There is a need for epilepsy-based health education programs to enlighten Nigerian communities and reduce the stigma associated with epilepsy. Epilepsy in Nigeria is viewed by some as a contagious and an infectious disease or a condition imposed from the gods, possessed by demons, as the work of witchcraft, or punishment from ancestral spirits, which are all related to a lack of knowledge about epilepsy leading to stigmatization of persons with epilepsy. Guided by the stigma theory, the purpose of this community-based, cross sectional study was to quantitatively examine the effect of an educational program on interpersonal, internalized, and institutional stigma of epilepsy in terms of knowledge, attitude, and treatment gained. Two hundred and fifty participants completed a general domain instrument which had been used in different countries, including South Eastern Nigeria, and revised for greater validity via a pilot study. Chi-square tests were used to examine any significant differences in participants' responses between pre- and post-test surveys regarding knowledge, attitude, and treatment gained of all 3 identified stigma levels. According to study results, the educational program reduced all 3 stigma levels in terms of attitude, knowledge, and treatment gained of epilepsy (p< 0.001). This study contributed to positive social change by providing information to public health workers on how to increase the knowledge and awareness of the South Eastern Nigerian community that epilepsy is not contagious or infectious and there is no need to isolate persons with epilepsy from their societies.

WISEWOMAN (WW) is a comprehensive program for medically underserved women in South Dakota (SD), aged 30 to 64, which aims to reduce morbidity and mortality from chronic diseases. Screening services include blood total cholesterol, blood pressure and blood glucose, and body mass index (BMI). Lifestyle intervention (LSI) sessions are also offered to address physical activity and nutrition. The purpose of this retrospective longitudinal study was to quantitatively examine whether the combination of LSI's and clinical screenings or clinical screenings alone lead to improvements in blood pressure, blood glucose, total cholesterol, and/or BMI at rescreening 10 to14 months from initial screening. Guided by the social ecological model, it was hypothesized that SD-WW participants attending the screening sessions as well as the intervention sessions would have greater reductions in blood pressure, total cholesterol, and blood glucose than participants who only received screenings. Participants included 653 low-income women aged 30 to 64 enrolled in the screening alone (N=423) and SD-WW program (N=230) from 2000-2005, who completed both the screening and rescreening 10 to14 months later. Secondary data analysis using forced-entry multiple regression of the traditional measures employed in the screening alone control condition yielded significant predictive models for change scores in blood pressure, BMI, blood glucose, and cholesterol among all participants. Neither dummy variable regression nor ANOVA results indicated any significant impact of the SD-WW intervention on these same health outcome changes. Findings contribute to positive social change by demonstrating that screening alone is effective in predicting health outcomes, thus allowing more disadvantaged women to be served by public agencies that may face reduced funding for their array of programs.

More than half of the incidents and mortality rates from cervical cancer occur among minority groups, including immigrant women from continental Africa living in the United States. Although researchers have examined cervical cancer screening practices among minority populations, including Black women in Africa and in the United States, there are few studies on cervical cancer screening and associated risk factors, specifically among African women living in the United States. The purpose of this study was to investigate the association between selected factors and cervical cancer screening practices among African immigrant women living in the United States. Using the behavioral model for vulnerable populations as a theoretical basis, this cross-sectional quantitative study was focused on determining the association between family income, level of education, language of interview, insurance status, age, and perceived health status and cancer screening practices. Data on 572 African immigrant women from the National Health Interview Survey in 2005, 2008, and 2010 were used for the study. Chi-square tests and logistic regression were used to analyze the data. Key findings indicate that family income, education level, and age were significantly associated with cervical cancer screening practices among African immigrant women in the United States. Findings from the study support positive social change by targeting at-risk groups for cervical cancer screening programs. The long-term goal of early cervical cancer screening is to lower cervical cancer rates among African immigrant women in the United States. The findings from the study can be used by community health professionals to provide education that can lead to utilization of cervical cancer screening services based on guidelines and recommendations.

African American men have the highest prostate cancer occurrence and deaths of any population, yet many are unaware of screening opportunities or prognoses if diagnosed with the disease. The focus of this study was to learn whether a web-based prostate health education decision aid would increase prostate cancer knowledge, declared intention to be screened, and the likelihood of scheduling a prostate-specific antigen (PSA) test. The transtheoretical model of behavior change served as the theoretical framework for the study to assess readiness to adopt new behaviors. A total of 128 African American men between the ages of 40--65 without a history of prostate cancer participated in the study and were divided into 2 nonequivalent groups. The control group had 48 participants, and the intervention group had 80. After reviewing the web-based intervention, participants completed a demographic questionnaire, The Prostate Knowledge Questionnaire, and an Intent-to-Screen Tool. Mean differences in knowledge change were compared while adjusting for covariates using least squares regression. There was no significant improvement in the Prostate Knowledge Change score between the experimental and control groups. Therefore, the alternate hypothesis cannot be accepted. The social change implications suggest that the web-based decision aid studied in this project may not be the best tool to increase knowledge about prostate cancer screening. Therefore, more research is needed regarding ways to reach and inform African American men about the pros and cons of prostate cancer screening to foster informed decision making.

In Cameroon, many disabled people (an estimated 10-20% of the population) have inadequate access to education and health care, and disabled people's organizations (DPOs) are advocating for social change. Yet, there is a scarcity of information regarding how African DPOs address HIV and AIDS. The purpose of this study was to assess how DPOs in Cameroon have responded to AIDS in the disabled population and to identify strategies to enable DPOs to manage AIDS issues. This study was guided by the complex adaptive systems theory as the theoretical framework. The research questions focused on what DPOs have done to develop their organizational capacities to address AIDS issues, and on the contextual factors that influence these organizational capacities. To answer the research questions, a qualitative, multiple case study was conducted. A purposeful sample of 25 people, primarily executive members of four community-based nongovernmental DPOs and key informants with experience in this field, participated in interviews and focus groups. Information was gathered from documents and participant observation. Data were coded using a priori and emergent codes and iteratively analyzed into themes. Evident themes were that capacities in these groups were limited by marginalization and poverty, a lack of connection between DPOs and the AIDS community, limited health education, and inadequate understandings of the complexity of AIDS. DPOs desired participation in AIDS-related efforts and continued to explore potential opportunities. These results could be used to enhance social change by improving AIDS practices and research programs, increasing organizational capacity and social inclusion of DPOs, and the development of policy at organizational and governmental levels.

Cardiovascular disease is the leading cause of death in the United States; firefighters are at a greater risk for both the disease and death. Their exposure to stress, toxic fumes and smoke, unhealthy eating habits, excessive weight, and low levels of physical activity are all contributing risk factors to this disease. The purpose of this quantitative study was to determine the effectiveness of a multi-faceted program of exercise and nutritional counseling to decrease body fat composition and increase fitness levels nine months after initial implementation among a sample of 202 firefighters. Social learning theory was the theoretical foundation for the study, as the firefighting population utilizes strong social networks which aid in the ability to observe, model, and imitate new learned healthier behaviors. Statistical analysis showed no significant difference between pre- and post-body composition. There were significant differences seen between pretest- and posttest fitness scores. The implication for positive social change lies in the fact that these study findings indicate that voluntary exercise and nutrition programs may not be adequate to address the issue of obesity among the firefighter population. Results can be used to inform better nutrition and exercise interventions for firefighters, thus helping them attain their goal of becoming a healthier workforce.

Lack of fruit and vegetable (FV) consumption is directly linked to the prevalence of obesity and chronic disease in the United States. The USDA Fresh Fruit and Vegetable Program (FFVP) offers elementary school teachers access to healthy foods as part of the public school classroom experience. The purpose of this study---which was based on self-efficacy theory and the socio-ecological model---was to examine if an association exists between selected factors: (a) daily fruit and vegetable consumption, training status in the USDA Fresh Fruit and Vegetable Program (FFVP), and an established school nutrition policy and (b) nutrition-teaching self-efficacy (NTSE) among elementary school teachers who participated in the FFVP. Using an online survey, 66 teachers out of 114 (58% response rate) completed a 26-question survey adapted from the Nutrition-Teaching Self-Efficacy Scale and the National Cancer Institute's Food Attitude and Behavior Survey. Based on the results of the chi-square test of association (p = 0.031), an association between daily FV intake and NTSE among teachers involved in the USDA FFVP was confirmed. The odds of having high NTSE are 3.45 higher in those who consume more than 3 cups of combined FV each day (p = 0.029). There were no significant associations between NTSE and FFVP training and established school nutrition policy. The social change implication of this study is that healthier, confident teachers build healthier school environments and create the impetus for increasing FV consumption in the community at large, thereby helping to reduce the risk of obesity and chronic diseases.

<p> Individuals diagnosed with dementia make up the majority of the population in skilled nursing facilities (SNFs). Certified Nursing Assistants (CNAs) are the primary caretakers of older adults living in SNFs. The purpose of this grant project was to write a proposal for funding to provide Person-Centered Care (PCC) training to help CNAs enhance their skills to better enhance the quality of life of older adults living with dementia in SNFs. </p><p> The goal of PCC training is to help CNAs better understand the signs and symptoms of Alzheimer&rsquo;s and dementia, improve communication skills, and provide strategies to manage the behavioral and psychological symptoms of dementia. Previous research on PCC has found it to be effective in improving the quality of care of older adults who are affected by dementia and who are living in nursing homes. </p><p> Actual submission or funding of the grant was not required for the successful completion of this project.</p>

<p> Fibromyalgia (FMS) goes undiagnosed in as many as 3 out of 4 people who have the disease. Primary care providers (PCPs) are the first to evaluate patients; therefore, PCPs need to be able to recognize FMS, implement initial treatment, and refer for further consultation. The Fibromyalgia Diagnostic Screening Tool (FDST), a validated instrument to identify FMS, can improve the speed and accuracy of FMS diagnosis. The purpose of this project was to familiarize PCPS with the FDST, evaluate their receptiveness to the tool, and train them in its use. The Leventhal, Diefenbach, and Levanthal, common sense model of illness provided the theoretical framework to guide this quality improvement project. A 45-minute in-service and accompanying reference manual was given to 4 participating PCPs, along with a demographic questionnaire asking about their age, race, gender, marital status, and years in practice. Following the in-service, a 10-question self-completed questionnaire consisting of a combination of open-ended and nominal scale yes/no questions, was administered. A thematic analysis revealed 2 primary barriers for diagnosis without the FDST: lengthy screening time and trouble differentiating FMS from a patient&rsquo;s other conditions. In response to one of the yes/no questions, the participants all replied that the in-service on FDST was helpful in diagnosing FMS. Implications for social change include improved diagnosis with a diagnostic screening instrument, improved quality of health care, and cost effectiveness at the system level for chronic disease prevention and management. This project demonstrates in a localized primary care setting that the FDST may offers PCPs a reliable method to diagnose FMS.</p>

<p> Health literacy among the elderly Hispanics is a problem for 44% who read at the lowest level due to issues with recognition, cognition, or vision. The purpose of this study was to determine the extent that elderly Hispanics have problems with medication adherence due to health literacy. The social cognitive theory was the framework for this study. Inclusion criteria consisted of being 65-75 years of age, and speaking and/or reading English and/or Spanish. Questionnaires from 156 individuals were completed in Cobb County/Atlanta GA and analyzed using multiple regression to determine the relationship between health literacy and medication usage. Medication adherence was the dependent variable and independent variables were gender, age, Hispanic origin, education, income, income means, health insurance, health literacy, and medication usage. Statistical significance was noted in medication adherence, health literacy, and working full-time. Results were based on the correct answers from health literacy questions, which showed an association between medication adherence and health literacy and a reduction in medication adherence problems among elderly Hispanics who worked full-time. These findings showed a significant association between medication adherence and health literacy level among elderly Hispanics. No medication adherence problems were noted among participants who had good health literacy, unlike participants with poor health literacy. A larger ethnic group may show a variation of problems in future studies. Implications for social change could include recommendations for the use of Spanish language hotlines and reading materials to provide care, knowledge, and medication information assistance.</p>