCPs, adapt patient centered interventions and modify existing chronic disease care strategies to minimize or prevent lifestyle and environmental factors that affect chronic disease outcomes. Such improvements could contribute to positive social change by eliminating or reducing the overcrowding that occurs in emergency departments in Maryland and other states.

An increasing number of adults are plagued with weight problems in the United States. Approximately 34.9%, or 78.6 million, in the United States is obese.Obesity and overweight cost the United States about $150 billion, which is 10% of the annual budget. The Health Belief Model was used as a framework for the study.The purpose of this phenomenological study was to explore the lived experiences of 10 obese or overweight adults in Columbia, South Carolina. Participants were purposefully selected and interviewed face to face and recorded based on the phenomenological approach. NVivo11 for Windows was used for data coding, organization, and analysis. All 10 participants had a general idea of what society perceives as 'healthy' Data were coded and analyzed to reveal three themes: changing food culture, experiencing physical activities, and understanding overall well-being. Findings may be used to develop preventive measures to improve obese and overweight individuals' quality of life.