African American men who have sex with men (AAMSM) are at a greater risk of contracting HIV than any other ethnic group, subpopulation, or race. Personal, environmental, and social variables can affect risk behavior. Driven by Beck's cognitive theory of depression, this quantitative study examined the relationship between depression and HIV risk behaviors in a sample of AAMSM (n = 108). Data was gathered via the Beck Depression Inventory and the HIV Risk Behavior Questionnaire. Simple and multiple linear regression analysis were conducted to analyze the data to determine the correlation between HIV risk behavior and depression. According to study findings, there was no significant relationship found between depression and HIV risk behavior in this sample of AAMSM after accounting for the variance associated with the covariates: age, alcohol and substance use, condom attitudes, HIV knowledge, and income. While the study findings do not indicate depressive symptoms were associated with HIV sexual risk behavior, age, alcohol or drug use, and condom attitudes were significantly and positively related to HIV sexual risk behavior. Future research is recommended to identify factors specific to AAMSM for use in devising African American MSM-centric interventions. The results could inform the development of interventions targeting older AAMSM to alter behaviors associated with alcohol and drug use to impact sexual risk behaviors and reduce HIV transmission in AAMSM, thus resulting in positive social change in their lives and the lives of their families and communities.

Preexposure prophylaxis (PrEP) is an innovative biomedical approach that has been used over the past 6 years to avert the spread of human immunodeficiency virus (HIV). Under-prescribing of PrEP could increase the probability of HIV exposure among serodiscordant couples/partners and those who do not practice safe sex. Previous PrEP research has not assessed the association between awareness of PrEP, years of experience of providers, provider types, and the frequency of PrEP prescription among physicians. Precaution adoption model framed this study, which aimed to evaluate the bond between the independent variables relating to awareness of PrEP, years of experience, and provider types with the outcome of the frequency of PrEP prescription among physicians. A cross-sectional design was applied to survey 100 physician participants. Kendall's tau-b correlation test and Fisher's exact test were used to analyze the research questions. Eighty-seven percent of the surveyed physicians had low awareness about PrEP, and 90% never prescribed PrEP. Lack of awareness was the primary barrier to prescribing PrEP at the providers' level. Kendall's tau-b correlation test showed that higher awareness of PrEP and years of experience were associated with the frequency of PrEP prescription at 95% confidence interval. However, Fisher's exact test showed an insignificant difference between provider types and the frequency of PrEP Prescription. These findings support the notion that independent of specialty, the more physicians know about PrEP and the more years of experience they have, the more they prescribe it. The results and recommendations could enhance positive social change by providing information to develop an inclusive PrEP education curriculum for health care professionals.

Job dissatisfaction is becoming a fundamental concern for employers. Employee engagement makes an organization more productive and can reduce absenteeism. The purpose of this quantitative study was to examine the relationship between employer-sponsored wellness-program participation and job satisfaction among for-profit college and university leaders. Data collection involved an online survey of 400 faculty members' from for-profit universities in the United States contacted using the Job Satisfaction Survey; 103 participants completed the survey. The theoretical framework was the need-satisfaction theory, which includes the factors that promote job satisfaction and job dissatisfaction. The results came from a multiple regression analysis that indicated a significant negative relationship between job satisfaction and participation in the employer-sponsored wellness program (β = -.22, t = -2.24, p = .027), where faculty who were not participating in the wellness program had higher levels of job satisfaction (M = 3.62) in comparison to those who did participate (M = 3.80). Interaction analyses indicated a relationship between gender and job satisfaction (β = -.26, t = -2.70, p = .008). Females were more likely than were males to have higher levels of job satisfaction, as well as years of experience and job satisfaction. Faculty who had been employed for between 11 and 15 years were more likely to have higher levels of job satisfaction. Job satisfaction appear lower for those who participate in employer-sponsored wellness programs because of the personal gratification employees' experience. The findings may contribute to social change with information that leaders could use to reduce absenteeism, increase productivity, and profitability.

Consistency in clinical preceptor training for sonography students is important in assuring equity in sonography student evaluation. Review of a local community college sonography program revealed a gap between expected roles and responsibilities of clinical preceptorship and what was actually done in the clinical setting. The purpose of this project study was to explore perceptions of graduates and preceptors regarding what constituted best practices in the evaluation of sonography students in the clinical setting. Knowles's theory of active learning provided a framework for understanding the student-preceptor relationship in the evaluation process. Research questions focused on sonography graduates' and clinical preceptors' perceptions of important practices for ensuring consistency and equity in clinical evaluation. A case study design composed of face-to-face interviews with 5 graduates and 5 preceptors at the study community college was used to address the research questions. Sonography graduates were at least 2 years post-graduation; preceptors had at least 1 year with the program and at least 2 years of clinical experience. Interview data were transcribed verbatim and open coded to identify common themes. Four themes were identified: similar definitions of consistency in evaluation, importance of immediate feedback after skillls performance, potential favoritism in clinical evaluation, and the need to enforce program policies. Findings were used to design a clinical preceptor training workshop that could provide a better understanding of effective measures to attain consistency and equity in the evaluation process, fostering positive social change by helping prepare sonography students as competent practitioners to address health care needs locally and globally.

Nigeria is one of the countries with the highest Under-5 Mortality rates (U5M) estimated at 117 deaths/1000 live births. Despite public health control initiatives, no significant improvement in U5M has been demonstrated. The purpose of the study was to determine whether history of Adverse Pregnancy Outcomes (APO) and maternal socioeconomic factors could predict the death of children before their fifth birthday, using the life course health development and fetal programming theories. The study population was women in their reproductive age (15- 49 years). The study was a secondary data analysis of the datasets obtained from three Nigeria Demographic and Health Surveys (2003, 2008, and 2013). Complex samples multivariate logistic regression was used to determine the associations among variables. The results showed that lower education level (p < 0.001), lower income level (p <0.05), rural residential setting (p< 0.01), and lower socioeconomic status index (p < 0.001) of women were statistically significant predictors of U5M. APO was not statistically associated with U5M (p > 0.05). This concludes that children of women with low socioeconomic factors and status index could be at higher risk of death within the first 5 years of their lives, and women with history of APO stand no greater risk of losing their under-5 children. The study would contribute to positive social change among women in Nigeria through early identification of women whose children may be at risk of U5M and provision of evidence-based advocacy to urge increased government and public attention to women and child welfare.

The emerging health care culture of accountability for patient outcomes compounds problems for already overwhelmed clinicians struggling to fit everything entailed in complicated office visits into 15-minute appointments. Unprocessed frustrations tempt clinicians to use ineffective and outdated methods for trying to get their patients to comply or adhere to their care plans, undermining effective health care management. The intention of this project was to evaluate whether educating medical assistants in the health coaching method of motivational interviewing can improve the patient care approach while simultaneously assisting clinicians struggling with insufficient time. Several individual scheduling conflicts limited the target population into two primary care medical assistants and two auxiliary primary care office staff who voluntarily chose to learn the new approach. Guided by the adult learning theory, an educational lecture project was designed to capture the spirit of motivational interviewing through basic descriptions and strategies that will assist learners to focus on person-centered conversation skills, helping to balance both the needs of the patient and clinician. Following the education, participants filled out an anonymous post-lecture evaluation questionnaire to provide immediate feedback about learner understanding. Responses indicated the project met its stated objectives, and results showed the versatility of the motivational interviewing method which can be learned and effectively applied by health care workers from a wide range of professional backgrounds. Motivational interviewing is an innovative approach that utilizes therapeutic communication to promote behavior changes that lead to improved health of our communities and country.

Shift work is commonplace in many fields that require around-the-clock employee coverage. There is ample evidence that two-tier shift work can detrimentally affect health and functioning. The purpose of this study was to understand the impact of three-tier shift schedules on physical and mental health and community functioning, a concept which refers to activities and behaviors performed by individuals or groups within a system. This study used a qualitative phenomenological design, and community functioning and recovery theory were central to the conceptual framework. In-depth interviews were used to explore the perceptions of three-tier shift workers on their functioning, relationships, mental health, physical health, and safety. Special attention was paid to sleep, using restoration theory, which indicates that sufficient sleep is necessary to avoid mental and physical breakdown. The data were organized into themes, and epoché and bracketing were used during the interviews and data analysis. The results of the study add to the literature on how three-tier shift schedules affect employees. Emergent themes included overwhelmingly negative perceptions of three-tier shift workers on their health and safety, difficulty adjusting to the three-tier shift schedule, negative impact on workers' personal lives, negative impact on workers' mental health, negative impact on workers' physical health, and negative impact on workers' performance and safety. These findings could lead to positive social change through policy creation on healthier shift schedules, which could result in healthier employees, stronger family units, and safer roads and worksites.

Adolescents with Type I and Type II diabetes need to monitor blood glucose and food intake, administer insulin, and participate in activities including physical education during school hours to maintain glycemic control. Glycemic management programs (GMPs) exist for the improvement of diabetes management during school hours. The purpose of this project was to evaluate a GMP in a school system in a rural area in the Southeastern United States. The goal was to determine if the existing GMP met objectives and to make recommendations for continuation, revision, or discontinuation of the GMP. The logic model provided the basic framework for the evaluation of the GMP by using a graphic flowchart depicting health outcomes prior to and after the implementation of the program. The review consisted of approximately 2,100 students from 9th to 12th grade, and out of those students there were 77 participants from 2010 and 89 participants from 2015 with diagnosis of diabetes. A t-test outcome evaluation found the updated GMP was associated with the lowering of hemoglobin A1c readings. Mean A1c in 2009 was 8.6% (180 - 190 mg/dl), with the mean decreasing to 7.2% (150 mg/d) in 2015. Changes in the program led to 1-to-1 care management based on children's individual needs and parental involvement. Findings show that the GMP improved glycemic management by empowering and individualizing care. This project contributes to positive social change by contributing to data from the Diabetes Prevention Program Research Group study showing that prevention of onset of Type II diabetes mellitus in adults and adolescents is successful through early detection of prediabetes in childhood.

Diabetes mellitus is a chronic disease that affects millions of people in the United States. The purpose of this project was to develop a guideline to help clinical staff provide clear and concise diabetes self-management instructions to patients in a community setting. Orem's self-care deficit theory (SCD) and health belief model (HBM) provided a platform to assess how patients' self-care deficit contributes to illness and the effect of patients' perception of illness. SCD theory and the HBM provided the framework for the development of the guideline to decrease diabetes acute complications through self-management education. The practice-focused question was whether the diabetes treatment guideline would decrease diabetes complication, improve the quality of care received by the diabetic patients, and if the facility would adopt the developed guideline. AGREE II Tool was used to assess the quality of the guideline and the staffs' desire for the adoption of the guideline. Data were collected from questionnaires given to staff members at the practice site in 2 rounds. Six medical staff were asked to critique the initial guideline, and 5 medical professionals were asked to assess the final guideline. Most of the participants' scores indicated strong agreement that full consideration was met. The score in all 6 AGREE II domains was above 90%, and 100% of the participants recommended the guideline to be adopted in the facility. Data analysis indicated the diabetes practice guideline is valid, will enhance the treatment of diabetes, and the practice site employees were eager to adopt the treatment guideline. Findings may be used to increase population health and reduce acute complications from diabetes mellitus.

The preferred method of communication for most prelingual/culturally Deaf individuals is American Sign Language (ASL), and members of this linguistic/cultural minority community are often not recognized as being bilingual. Many prelingually/culturally Deaf individuals have limitations and deficits in English proficiency; which can lead to deficits in general knowledge of health-related terminology. Current projections are that older adults are expected to live longer, and will also experience the development of, increases in and more extended periods of living with senescence/age-related health disorders, also includes prelingual/culturally Deaf individuals. This quantitative research project, utilizing the theoretical framework of health literacy and a modified version of the REALM (Rapid Estimate of Health Literacy in Medicine), utilizing American Sign Language (ASL) graphics; analyzed the convergence of prelingual/cultural Deafness and health literacy related to senescence/age-related disorders. An evaluation of a sample population of 27 Deaf participants, on health-related items of medical words, medical conditions medical procedures, and medical/numeracy instructions revealed significant deficits in all areas of health literacy. These deficits are critical and impact one's ability to manage effectively, age-related disorders. The results of this study will inform the health care community of the unrecognized magnitude, implication, and the need for positive social change in health care policies and procedures related to the appropriate provision of medical, health care, and health-related information for prelingual/culturally Deaf individuals.