The purpose of this study was to identify factors contributing to non-compliance to TB treatment amongst pulmonary TB patients in Waterberg district, Limpopo. The health-belief model was the conceptual framework which guided this study. A quantitative, cross-sectional, descriptive study design was used. Data was collected using a structured questionnaire administered by trained data collectors. Data was collected from 215 respondents. Informed consent was obtained from each respondent prior to data collection. MS Excel and SPSS were used to analyse data. Findings on significant factors contributing to noncompliance to TB treatment include; non-availability of food whilst taking TB treatment, disbelief in the fact that TB can result in death if not treated, belief in traditional medicine for curing TB, bad healthcare worker attitudes, long distance to the clinic for treatment, belief that TB treatment takes very long and the pill burden / Health Studies / M.A. (Public Health)

The purpose of this study was to determine whether adults with type 2 diabetes participating in American Diabetes Association (ADA) diabetes self-management education (DSME) randomly assigned to an intensive follow-up group (IFG), utilizing continuous glucose monitoring system (CGMS), or a standard follow-up group (SFG) have any significant differences in mean HgbA1c values and health belief scores over time. Baseline HgbA1c values and health beliefs were measured using the revised Expanded Health Belief Model (HBM) questionnaire. The questionnaire measured the 8 HBM domains: perceived susceptibility; severity; treatment benefit; cues to action; motivation; barriers; self-efficacy and structural elements. Twelve weeks after DSME, patients returned for follow-up based on random assignment. The SFG received routine follow-up care: HgbA1c measurements; behavioral goals and education assessments. The IFG received routine follow-up and CGMS. Patients wore the CSMS for 72 hours and recorded their daily food, blood glucose values, medications and physical activities. Results were analyzed and reviewed with patients. Both groups returned in 24 weeks for HgbA1c measurements and to complete the HBM questionnaire. A repeated measure ANOVA analysis showed a statistically significant reduction in mean HgbA1c at each time period (F=86.75. p>.0001 ) from week 1 to week 12 (SFG 8.6-7.1; IFG 8.5 --7.1,) and from week 12 to week 24 ( SFG 7.1 to 6.9; IFG 7.1 -- 7.0). There were no significant differences found between the groups. (F = 0.17 p > 0.87). Following DMSE and follow-up intervention some health belief scores improved but no significant differences were found between groups except for severity scores. (SFG 27.05, IFG 25.00, p=0.03). The power of the study to detect small differences between the groups was affected by the higher than anticipated attrition and the significant lowering of HgbA1c in the education arm of the study. Both groups achieved a high success rate (58% IFG; 55% SFG) to lower the HgbA1c to the ADA goal of less than 7. DSME and follow-up care (both standard follow-up and more intensive follow-up) achieved a significant lowering of HgbA1c (1.6%), which has been shown to reduce diabetes related morbidity and health costs.

Health care associated infections cause major challenges to the provision of health care. This isdue to the burden placed on individuals, their families, and health services. Hand hygiene actions are cost effective measures towards reducing the spread of health care associated infections and have proven very effective in preventing microbial transmission during patient care. It has beenproven that health care workers hands are the main routes of transmission of health care associated infections. Despite this, hand hygiene is still frequently overlooked by health careworkers especially in settings with limited resources. This paper therefore explores hand hygieneknowledge and behaviours of public and private health care workers in The Gambia with focuson the health belief model. The required information has been gathered from 4 public and 2 private health care facilities through the use of a questionnaire based on the WHO evaluation toolkit. Hand hygiene knowledge of health care workers corresponded with their hand hygiene behaviour. Inadequate hand hygiene performance was noted in many health care workers as wellas limited availability of hand hygiene resources from health care facilities. Private health care facilities provided better hand hygiene opportunities for their health care workers yet neither private nor public health care facilities offered adequate hand hygiene training and feedback on hand hygiene performances to their health care workers.

Master of Science / Department of Hospitality Management and Dietetics / Elizabeth B. Barrett / The Centers for Disease Control estimates that each year 48 million Americans become ill, 128,000 are hospitalized, and 3,000 die of foodborne diseases. In 2011, the CDC reported that Norovirus caused the majority of all foodborne diseases and can be eliminated with proper handwashing, which is the number one way to prevent the spread of foodborne disease. The purpose of this study was to use the Health Belief Model to determine differences in university foodservice employees’ beliefs and perceptions about handwashing and foodborne illness. The constructs of perceived susceptiblity, severity, barriers, benefits, and self-efficacy as they relate to handwashing were used to examine the differences in demographics. Instrument development included a review of literature, focus group feedback, a pilot study and a review by industry experts. The final instrument was distributed to all foodservice employees at Kansas State University using Qualtrics and pen-and-paper surveys. Frequencies, means, t-tests, ANOVA, and regression were used for data analysis and to answer research questions. Results indicated respondents who were older (above 23 years of age), full-time employees, had more than three years of experience, and were food safety certified had a higher perception of susceptibility, benefits, and self-efficacy of handwashing and its relationship to reducing foodborne illness. Perceived severity was highest among respondents with food safety certification and more than three years of experience. Supervisor/Manager category did not agree on barriers to handwashing in the workplace with other positions; however, most employees did not rate barriers as a problem. Non-white respondents showed a lower self-efficacy for ability to wash hands correctly. Results of this study highlight the need for self-efficacy focused handwashing training for first year and non-white employees.

Morbidity due to noncommunicable diseases (NCDs) has become a worldwide epidemic. As a result, the United Nations (2015) Sustainable Developmental Goals (SDGs) included goal (3.4) that aims to reduce the premature mortality from NCDs by one third. All countries, regardless of income, are required to develop strategies and achieve a reduction in the burden of NCDs. This study, conducted in the Sultanate of Oman, aimed to explore individuals' knowledge, perceptions, actions and intentions to modify their lifestyle to reduce their risk of stroke. The Health Belief Model (HBM) was used as the underpinning theoretical framework to provide a broader conceptual understanding of the Omani sociocultural and structural influences on individuals' lifestyles. A convergent mixed methods design within a realist social constructionism methodology was used. Both quantitative (344 questionnaires) and qualitative (10 interviews) data were integrated using a narrative weaving approach. The study results confirm that both agency and structure influenced the adoption of healthy behaviours in Oman. The study indicates that the study participants are likely to engage in health-related behaviours when they perceived the benefit of such a course of actions in term of it reducing their risk of stroke. The study found that in the Omani setting, individual factors such as fear, family experience and physical sickness, the psychological status of chronic conditions and a cost-benefit analysis of the behaviour influence the individuals' decisions to practise a healthy lifestyle. The major finding in the study showed that perceptions of risk vary among individuals who share the same culture and religion, particularly individual perception of religious belief was found to influence their susceptibility to stroke risk. In addition, the study identified some sociocultural and structural factors that influenced the individuals' decisions to engage in a healthy lifestyle. This study presents an extended HBM to incorporate the role of individual religious beliefs as an individual factor. The study suggests that health improvement plans are needed in Oman to develop both individual- and community- level interventions to achieve the target of SDGs for NCDs.

Perception of cervical cancer screening among Immigrant African women residing in Houston, Texas Esther I. Orji M.Ed., University of Lagos, 2002 B. Ed, Abia State University, 1998 A.C. E. University of Benin, 1990 Dissertation Submitted in Partial Fulfillment of the Requirements for the Degree of Doctor of Philosophy Public Health Walden University August 2016 Disparities in cervical cancer screening participation still exist especially among immigrant and minority women compared to non immigrant populations. Research investigators through multiple studies have explored reasons for non participation in cervical cancer screening among immigrant and minority women. However, there was limited research specifically on how immigrant women of African descent could be empowered to overcome barriers associated with cervical cancer screening in Houston Texas. The purpose of this study was to explore and understand the perceptions of factors which are barriers to perform cervical cancer screening tests among immigrant women of African descent, as well as their beliefs on preventive medicine, and how immigrant women could be empowered in order to overcome barriers associated with cervical cancer screening. The theoretical framework was based on the health belief model. The participants for the study were 20 immigrant women of African descent aged 21-65. A semi-structured interview schedule which comprised of open ended questions was used to collect data on the perspectives of immigrant women towards cervical cancer screening. Data was transcribed verbatim and analyzed thematically. The social change implications of the study can be that immigrant women could be more encouraged to seek access to the appropriate state of the art in cervical cancer screening which could contribute in reducing mortality, morbidity rate, and costs associated with cervical cancer.

There has been inadequate attention to the aftercare of psychiatric patients, resulting in an increase in readmission rates plus longer hospital stays. There is a gap in the aftercare for psychiatric patients; The purpose of this qualitative retrospective study is to explore what may have contributed to readmission for psychiatric patients. The biopsychosocial model was used as the theoretical framework to support the direction of the research. The health belief model and transtheoretical model of change were used to further support for biopsychosocial model. The research questions were created to determine the influences on readmission, psychological well-being, explore the adaptation to aftercare and narrative of aftercare from the caregiver. This study used a content analysis to identify patterns and themes with a total of 10 participants. The data used had been previously collected by the behavioral transition team at Houston Methodist Hospital which consists of case notes, mental health diagnoses, hospital history and reasons for readmission. The findings include reports of psychiatric patients not adhering to their prescribed medication due to its side effects or cost, caregivers feeling overwhelmed, and the importance of psychoeducation. Once adjustments were made to the dosage or a prescription for less expensive medication, adherence improved, regular attendance to therapy sessions occurred, and the increase in the level of frustration from the caregiver. Psychiatric patients can benefit in post-discharge care if there is more focus on the reasons for hospital readmission by developing a treatment plan for the prevention of a relapse. This study may improve patient vulnerability to mental health issues and to assist psychiatric patients in establishing balance in their lives.

African American women are 18 times more likely to contract HIV than are European American women, yet they are less likely to be tested for HIV. Lack of HIV testing leads to late diagnosis and increased mortality from HIV-related illnesses. Based on the health belief model, this correlational study analyzed the extent to which HIV stigma mediated the relationship between perceived benefits or perceived severity of HIV and the uptake of HIV testing among African American women in New Jersey. A total of 93 African American women aged 18 and older who resided in New Jersey completed online questionnaires. Data were gathered via the Perceptions of Stigmatization by Others for Seeking Help (PSOSH) scale, the Benefits of HIV Testing Scale, and the Severity of HIV Infection Scale. Although there was a relationship between stigma and perceived severity of HIV, this relationship did not translate into uptake of HIV testing. Perceived benefits of HIV testing did show an impact on uptake. Based on the findings of this study, research and intervention programs should concentrate on the potential benefits of HIV testing among African American women. Through dissemination of these findings, positive social change that may result through increased rates of HIV testing in this population and ultimately better health outcomes for patients who have HIV. Additionally, the findings on HIV benefits could be used as supporting data for policymakers to improve HIV/AIDS prevention programs aimed at African American women by emphasizing the benefits of testing.

In the United States, over three million adults, age 50 and older, reported a diagnosis of serious mental illness (SMI) in the past year. Most of them live in community-settings and are less likely than younger adults to utilize mental health treatment. Lack of and insufficient treatment for SMI places them at increased risk of morbidity, earlier mortality, cognitive decline, and diminished quality of life. The current study aimed to: (1) examine the factors that influence Black and White older adults, who live with SMI, to seek and engage in outpatient mental health treatment; (2) identify the perspectives of Black and White older adults, who live with SMI, on the issues of accessibility, affordability, appropriateness, and availability of outpatient mental health services; and (3) determine whether the perspectives of Blacks and Whites are different on the issues of accessibility, affordability, appropriateness, and availability of outpatient mental health services. I developed a qualitative, interview-based study using the health belief model (HBM) as the theoretical framework. Individual semi-structured interviews were conducted with 19 participants, between the ages of 50-70 years (mean age 58.9), who had a clinical diagnosis of bipolar disorder, schizoaffective disorder, and schizophrenia. The interviews were audiotaped, transcribed verbatim, coded and analyzed using thematic analysis. Data themes related to factors that influenced outpatient mental health treatment and services were identified and organized based on the six HBM constructs. Perceived barriers to mental health treatment engagement included lack of knowledge about available treatment and services in the community, poor mental health literacy, and stigma. Improved sense of well-being and increased socialization were perceived benefits of mental health treatment engagement. Risk of homelessness emerged from the data as the main influence for Black and White older adults, who live with SMI, to seek and engage in outpatient mental health treatment. For all participants, access to and availability of mental health services were not current issues. All except one participant had some type of medical coverage for their treatment and most of them felt that their current treatment was appropriate. There were no differences between Black and White older adults on the issues of accessibility, affordability, appropriateness, and availability of outpatient mental health services. In addition, Black participants did not feel a need for mental health services to be specifically tailored to Black older adults, and instead indicated they saw no differences in Blacks and Whites related to mental health services. These findings are contrary to existing research and may be indicative of the gravity of mental illness-related stigma, compared to racial stigma. Better promotion of available mental health services in the community, mental health outreach, and community education about mental illness may be helpful for earlier identification of symptoms related to mental illness, earlier treatment and intervention, stigma reduction, and improved health and quality of life for community-residing older adults who live with SMI.

Occupational exposures of healthcare workers tend to occur because of inconsistent compliance with standard precautions. Also, incidence of occupational exposure is underreported among operating room personnel. The purpose of this project was to develop national estimates for compliance with standard precautions and occupational exposure reporting practices among operating room nurses in Australia. Data was obtained utilizing a 96-item self-report survey. The Standard Precautions and Occupational Exposure Reporting survey was distributed anonymously to 500 members of the Australian College of Operating Room Nurses. The Health Belief Model was the theoretical framework used to guide the analysis of data. Data was analysed to examine relationships between specific constructs of the Health Belief Model to identify factors that might influence the operating room nurse to undertake particular health behaviours to comply with standard precautions and occupational exposure reporting. Results of the study revealed compliance rates of 55.6% with double gloving, 59.1% with announcing sharps transfers, 71.9% with using a hands-free sharps pass technique, 81.9% with no needle recapping and 92.0% with adequate eye protection. Although 31.6% of respondents indicated receiving an occupational exposure in the past 12 months, only 82.6% of them reported their exposures. The results of this study provide national estimates of compliance with standard precautions and occupational exposure reporting among operating room nurses in Australia. These estimates can now be used as support for the development and implementation of measures to improve practices in order to reduce occupational exposures and, ultimately, disease transmission rates among this high-risk group.