Maternal Mortality Rate (MMR) in Ethiopia remains one of the highest in the world due in part to very limited use of maternal health services. However, the underlying factors for limited use of the services and hence the high MMR are not well known. The purpose of this study was to identify factors associated with use of maternal health services and maternal health risks, to analyze inequity patterns between use of maternal health services and maternal health risks, and to measure the magnitude and trends in inequity. Behavioral-cultural and structural theories of health inequalities were used to frame the study. Research questions included whether there were trends of inequity in use of maternal health services, if sociodemographic characteristics were associated with use of the services, and whether inequities in use of the services were associated with maternal health risks. The study design was quantitative and used data collected through Demographic and Health Surveys (DHS) conducted in 2000, 2005, and 2011. DHS had employed stratified 2-stage cluster design; this analysis used logistic regression method, odds ratio chi-square test, and correlation measures. The findings indicated statistically significant inequities on use of antenatal care and skilled birth attendant services associated with women's residence, level of education, income, administrative region, distance to a health facility, out-of-pocket payment for health services, and involvement in decision making. Based on the findings, it is recommended to design maternal health policies and programs that improve access and use of the services, specifically for women in rural areas, with no education and with limited economic capacity. Further research is also recommended for regions where sample size was limited. Maternal health policies and programs designed to reach the most disadvantaged women could increase service use and improve maternal health, leading to positive social change.

As there continues to be a nursing shortage and a lack of diversity in the nursing profession, it is important to retain at-risk students who have been admitted to nursing programs. The purpose of this program evaluation was to compare at-risk students who had not received retention services to at-risk students who had received retention services at a Midwestern college. A formative evaluation was conducted using information from three sources: the college, the students, and the community. Guided by a constructivist theory defined by Ponticell, this study examined the effectiveness of the retention program in terms of its impact on course completion rates, semester, and cumulative GPAs, and number of students on probation and dismissed from the college. Using a retrospective quasi-experimental design, data from 72 students in 2 groups were compared using chi-square, t tests, and one-way repeated-measures ANOVA. Although the results were not significant, students who received retention services were less frequently on probation and dismissed, had higher course completion rates, and had higher GPAs. In addition, 54 graduating students were surveyed, and their perceptions of the retention services were positive, with an overall mean score of 4.02 out of 5.0. Themes identified through a community key informant interview included student/personal responsibility, family responsibility, and community responsibility. The program evaluation was summarized in an evaluation report that included the results and recommendations for continuation or the addition of retention services. This study may impact social change as the retention services are reviewed and adjusted in order to produce an increased number of qualified, diverse registered nurses.

To improve U.S. residents' health, advocates are focusing their efforts on workplace health. Researchers have found that unionization is a positive influence on workers' participation in health promotion programs relating to smoking and obesity prevention. However, the effect of union membership on other health promotion initiatives, such as influenza vaccination compliance among health care workers, has not been examined. The purpose of this quantitative study was to address this knowledge gap between a union and a nonunion health care facility in the U.S. state of Pennsylvania. The health belief model was used to determine if different domains of influenza vaccination perception predicted vaccination behaviors among union and nonunion health care workers. A secondary analysis was performed on the 2013-2014 Influenza Vaccination Survey, which was completed by 2,480 health care workers. While a chi-square analysis showed that vaccination compliance was not statistically different between facilities, a binary logistic regression revealed a significant difference in predicted vaccination behaviors for each domain of influenza vaccination perceptions. Among union health care workers, perceived barriers yielded the highest positive predictability of vaccination compliance, whereas perceived benefits were positively associated with vaccination compliance among nonunion workers. These study findings affect social change by identifying vaccine compliance predictors among union and nonunion health care workers. By focusing on these predictors, health care facilities may be able to improve levels of vaccination compliance and achieve the Joint Commissions' vaccination goal of 90% compliance amongst all healthcare workers.

Numerous studies have revealed that immigrants' health and well-being is challenged by an increased susceptibility to diabetes/chronic disease as they settle in the United States. This study investigated a potential association between the incidence of diabetes/chronic disease and various lifestyles factors among Sub-Saharan African immigrants and refugees. The lifestyle factors studied were sociodemographics, food practices and dietary habits, access to healthcare and insurance, acculturation, and the length of stay in the United States among these immigrants and refugees residing in Minnesota. The health belief and the socioecological models guided this study to improve understanding of Sub-Saharan African's health behavior and practices. This study was a cross-sectional, quantitative inquiry using data from 71 Sub-Saharan African-born individuals (36 women and 35 men) between 18 and 65 years of age who completed a modified Metro Adult Health Survey Questionnaire. Logistic regression analysis indicated that the participants' increased length of stay in the United States (B = .33, P = .02) was significantly associated with an increased incidence of diabetes/chronic disease. In contrast, participants' acculturation in the United States (B =.09, P =.41) was not significantly associated with the incidence of diabetes/chronic disease. The implication of this study is that immigrants have increased incidence of diabetes/chronic disease with an increasing length of stay in the United States. This study contributes to positive social change by providing knowledge of African immigrant health and incidence of chronic disease useful to public health educators, practitioners and other service providers who seek new direction in improving the health and health outcomes of African-born populations.

Obesity is a risk factor for chronic diseases among the ethnic minorities for adult immigrants in the United States. There have been many research studies conducted to examine the relationship between the predictors and obesity in minority groups in the United States, that relationship was unknown in Meskhetian Turk (Ahiska) immigrant populations. Guided by social ecological model and acculturation theory, this study examined the predictors of obesity in the Meskhetian Turk (Ahiska) immigrant population in the western United States. Data were collected from 109 participants using CDC's Behavioral Risk Factor Surveillance System, Stephenson Multigroup Acculturation Scale, and Perceived Stress Scale. Participants were recruited through flyers in a public setting and data were analyzed through SPSS using logistic regression and Spearman's correlation. The result of the study showed no statistical association between obesity and the predictors of age, gender, socio-economic status, physical activity, acculturation, and perceived stress. This study, however, showed a significant association between daily vegetable, fruit, and hamburger, cheeseburger or meat loaf consumption and obesity, and weekly vegetable consumption, monthly hamburger, cheeseburger or meat loaf consumption and moderate/morbid obesity. The study findings suggest that, through targeted community-based intervention and education programs, there is positive social change in the value of healthy lifestyle and the impact of the predictors of obesity, especially diet of Meskhetian Turk (Ahiska) immigrant population in the United States. Further investigation should focus into other causes of obesity using a larger sample size.

Heart failure patients are responsible for managing fluctuations in symptoms between exacerbations by employing treatment adherence, active monitoring, and management strategies based on expert guidelines. Despite education, delayed help seeking persists among those in the need of acute medical intervention, as evidenced by high hospital admission and readmission rates. The purpose of this qualitative grounded theory study was to explore the decision making processes undertaken by heart failure, community-dwelling individuals as they experience symptom changes. Eighteen face-to-face interviews were conducted with participants who had heart failure and received self-management education from a home care agency in Southern Ontario, Canada. Data were analyzed using iterative steps of open, axial, selective coding, and qualitative software text queries. Three process themes were identified: perceiving symptoms, normalizing symptoms, and adapting to symptoms, with an overarching theme of control and absence of consultative behaviors. The central concept revealed in this study was normalizing symptoms in heart failure which included actions taken by participants to mitigate symptom fluctuations. Daily fluctuations were assimilated into normal life resulting in desensitization of symptom recognition and a loss of functional capacity. These findings can be used to inform system changes needed to strengthen consultative patient-health professional relationships required for effective self-management problem-solving. This study leads to positive social change by explaining how self-management is practiced from the patient's perspective, which can inform practice recommendations and future research.

This phenomenological qualitative study explored the parenting role of nonresidential fathers of children living in shelters. Special attention was paid to the perceived contributions of these fathers to the overall health and general well-being of their children residing in shelters. Often separations of nonresidential fathers from their children in shelters decreased their contributions to their children's health and well-being. Increased knowledge of these parental roles and contributions can enhance programs and policies to support these fathers in improving the health and well-being of their children. In-depth semistructured interviews were conducted with 6 demographically diverse nonresidential fathers living in Philadelphia. The health-belief model, in conjunction with the revised health-belief model, was used as a theoretical framework for this study. The research questions were designed to explore nonresidential fathers' parenting roles, perceptions of their contributions, and the facilitators of and barriers to their parenting while their children resided in shelters. An inductive approach to data analysis informed study findings of nonresidential fathers' active participation and engagement in their children's lives, including involvement in their healthcare and health promotion. Perceived facilitators to their parenting role included internal and external motivators, whereas perceived challenges and barriers to their parenting role were externally based. Finally, study findings showed these fathers to be present and making significant contributions to the improved health and overall well-being of their children while they resided in homeless shelters.

Diabetes is the 7th leading cause of death in the United States. Uncontrolled diabetes and lack of self-care knowledge leads to increased emergency department (ED) visits, utilizing limited health care resources. The practice-focused question asked whether a patient-focused diabetic self-care toolkit could decrease the number of diabetes-related ED visits. The purpose of this project was to reduce the number of diabetes-related ED visits and was supported by the social cognitive theory. The sources of evidence included the facility's ED Information System (EDIS) data and a patient survey developed by the project lead. There were 149 participants (135 males and 14 females). Before program implementation there were 3240 total ED visits with 124 diabetes-related disposition diagnoses. Post-project there were 3362 total ED visits, with 126 diabetes-related disposition diagnoses. Data collected revealed no meaningful difference between the pre-project and post-project ED diabetes related visits. However, of the 124 pre-project diabetes-related visits, 59 had a triage complaint or disposition diagnosis of medication refill, and of the 126 post-project diabetes-related visits, 33 were medication refills. Although implementation of the diabetes resource toolkit did not help to decrease diabetes related emergency department visits, it did identify that 47.58% of pre-project visits and 26.19% of post-project visits were related to medication refills, showing a 21.39% post-project decrease in medication refill visits. This identifies one potential positive impact of the toolkit implementation. The implications for positive social change from this project is the recognition that medication refills are an impacting contributor to diabetes-related ED visits and from that, nursing practice can gain new knowledge in the fight against diabetes.

The U.S. Food and Drug Administration (FDA) uses the FDA Adverse Event Reporting System (FAERS) to monitor adverse events resulting from pharmaceutical drug use. However, this system has limitations such as not allowing real-time data collection. To address these limitations, the FDA launched the Sentinel Initiative in 2008. This comparative case study was conducted to describe perceptions of investigating the efficacy of the Sentinel Initiative compared with the FAERS. The study was based on the theory of preemption as it emphasized the need for efficient means for providing unquestionable proof that consumers suffered adverse drug effects. The sample included interivews of 20 individuals, who worked closely with the FAERS program and were familiar with the Sentinel Initiative. In-depth key-informant interviews had been conducted to determine the perceptions of the participants regarding the challenges and benefits of the Sentinel Initiative compared with FAERS. To analyze data, content analysis was used. The study concluded that the FAERS and Sentinel Initiative provided a systematic database, which included health data, that could be used to improve public health. Due to the FAERS and Sentinel Initiative, adverse effects of drugs will be recognized and the safety of the patients and the public will be prioritized. The findings of this study have potential social impact for positive change at the societal level, organizational level, and individual level in terms of overall safety of the drugs. Sentinel initiative at its present state complements the existing FAERS and leverage its benefits by connecting at a grass roots level patients to an organization level as well as stakeholders to make an impact in providing safer drugs on the market.

Minority groups experience disproportionately worse health outcomes. An identified solution is to increase the number of minorities providing healthcare in their own communities. Primary care complementary and alternative medicine (CAM) providers are a potential resource. Many investigators have demonstrated the efficacy of science-based pipeline programs for increasing the roles of students in allopathic health professions. Whether these programs influence matriculation of minorities into a CAM university is unknown. The main purpose of this study was to gain an understanding of a pre-college science academy at a CAM university and determine whether the experience increased interest in and motivation for CAM careers. It was also important to learn more about what factors may facilitate or impede minority student matriculation in a CAM university. In this phenomenological study, a mixed purposeful sampling strategy was used to select 9 students who had participated in a science academy at a CAM university. Individual in depth, semi-structured, interviews were conducted and analyzed using a process of inductive analysis. The results indicated that barriers to college matriculation included cost and the complexity of the process. The desire to elevate status steers some minorities who use CAM modalities as their indigenous health practice, towards high prestige allopathic careers. Participation in the science academy increased interest in and utility of CAM, but did not change preconceived career choices. These results contribute to the existing literature and can enrich social change initiatives by increasing the number of minorities providing healthcare in their own communities, and further understanding of the factors that influence underrepresented minority career choices.