Increased demand for culturally sensitive healthcare services suggests that interprofessional beginning healthcare students need to gain the necessary cultural competency skills to be successful in delivering positive health outcomes for diverse patients. Bandura's theory of observational learning, Mezirow's theory of transformative learning, and Purnell's and Paulanka's model of cultural competence informed the framework for this research. The purpose of this quasi-experimental quantitative study was to determine the relationship between mode of instruction (observing role models in videotaped role-play simulation) and increased transcultural self-efficacy in cultural competence instruction. A convenience sample of 196 students enrolled in an interprofessional education (IPE) course was randomly assigned at the time of course enrollment to either control or experiment course sections. Pretest and posttest data were collected anonymously through paper-and-pencil administration of the Transcultural Self-Efficacy Tool-Multidisciplinary Healthcare Provider (TSET-MHP). Paired-samples t test showed that students in the intervention group had statistically higher (p < .05) posttest scores in perceived transcultural self-efficacy after observation of standardized patient actors in a videotaped role-play simulation than did students in the control group. These results support the use of videotaped role-play simulation for cultural competence instruction as a means to achieve improved patient care within the culturally diverse population in the healthcare system.

Influenza vaccination is recommended for persons with high-risk health conditions such as chronic diseases to prevent flu-related complications and death. African Americans 65 years and older have consistently been reported to have the lowest influenza vaccination rates compared to all other racial groups, despite having higher rates of chronic diseases. A review of the literature indicated that there is a dearth of qualitative studies examining the grounds for these low rates. In this study, 15 African Americans 65 years and older were interviewed to explore the factors that contribute to low rates of flu vaccination among this racial group. Research questions using the constructs of the theory of planned behavior gathered the behavioral beliefs, normative beliefs (social norm), and control beliefs affecting low influenza vaccination uptake among older African Americans. Data analysis yielded 5 major themes: (a) fear of illness, (b) vaccine does not work, (c) self-advocacy, (d) have access to flu vaccine, and (e) education needed. These findings suggest that older African Americans would benefit from system, organization, and policy changes that support improved provider efforts and community interventions specifically targeting their concerns about flu vaccination. Implementation of strategies supported by evidence found in this study may improve understanding of flu vaccination from the perspective of older African Americans, and potentially increase the rates of influenza vaccination among this racial group to bring about positive social change.

Hospital administrators face challenges that arise from environmental factors or psychosocial factors, and lack resources to deliver valuable medical services to stakeholders, including patients and employees. A multicase study served to explore experiences and gain a broader perspective of hospital administrators' use of strategies to optimize patient services. Ten hospital administrators from acute care hospitals in Nevada and California were purposefully selected from the population of hospital managers with a minimum of 2 years of documented experience in successfully implementing management strategies to improve patient services. The conceptual framework was Drucker's management theory. Data were collected from semistructured interviews with 10 administrators, from the participants' archival documents, and from hospital archives. Interview transcripts and data from multiple hospital locations were coded and analyzed using methodological triangulation. Five themes identified from data analysis were triple-aim strategy, evidence-based practice, lean methodology, public health strategy, and innovation strategy. Implementing the appropriate strategy in each hospital setting might facilitate identification of elements that are lacking, mitigating, or slowing down the hospital improvement process. The findings of this study might contribute to positive social change by creating platforms for sharing information among patients and providers, payors, pharmacies, and policymakers.

The purpose of this phenomenological study was to examine migrant women farmworkers' views of perinatal care management while working in the fields. Like men, women migrant farmworkers are exposed to many physical, chemical, and biological hazards that pose human health risks. However, women of childbearing age are at an increased risk of having reproductive health difficulties and adverse pregnancy outcomes, and the infant mortality rate among migrant farmworkers is estimated to be twice the national average. Perinatal care is a critical factor in reducing adverse outcomes for perinatal and newborn mortality. Face-to-face interviews were conducted with 15 migrant women farmworkers between the ages of 18 to 40 years who had experienced at least 1 gestational period during while working in the Midwest agricultural stream. Participants were voluntarily recruited from farms in Northern Ohio using purposeful sampling techniques. Guided by the social ecological model, data were analyzed via inductive coding techniques to tease out common themes. All participants reported a basic understanding of prenatal care but due to numerous occupational, community, and access barriers, could not participate in what they perceived as normal prenatal care. Also, participants stated when in gestation they were expected to perform the same jobs as women not in gestation. These findings may inform the work of public health providers and migrant healthcare clinicians of migrant women farmworkers' challenges while receiving perinatal care in Northern Ohio; results can also be used to influence local and national migrant healthcare policies on comprehensive maternal healthcare for migrant women farmworkers in Ohio and across the United States.

Background: Worksite screening programs are increasingly being provided by employers as a means to reduce cardiovascular risk in employees. A screening program that consists of fasting serum analysis of glucose plus a lipid panel is offered yearly to employees at the VA medical center in Tampa. A retrospective study was conducted to determine if a wellness clinic exposure resulted in significant changes in employees' markers of cardiovascular risk. Methods: Computerized records were used to follow serial outcomes for glucose, triglycerides, HDL cholesterol, and LDL cholesterol in employees whose screening results showed abnormal levels of one or more of these markers. An intervention group with 66 subjects received a wellness clinic visit including a health risk assessment and education for lifestyle change, and a reference group with 109 subjects received only serum analysis. Outcomes at repeat screening were compared for the two groups. Results: Both groups showed improvement in cardiovascular risk. In the intervention group there was significant intra-subject improvement from baseline for all markers except glucose. For triglycerides and LDL cholesterol there was a significantly greater proportion of subjects who improved in the intervention group. In addition, the improvement for triglycerides was significantly better in the intervention group. Conclusions: This investigation confirms the value of a worksite wellness program in reducing cardiovascular risk in the population studied. A differential impact of age and gender was seen for glucose and triglycerides and indicates that such modifiers should be considered through covariate analysis in assessing wellness program effectiveness. Increasing levels of employee wellness participation to targets identified in this study and adding a health risk assessment for everyone screened will help to identify the specific benefits of the face to face wellness counseling intervention.

Pharmaceutical drugs are one of the most socially important health care products. They are part of many individuals' everyday lives, from the eradicating of diseases at birth to treating patients at the end of life. However, for many patients access is prevented due to expensive cost. This study explored cost-related non-adherence (CRN) and researched if reimportation of pharmaceutical drugs from other countries could increase patient drug adherence. The perceptions of 10 patients and 10 providers in Maine were assessed. Maine is the only state that allowed its citizens to purchase prescription drugs from abroad. The research questions addressed (a) how reimportation drugs could contribute to drug adherence, (b) the perceptions of patients, and (c) the perceptions of key providers of reimportation. This study was guided by a theoretical framework utilizing Kurt Lewin's theory of organizational change. Participants answered 15 open-ended questions. The study utilized a qualitative grounded theory approach; data were analyzed inductively. The research demonstrated that patients and health care providers had positive perceptions for a reimportation policy. Future research of other regions for this topic should prevail. Member checking was used to validate the emerging theories of increased long term drug adherence incentivized by affordable drug cost, which contributes to perception of competence, better management of current disease, and decreased safety concerns. Positive social change implications can be achieved through savings to the health-care industry by creating a pathway to affordable drugs that will bring more drugs to market and create a competitive structure that can drive down pricing.

Pharmaceutical drugs are one of the most socially important health care products. They are part of many individualsâ?? everyday lives, from the eradicating of diseases at birth to treating patients at the end of life. However, for many patients access is prevented due to expensive cost. This study explored cost-related non-adherence (CRN) and researched if reimportation of pharmaceutical drugs from other countries could increase patient drug adherence. The perceptions of 10 patients and 10 providers in Maine were assessed. Maine is the only state that allowed its citizens to purchase prescription drugs from abroad. The research questions addressed (a) how reimportation drugs could contribute to drug adherence, (b) the perceptions of patients, and (c) the perceptions of key providers of reimportation. This study was guided by a theoretical framework utilizing Kurt Lewinâ??s theory of organizational change. Participants answered 15 open-ended questions. The study utilized a qualitative grounded theory approach; data were analyzed inductively. The research demonstrated that patients and health care providers had positive perceptions for a reimportation policy. Future research of other regions for this topic should prevail. Member checking was used to validate the emerging theories of increased long term drug adherence incentivized by affordable drug cost, which contributes to perception of competence, better management of current disease, and decreased safety concerns. Positive social change implications can be achieved through savings to the health-care industry by creating a pathway to affordable drugs that will bring more drugs to market and create a competitive structure that can drive down pricing.

Although Talcott Parsons’s sick role theory, as described in 1951 in The Social System, has been severely criticized for its inapplicability to chronic illnesses, a portion of the theory is still a relevant and necessary factor in terms of understanding and treating chronic illness today. Using data from the 2012 National Health Interview Survey, this study looks at the individual effects of sex, age, race, cohabitation, education and region of residence on the likelihood of chronically ill patients considering themselves limited in their amount or kind of work as an indicator of sick role adaptation. Results show statistically significant relationships between work limitation and sex, age, cohabitation, education and region of residence, when controlling for the duration of the respondents’ condition. Further evaluation of these results is provided.

Nearly 11 million deaths in 2012 can be attributed to ischemic and hypertensive heart disease, stroke, and diabetes. Yet, these diseases are highly preventable and even treatable via improvement in nutritional intake and physical activity. From a public health perspective, primary care providers have promising and population-wide potential for modifying patient behavior to reduce dietary risk factors. However substantial socio-structural barriers prevent physicians from applying nutrition to improve patient outcomes. In my thesis, I first examine the epidemiological context in both the populations of United States and Switzerland. I then elucidate the importance and context of the application of nutrition knowledge in primary care based on the ideologies of holistic, patient-centered health. Then, I identify and analyze the obstacles physicians face in applying nutrition in patient care, as well as the sociological structures in which these barriers arise. Lastly, I set forth models of progress to improve patient outcome via reformed and restructured application of nutrition in primary care, using studies of exemplary strategies for addressing these barriers to nutrition counseling.

Research indicates that law enforcement officers (LEOs) have a higher prevalence of developing coronary artery disease (CAD) compared to the general population. Sleep deprivation and physical inactivity have been found to be related to many risk factors for CAD. This cross-sectional study examined the health status and the relationship between sleep and physical activity outcomes versus CAD risk factors among 27 University LEOs. The subjects’ health behaviors, and CAD and metabolic syndrome risk factors were described using basic statistics. Accelerometer derived sleep and physical activity outcomes were correlated to measures of health to identify potential relationships. 33% of LEOs were classified as moderate risk for CAD; 92% had dyslipidemia, 58% had elevated triglycerides, 23% had prediabetes, and 22% suffered from obesity. The administrators and first shift LEOs slept more compared to second or third shift LEOs. The LEOs were more sedentary while on-duty. In addition, sedentary time was correlated to systolic blood pressure. LEOs accumulated 24.4 min·d-1 of moderate-to-vigorous physical activity (MVPA), but only spent 9.3 min·d-1 in continuous bouts of MVPA. In conclusion, multiple CAD risk factors were present in these LEOs and achieving adequate amounts of physical activity and sleep may decrease their risk of developing chronic diseases.