Perinatal experiences of mothers in general have an impact on the well-being of the mother and child. It is however not known what the experiences of Kenyan immigrant mothers are in regards to their culture and immigration status. The purpose of this study was to explore the perinatal experiences of Kenyan immigrant mothers with respect to their cultural background and immigration to the United States. The study approach used for this study was a qualitative phenomenological approach. A total of 20 women participated in the study in a focus group session. Bronfenbrenner's ecological systems theory was used to examine how the different environmental factors around an individual affect them and influence their life as well as decisions. The results of the study showed that the various layers of the ecological system have a significant role in an individual's life, especially when that individual is exposed to a new environment. Future studies should examine the experiences of single, young, and new mothers who do not have a social support system and family around to support them. The findings from this study can promote positive social change by informing the public health community about the issues that arose as well as assisting in developing programs that are geared to this particular group as well as other similar groups that might have similar situations.

In recent years mosquito-borne diseases have reemerged, largely because of pesticide resistance. The mosquitoes develop resistance to pesticides because of broad and repeated uses of pesticides. Preventing the development of pesticide resistance requires proper understanding of the environmental factors potentially associated with the development of the resistance. The purpose of this study was to investigate the environmental factors associated with the resistance to pesticides by the Culex mosquitoes. This correlational study included the analysis of archived data samples (N = 29,794) from the Field Cage Tests results conducted between 2013 and 2017 by a large county public health department. The compartmental model was used to help understand and interpret study findings. To examine the associations between the independent variables (i.e., wind speed, temperature, humidity, time, month, and weather conditions) and the dependent variable (i.e., pesticide resistance), chi-square and multiple logistic regression analyses were performed. The results showed that the odds of mosquitoes developing resistance were 2.1 times higher during high temperatures than at low temperatures [x2(1) = 346.5, p = .000]; the resistance was 1.5 times higher during high humidity than in low humidity [x2(1) = 7.23, p = .007]; and the odds of mosquitoes developing resistance to pesticides in August were 3 times higher than when sprayed in June or July [x2 (2) = 702.606, p = .000]. Study findings may be used to help with the development of more effective methods for vector control thereby reducing the numbers of nuisance and disease-carrying mosquitoes along with a possible reduction in the incidence of mosquito-borne diseases and related human morbidity and mortality.

Successful marketing strategies for clinical validation packages not only help laboratories increase the accuracy and efficiency of testing, but also facilitate clinical quality awareness and collaboration. False diagnosis and inefficiency in healthcare can be costly, and managers in diagnostic instrument manufacturing organizations need strategies to promote validation packages to help laboratories reduce errors leading to inappropriate treatment. The purpose of this single case study was to explore strategies business development managers use to integrate dynamic capabilities for marketing instrument validation packages aimed to increase clinical laboratory quality and test accuracy. The conceptual framework was Teece's concept of dynamic capabilities. The data collection process involved semistructured interviews with 4 business development managers from a diagnostic instrument manufacturing organization in the western United States who had successfully marketed validation packages. Analysis of the audio recordings, notes from the interviews, and marketing flyers yielded 1 overarching theme, collaboration of cross-functional teams, and 4 subthemes: integration, effectiveness, partnership, and profitability. The results suggested dynamic capabilities created value for validation packages, differentiated the products and services from those from the competitors, and increased customer satisfaction and profitability. The implications for positive social change include the potential to promote validation packages to clinical laboratories and raise awareness of laboratory quality, leading to improved healthcare outcomes.

In the United States, college students face an increased risk of sexually transmitted diseases, sexual assault, and unwanted pregnancy due to experimental sexual behavior compared to individuals who do not attend college. Based on the theoretical framework of familism, the purpose of this study was to examine the relationship between sexual attitudes and familism among college students. Data were collected from nontraditional adult students who attend an online institution of higher education. The Familism Scale and the Brief Sexual Attitudes Scale were used to measure the variables of familism and attitudes about sex. Findings from multiple linear regression analyses indicated a statistically significant relationship between total familism and permissiveness (r = -.265, n = 118, p < .01) and between total familism and birth control attitudes (r = .20, n = 118, p < .05). There was no statistically significant relationship between total familism and communion (r = .094, n = 118, p < .353) or between total familism and instrumentality (r = -.09, n = 118, p = .402). Results may be used to inform community health centers interested in using educational approaches to educate community members and college institutions on how students make decisions about sex.

Homelessness among older women is a growing problem in many metropolitan areas of the United States. Researchers have indicated that health issues and problems accessing basic care are connected. Older homeless women face increased health issues, multiple challenges related to accessing basic care, and low incomes which put them at higher risk of becoming homeless, staying homeless, and delaying medical treatment. The homeless who lack fulfillment of social support and timely medical care are considered repetitive users of the emergency department and hospital stays. The purpose of this phenomenological study was to explore the experiences and beliefs of older homeless women with system access. The research questions were focused on what the study participants knew about healthcare system access, their personal experiences, and linked uses of access with healthcare services, as well as, negative barriers and enablers. Guided by the theory of disengagement, face-to-face in-depth interviews with 12 homeless women ages 45 and above was performed. Content analysis was used to analyze responses from interviewees. Findings included the lived experiences and beliefs regarding healthcare services linked with personal health, barriers related to healthcare services, and enablers toward healthcare access. The results of this study produced needed insights on how to shift public and persuasive support methods to meet changing health needs and desires of older homeless women. This study may lead to positive social change through gained knowledge of the personal experiences, beliefs, attitudes, and perceptions of older homeless women.

Methicillin-resistant Staphylococcus aureus (MRSA) strains have spread in Saudi Arabia, increasing morbidity, mortality, and financial burdens. Recent studies have suggested the phenotyping methods typically used to classify MRSA as either health care MRSA (HA-MRSA) or community-associated MRSA (CA-MRSA) cases are unreliable, because they lack concordance with the results of genotyping. Yet the expense associated with genotyping precludes its use in the Saudi Aramco population in Saudi Arabia. The absence of a standardized and affordable method to classify MRSA into CA-MRSA and HA-MRSA has been a challenge for infection control programs in Saudi Arabia. The objective of this quantitative, secondary data analysis was to determine the most reliable phenotyping approach to strain identification using John Hopkins Aramco hospital data. The ecological and antibiotics selection pressure theories framed this research. The results of concordance, and sensitivity and specificity tests, suggested hospital admission profiles and susceptibility pattern were the most reliable phenotypic predictors of genotype-based classifications. Multiple logistic regression for susceptibility pattern (OR = 15.47, p < .001) and hospital admission profile (OR = 2.87, p = .008) confirmed those results, whereas all other variables were not found to be statistically significant. These results can be used to clarify the epidemiological and molecular factors that affect the transition of MRSA from health care facilities to the Saudi Aramco community. Implications for positive social change include faster and more reliable classification of MRSA to aid in disease surveillance and the selection of appropriate treatments to reduce MRSA-related morbidity and mortality.

Pay-for-performance (P4P) programs improve the effectiveness, quality, and overall value of healthcare. In today's world of advanced technology and changing trends, physician organizations hesitate to adopt P4P program methodology. A gap in the literature was identified, as there were no guides found that explained how to implement P4P initiatives that improved quality of care. The purpose of this study was to gain a better understand-ing of P4P, and the phenomenology of practice theory was applied to obtain different perspectives about P4P programs and how incorporating technology improved quality of health provisions. Basic qualitative methodology was used, and semistructured telephone interviews served as the instruments to collect valuable data. E-mail invitations were sent to participants identified by the P4P Team Director, with interview questions to use as talking points during the telephone interview sessions. Post interview summaries were sent to the participants to review, approve or edit prior to inclusion into the study. Pat-terns were identified and showcased in a qualitative data coding analysis spreadsheet and a semistructured interview coding graph revealed that technology stood out amongst all key words. The results of the study confirmed that merging technology with P4P pro-grams produced positive patient outcomes. The use of the phenomenology of practice theory was justified as different responses were provided by the participants. From a so-cial change perspective, when technology and preventive healthcare initiatives are merged, P4P programs improve the quality of care. Inpatient bed days are reduced, and public reporting of physician organizations and health plans performances encouraged the onboarding of new physician organizations using the study site's measure sets to improve their quality of care efforts, thus resulting in better patient outcomes.

Physical activity is associated with many health benefits to include weight management, lower risk for chronic diseases, and improved mental health and self esteem. The built environment has been linked to lower physical activity levels and overweight and obesity in children living in low income communities but the exact causes need further investigation. The purpose of this quantitative, cross sectional study was to examine the association between parents' perception of safety and body mass index (BMI) percentile and children's physical activity/ inactivity levels and children's BMI as measured by the National Survey of Children's Health (2011/12 NSCH). The sample consisted of low income African American and Hispanic parents and their children between the ages of 6 to 17 (n=109) who live in Pennsylvania. The study used social ecological theory as the theoretical framework. Data analysis included descriptive analysis and Chi square analysis of variables related to safety, physical activity and children's BMI percentile. The results indicated a strong negative correlation of Hispanic parent's perception of safety and their children's BMI percentile, and a moderately negative correlation of African American parents' perception of safety and their children. In addition, a strong negative correlation of Hispanic parent's perception of vandalism and their children's BMI percentile was found. The study contributes to social change by increasing awareness of public health policy makers and officials that parental concerns for safety and vandalism should be considered in the creation of policies geared at reducing unsafe aspects of the community, the design of educational programs for parents and children, and alterations within communities to improve health.

Women face great risks in pregnancy and childbirth, especially in developing countries where there are very few skilled birth attendants and negligible government investments in maternal health programs. As a result, obstetric fistula (OF), a potentially fatal but preventable and treatable condition, affects some 3 million women and girls globally. In Sierra Leone, the prevalence of OF is extremely high, but the absence of quality data to inform decision-making, both on prevalence and risk factors, is a barrier to creating an environment for OF prevention and care. The purpose of this phenomenological study was to explore and document the barriers to medical care, and the perceptions of patients and medical personnel concerning the complexities of OF. In-depth interviews were performed over a 2-month period with 12 patients and 8 medical personnel at the Aberdeen Women's Center in Freetown, Sierra Leone. Results showed that patients face multiple medical barriers including high costs, fear of hospital treatment, severely inadequate treatment, and severe physical sequelae including paralysis and foot dragging. Multiple emotional, social, and financial harms related to OF were also reported, including stigmatization, abandonment by family, embitterment, depression, and job loss. Most patients expressed a preference for traditional birth assistants over medical personnel. However, many also benefitted from the intervention of friends or other good Samaritans. The results and recommendations from this study should be helpful in informing the general public and policy-makers about OF as a major public health problem, and in the design and delivery of programs to eradicate or alleviate the problem of OF in Sierra Leone.

The incidence and knowledge of the risk factors of stroke across ethnic groups in the United States have been examined in multiple studies. However, it is not well known if the foreign-born African immigrants who constitute about 4% of the U.S. immigrant population are at a higher risk of the incidence of stroke than are other nonimmigrant population in the U. S. This ethnographic study explored the perceptions of Anglophone African male immigrants residing in San Diego on the risk factors of stroke. The theoretical framework for this study included the health belief model and the health promotion model. Data were collected through unstructured, in-depth interviews with 8 male participants. Interview transcripts were analyzed using Nvivo 10 computer software and reviewed manually. A key finding was that most of the participants reported a lack or limited knowledge of stroke disease and no knowledge of the warning signs of stroke prior to migrating to the United States, but that they acquired some knowledge after integrating into mainstream U.S. society. Other findings were that using preventive services such as engaging in periodic medical check-ups and screening for high blood pressure, diabetes, and high cholesterol were not common practices in the home countries of the participants; that the participants considered women as resource persons on health issues; and that the participants struggled with negative attributes associated with sickness and hospitals. Results of this study might encourage changes in the health behaviors and beliefs of the African-born male adults by raising their knowledge and awareness of the prevalence of stroke and preventive measures available to them in the community.