In India poor sanitation accounts for 1,600 daily deaths of children under the age of five (Dasra, 2012). The societal and environmental conditions in India and many other developing countries have continuously stood as barriers to facilitating changes in sanitation behavior. Efforts made to improve hygiene have continuously faced opposing forces including major gaps between the supply and demand of sanitation. This paper will focus on one pilot program conducted in Chennai, India over the summer of 2014. This program was designed to teach school children safe sanitation and hygienic habits by providing a guiding tool to teachers. The study analyzed qualitative observational data collected over the seven-week pilot program period to identify the barriers to implementation experienced in this case study. The results indicate that the school administration was the greatest barrier to implementation in this case study. The results also highlight the contextual sensitivity of each of the barriers and their relationships to one another. The findings suggest that depending on the context of implementation of a health, hygiene, and sanitation program these barriers may be re-ordered in hierarchy to work towards achieving sustainable programs.

Maternal depression during pregnancy can have a negative impact on the developing child. Numerous studies have focused on postpartum depression and the influences on infant outcomes; however, there are limited data on pregnancy-related depression. The problem addressed in this study was the inadequacy and insufficiency of depression screening during the pregnancy period and access to quality-related health services for women. The purpose of this quantitative retrospective study was to test social cognitive theory on low birth weight and prenatal care adherence to pregnancy-related depression in women residing in Colorado. This research measured an association between pregnancy-related depression and both low birth weight prevalence and prenatal care adherence. Secondary analysis of archived data included data from Colorado vital statistics and the 2016 Colorado Pregnancy Risk Assessment Monitoring System. Data were analyzed using Chi-square analysis and multiple logistic regression. The findings showed that pregnancy-related depression was statistically significant of very low birth weight. I reported a summary of findings on p. 68. Biopsychosocial variables were significant to pregnancy-related depression. Pregnancy-related depression was significant in prenatal and postpartum depression. The implications of these findings for social change include the potential to support improved depression screening strategies during pregnancy that may contribute to transformation within the community by promoting more efficient and accessible healthcare for women.

The nurse practitioner (NP) role is more prominent now than ever before in primary healthcare, positioning them as providers who defend initiatives and ongoing health agendas. Obesity is among those agendas. The concept of instrumental role modeling was explained as a combination of understanding and physical presence that gives meaning and quality to inspire change. It implied that health professionals are not merely insightful clinicians but suggested their expertise is complimented by demonstrations of wellness in knowledge and practice. This topic of weight was perceived as sensitive but must be addressed. In this grounded theory study, the perspectives of NPs from clinical and academic settings were gathered. There was an overarching need for NPs to identify how they perceived themselves consequential to how others perceived them. Using a qualitative method gaps on the construct of instrumental role modeling as an emerging theory was addressed and revealed the ambiguities NPs encountered when challenged to identify their personal perceptions of obesity when counseling weight management. Using a grounded theory design, 11 NPs were interviewed and asked about how they reconciled perceptions of instrumental role modeling around discussions of obesity. Participant remarks produced theoretical constructs that instrumental role models: 1) are mindfully responsible when interacting with others, 2) need to balance accountability, approach and awareness to develop trust, and 3) need to be aware of the creative tensions that exist between accountability and approach when discussing illnesses and their co-morbid conditions. These findings provide evaluative dialogue for positive social change in clinical settings and valuable insight regarding the topic of obesity in academia.

Women’s mortality rate in the United States has increased in almost every age group in the past several years. However, more women in the United States are choosing yoga as a complementary health approach to improve general well-being. Thus, research on yoga and other factors that affect women’s health in the United States may inform public health initiatives to address the health disparities in women’s mortality rates. Grounded in the health belief model, the purpose of this study was to explore whether the factors of practicing the components of yoga, doctor’s recommendation for increased physical activity, body mass index (BMI) categories, hypertension, high cholesterol, age, and occupation predicted the self-rated health of women. This cross-sectional, secondary analysis of the 2017 National Health Interview Survey included 14,464 female respondents, and ordinal logistic regression analysis was used to examine the data. The results showed that self-reported participation in yoga, breathing as a part of yoga, and meditation as a part of yoga was associated with higher self-rated health. Additionally, participants with healthy weight BMI, teachers, and participants who did not receive recommendations for increased physical activity and did not have hypertension or high cholesterol were more likely to report better self-rated health. Based on the results of this study, public health researchers may continue to explore the effects of yoga on women and how a yoga-based population health intervention could help women in the United States live longer and healthier lives.

A concerning public health issue in America is about food deserts urban and rural communities that lack grocery retailers that offer affordable, nutritious, and diverse foods. Empirical evidence has shown significant associations between neighborhood disadvantage/disorder risk factors of high poverty and high percentages of ethnic minority residents with presence/ absence of healthy food retailers in food deserts. The purpose of this quantitative correlational study, framed by the disparities in food safety conceptual model, was to examine if county-level poverty, number of African American residents, number of elderly (i.e., age 65 or older) residents, vehicle ownership, and crime rates were significantly associated with presence/absence of healthy food retail environments in a stratified random sample of 160 Mississippi Delta Region counties. Variables were measured using SPSS 25.0 data set from federal sources. Data were analyzed using binary logistic regression. Findings indicated that the percentage of households below poverty level was significantly associated with absence of healthy food retailers, (Wald X2 = 7.62, p = .006). Logistic regression findings further showed that the county percentage of households with at least one vehicle was significantly associated with the presence of healthy food retailers, (Wald X2= 8.75, p = .003). As a result of this study, residents of the Mississippi Delta Region (MDR) may begin to petition their local, county, and state governments to enhance access to healthy foods, and in turn, such government institutions may develop programs and initiatives that help to make healthy foods affordable.

The purpose of this project was to design a chronic care plan using the chronic care management (CCM) framework to improve health services at lower healthcare costs. The practice-focused question explored whether the operationalization of the CCM model would impact progress toward the management of chronic illness for the target population of Medicare beneficiaries with 2 or more chronic illnesses in an urban acute care agency located in the western United States. The middle-range theory, logic rational plan model, Lewin’s change theory, and the CCM’s coordination care and collaborative care concepts were used to guide the project. Data were collected from nursing databases and government agencies. Nurses were significant to the CCM reform by supporting the elements for proactive care. Nurse practitioners can bill using the CCM codes, and clinical nurses can performed patient sensitive care. The social changes were patients with chronic illnesses realized a better quality of life at lower health costs.

Since 2006, Uganda has experienced a nonchanging neonatal mortality rate of 27 out of 1,000 live births, which is higher than the global average of 19 deaths for every 1,000 live births. The purpose of this retrospective cross-sectional study was to determine factors affecting access to health services and their impact on newborn deaths in Uganda. Mosley and Chen's model for child survival in developing nations provided the framework for the study. Secondary data from the 2016 demographic and health survey (UDHS) collected by the Uganda Bureau of Statistics (UBOs) was used. A total of 7,538 cases were used and analyzed using binary logistic regression and one-way analysis of covariance (ANCOVA). The results showed attending less than 4 antenatal care (ANC) visits during pregnancy increased the odds of neonatal deaths 1.57 times, while not taking antimalarial drugs during pregnancy increased the odds of neonatal deaths 1.67 times. However, receiving 4 or more tetanus toxoid (TT) vaccine doses before pregnancy was not statistically associated with an increased risk of neonatal death (p = .597). Also, there was no significant relationship between neonatal mortality and whether distance to health facilities was a challenge (p = .276) or receiving medical assistance during childbirth (p = .420). While there were significant differences in deaths of newborns in geographic regions while controlling for the number of ANC visits (p = .023), there were no differences while controlling for all three covariates, F(4, 117) = 2.00, p = .098. Findings may be used to inform government policies on ANC and malaria prevention during pregnancy, which may reduce neonatal mortality rates in Uganda.

Cardiovascular diseases (CVD) are responsible for more deaths than any other disease, continue to threaten the quality of life for many, and is a major burden to the health care system. The Framingham Heart Study (FHS) identified the major CVD risk factors that became essential to effective CVD screening strategies and the Framingham Risk Score (FRS), is used to assess CVD risk. Based on the concepts of the health behavior model and CVD as a cardiometabolic disorder, multivariate logistic regression analysis was used to evaluate the association between fasting blood glucose (FBG) levels and a CHD event, and to determine the value of FBG replacing a diagnosis of diabetes (DM2) in the FRS. The data set consisted of the 2,677 subjects of the FHS III cohort. In the univariate analysis, both DM2 and FBG were statistically significant (both p =.000), but the association was stronger for DM2, b = 2.138, OR = 8.483 (95% CI: 4.229, 17.105) than for FBG, b = .015, p = .000, OR=1.015 (95% CI: 1.009, 1.022). When adjusted for age, blood pressure, cholesterol, and smoking status, only DM2 remained statistically significant, OR = 2.295, p = .041, (95% CI: 1.035, 5.087) in the model. The FBG version of the FRS did not provide any improvement in performance, as it was marginally inferior to the DM2 version. Furthermore, the interactions between FBG and the metabolic risk factors were not statistically significant for this given data set. The results imply that a diagnosis of diabetes remains the factor of choice for inclusion in the FRS model for predicting the 10-year risk of CHD and replacing it with FBG provides little to no practical benefit. These findings support the use of CVD risk factor reduction and the use of effective screening tools in CVD prevention and promotion heart health.

Some early puberty girls engage in high-risk externalizing behaviors such as early sexual activity, delinquent behavior, and disruptive behaviors. Harsh parenting experienced by girls who develop early has been associated with delinquent and disruptive behaviors. The purpose of this quantitative correlational study was to examine predictive relationships between the style of parental discipline by mothers of early puberty girls and the likelihood and frequency of the girls' engagement in high-risk behaviors. Parenting style theory, including the authoritarian, authoritative, and permissive style of parenting, served as the theoretical foundation for the study. Survey data were collected from 28 mothers who identified as having a daughter who experienced early puberty. The Parenting Scale subscales were used to measure the dysfunctional parenting behaviors of laxness, overreactivity, and verbosity. Logistic regression analysis revealed no statistically significant relationships between the early puberty girl's involvement in risky behaviors and dysfunctional parenting. Results may be used by human service and public health officials to increase awareness of early puberty and to promote public health policies to address the individual, social, and economic implications of early puberty in girls.

Regular gynecological screenings are critical for women in promotion of health and preventing diseases like cervical cancer. Despite the importance of such examinations, many women fail to adhere to recommended screening protocols. As a result, women experience an increased disease risk. The current study examined the relationship between patient-provider communication quality, skill, and empathy on pelvic exam seeking behavior and exam-related anxiety and satisfaction. Additionally, negative self-concept, perceived poor genital self-image, and various elements of the socio-physical clinic environment were explored to better understand their impact on a women’s care seeking behavior. A total of 350 women 19 through 80 years of age completed a one time, 15-minute online survey regarding their gynecological care seeking behavior. Ordered logistic regression analysis revealed that when controlling for demographic variables and self-concept scores satisfaction was significantly impacted by the quality of provider communication. Specifically, higher quality of communication likely increases satisfaction by 12% (coef = .77; odds ratio= 1.19 at a p< .01). Avoidance was significantly associated with greater provider empathy indicating a 9% decrease in avoidance is likely as empathy scores go up (coef = -.19; odds ratio= 0.96 at a p< .01). When controlling for various demographic factors, self-concept scores and provider communication were not shown to be significantly associated with patient anxiety. These findings suggest that enhancing provider communication quality and empathy may improve satisfaction and lessen patient avoidance. Results also indicate that women who have a more positive evaluation of their genital self-image were more likely to feel greater satisfaction concerning gynecological care. Thematic analysis of open-ended essay questions revealed several themes among 3 main areas: 1). Clinician Communication (active listening, explanation, empathic communication, & pace), 2). Social Environment (hospitality& being relational), and 3). Physical Environment (Privacy, Aesthetics, & Sensate Variables). Detailed explanation, empathetic communication, and not rushing patients through procedures all emerged as important components that may guard against patient anxiety. Results suggest that distress related to gynecological care could be mitigated by easily modifiable improvements to the environment like increasing the temperature of the exam rooms, opting for less harsh lighting, providing a place to hang or set clothing, and more thoughtful placement of baby pictures. Results also suggest that improvements to modesty concerns within the exam room, like larger cloth draping and gowns, may significantly improve the patient experience.