Human papillomavirus (HPV) is the most common sexually transmitted disease in the United States. Despite most common transmission, HPV immunization in adolescents remains below target rates of 80% as outlined by Healthy People 2020 Objectives. Nearly all individuals will contract HPV during their lifetime. The purpose of this project was to educate providers on successfully promoting HPV immunization in adolescents utilizing evidence-based methods. The health belief model (HBM) was the theoretical underpinning utilized to teach providers on discussions about 9vHPV immunization with parents of adolescents. The practice focused question explored whether an education program using concepts from the HBM would increase provider perception of preparedness on recommending Gardasil 9 immunization in adolescents. Convenience sampling was utilized to recruit participants. There were 9 out of 25 providers that attended the educational in service with 8 completing the continuing education evaluation tool. Participants included providers who are affiliated and hold privileges with the health care system. Survey Monkey was used to analyze the participant evaluations. All the participants found the educational information relevant to increasing their perception of preparedness on recommending Gardasil 9 immunization in adolescents. The findings suggest that providers would benefit from training on recommending HPV immunization in adolescents. Continued training would help enhance timely immunization rates that could decrease cancer rates and reduce associated healthcare cost, in turn promoting population health and positive social change.

Abstract One of every eight women in the United States will be diagnosed with breast cancer in her lifetime. Although early detection of breast cancer is the most effective method of assuring survival, many women throughout the country do not avail themselves of this advantage. This study examined mammography screening practices of women age 55 and older who attended senior citizen centers in rural, non-metro, and metro counties in the areas designated by the Tennessee Department of Health as the Eastern Grand Division of Tennessee. Data was collected from four hundred women from fourteen counties in East Tennessee using the Champion Health Belief Survey instrument. Data analysis was done using SPSS software. Descriptive analyses were presented consisting of the percentage or mean responses for each of the survey items. Chi Square and ANOVA were used to test whether the observed proportions for mammography screening differed from the hypothesized proportions. Results from this study revealed that health beliefs and demographic characteristics were associated with a higher likelihood of having recent mammography. The health beliefs of participants concerning the perceived benefits to mammograms and the perceived barriers to obtaining mammograms significantly impact one’s willingness to engage in breast cancer screening practices. Also, the woman’s perceived susceptibility to the disease of breast cancer and their perceived seriousness of the disease of breast cancer have a significant impact on breast cancer screening practices. Additionally, a significant difference was found in the screening practices of women based on whether they had health insurance and if their physician recommended a mammogram.

The objective of this study was to examine the relationship between psychosocial correlates (big 5 personality traits, dispositional optimism, the Health Belief Model, breast cancer fear, mammography self efficacy, and social support) and breast self examination (BSE) and mammography in breast cancer-free women. In order to measure the social support of the participants, the MOS social support survey was adapted to Turkish culture in the scope of study 1. The sample of the study 1 included 241 participants. The analyses showed that Turkish version of the MOS social support survey had satisfactory psychometric properties. The sample of the study 2 was composed of 230 asymptomatic women for breast cancer. Independent samples t-test results indicated that among the Health Belief Model notions, perceived benefit, barrier, confidence, and health motivation significantly differentiated women who practiced BSE and who did not. However, the HBM notions were not able to differentiate women who had mammography and who did not have. Instead, social support significantly clarified the difference between v women who had mammography and women who did not have. Two hierarchical logistic regression analyses were carried out for BSE and mammography. Big 5 personality traits and dispositional optimism were entered at the first step. The HBM factors and self efficacy were entered at the second step. Breast cancer fear was added at the third step / and for the last step social support measures were added to the equation. For BSE, hierarchical logistic regression yielded no significant predictors but BSE confidence and susceptibility from the HBM. For mammography, the hierarchical logistic analysis resulted that only functional support, which was entered at the fourth step was significant. The strengths and limitations, as well as the implications of the findings, were discussed.

Little is known about how the decision for elective cesarean section comes about in the clinical environment. A prospective longitudinal study based on the Health Belief Model was conducted about first time mothers’ decision making processes and their health beliefs which led to their satisfaction with their decision about their mode of delivery. A convenience sample of 144 nulliparous women with singleton pregnancies and no medical indications requiring a cesarean delivery were recruited using internet based informational notices and with flyers. Women (n = 127) planning a vaginal delivery (VDMR) represented 88.2% of the sample and women (n = 17) requesting a cesarean delivery (CDMR) represented 11.8% of the sample. Data were collected during the third trimester and six weeks after the delivery using an internet-based questionnaire. Data were analyzed using t-tests and multiple linear regression to predict the effect of maternal health beliefs, maternal childbirth self efficacy, partner support, acceptance of the maternal role, and request group (VDMR vs. CDMR) on the dependent variables of maternal perception of the delivery and maternal satisfaction with her decision for the mode of delivery. Compared to women with VDMR, women with CDMR were significantly older, less educated, perceived more risk of emergent cesarean and less ability to deliver vaginally. Hypothesis testing indicated that the overall regression model did not significantly predict maternal perception of the delivery. The model accounted for a significant amount (15.1 %) of the variance in maternal satisfaction with the decision for mode of delivery. Acceptance of the maternal role and maternal request group significantly contributed to the model indicating that women with higher acceptance of the maternal role and women with CDMR had poorer satisfaction with their decision for the mode of delivery. The findings showed that factors influencing maternal perceptions of the delivery and satisfaction with the mode of delivery are different. Health beliefs had less relevance for perception of the delivery. It is possible that experiences that occur within the context of the delivery are more salient for maternal perception. Women with higher acceptance of the maternal role and who request a cesarean delivery are at risk for less satisfaction with their delivery decision and more decisional conflict and thus may need more support during decision-making processes and after delivery. Future research should examine the long-term impact of dissatisfaction with delivery decision on maternal outcomes.

Men who have sex with men (MSM) are disproportionately affected by HIV infection and account for more than half of all new HIV infections diagnosed in the U. S. The purpose of this study was to explore factors that influence sexual behavior among sexually active HIV positive MSM using constructs from the health belief model (HBM). A cross-sectional, correlational study was conducted with a non-randomized sample of 216 HIV positive MSM. Participants were predominantly Black/African American (85.6%). The mean age of the sample was 43.02 years (SD = 9.74) and ages ranged from 19 to 66. More than 90% reported a high school educational level or greater; and nearly half (47.2%) had been diagnosed with HIV for more than 10 years. The overall model predicted that participants who had perceived less severity of living with HIV and who had a positive attitude toward condom use were more likely to practice safer sex, accounting for 24% of the variance in sexual behavior (p < .001). When controlling for demographic characteristics (age, number of years diagnosed as HIV positive, number of recent sexual partners, and current antiretroviral medication use), the overall model accounted for 41% of the variance (p < .001). Participants who had a fewer number of recent sex partners and who had a positive attitude toward condom use were more likely to practice safer sex. Additionally, those who practiced safer sex (n = 58, 27%) reported significantly higher levels of perceived severity of living with HIV (p = .037), perceived benefits of safe sex (p = .018), perceived barriers to safe sex (p < .001), and self-efficacy for negotiating safe sex (p = .013) compared to those who did not practice safer sex (n = 157, 73%). Results from the study indicated there was a high prevalence of unsafe sexual practices among the participants. These findings support the need for additional research to explore factors that influence sexual behavior among HIV positive MSM with an emphasis on testing interventions that support safe sex practices.

Health risk behaviors are responsible for the majority of morbidity and mortality among adolescents. Researchers have identified three sources of risk-taking in adolescents – dispositional, ecological and biological. The Bioecological Model incorporates these three sources of risk-taking, however it lacks explanatory power. For this reason, this thesis focused on explaining risk perception of health risk behaviors (smoking cigarette, alcohol and marijuana use), and health risk behaviors by integrating the Bioecological Model with a more specific Health Belief Model. The relationship between risk perception and health risk behavior was also investigated as a first step in understanding adolescent decision-making using the Health Belief Model. Adolescents from a suburban Indiana area were asked to complete the Adolescent Health Risk Behavior Survey which assessed egocentrism, self-esteem, social norms, risk perceptions, and the incidence and prevalence of health endangering behaviors. Hierarchical linear regression was used to determine the ability of the systems in the Bioecological Model and their specific variables to explain risk perception of health risk behaviors. Hierarchical logistic regression was used to determine the ability of the systems in the Bioecological Model and their specific variables to explain health risk behaviors and to moderate the relationships between risk perception and health risk behaviors. Based on the results, it was confirmed that the Bioecological Model is important in understanding adolescent’s risk perception of health risk behaviors, and their self-reported health risk behaviors. It is also important in understanding the relationship between risk perception and health risk behaviors. Adolescent Variables, Microsystem, and Mesosystem were significant in predicting adolescent risk perception of all health risk behaviors examined, and self-reported smoking cigarette behavior and marijuana use. Adolescent variables and Microsystem were the only systems to predict adolescent self-reported alcohol use. The relationship between risk perception and reported smoking cigarette behavior was moderated by Adolescent Variables, Microsystem and Mesosystem, however for alcohol use the path was moderated by Adolescent Variables and for marijuana use the path was moderated by the Mesosytem. Results of this thesis imply the importance of considering the contribution of Bioecological Model variables when implementing prevention intervention programs specific to adolescent health risk behaviors.

Women infected with the human immunodeficiency virus are at increased risk for developing cervical cancer. Current guidelines reflect that Pap smears should be performed twice during the first year after diagnosis with HIV and annually thereafter. However, women with HIV are not obtaining Pap smears per the current guidelines. The purpose of this study was to evaluate HIV-infected women's attitudes toward cervical cancer and cervical cancer screening. The research design is an exploratory, cross-sectional, quantitative design. The sample of convenience consisted of participants recruited from two ambulatory HIV clinics in Florida. Attitudes were assessed using Champion's Health Belief Model and Self-efficacy scales. Knowledge was evaluated with an updated HPV/Cervical Cancer Knowledge scale. Sociodemographic variables were assessed using a Demographic Data form. The results indicate that HIV-infected women in the study were not knowledgeable about HPV or cervical cancer. They did not perceive that cervical cancer was serious, nor did they feel that they were susceptible to cervical cancer. Overall, HIV-infected women were confident in their ability to request a Pap smear, and they perceived fewer barriers and more benefits to Pap smears. Despite, perceptions of fewer barriers and more benefits a chart review revealed that approximately 43% of the study participants received a Pap smear during the past year. Perceived barriers was a significant predictor of Pap smear adherence (OR = 0.93, CI: 0.90 to 0.96, p < .01). Findings from the exploratory study provide important information to clinicians and researchers that will assist in the development of effective interventions to increase Pap test adherence. Additional research is needed to further understand factors that influence cervical cancer screening in this at-risk population.

Premature death due to cardiovascular disease, including myocardial infarction, is higher in Hispanics (23.5%) than non-Hispanic White (16.5%) adults. Delaying treatment over 60 minutes increases the risk of sudden death by 50%. The purpose of this study was to describe the perceived benefits and barriers to seeking cardiac emergency care including emergency medical services (EMS) activation during an acute myocardial infarction (MI) in Mexican American adults. A qualitative descriptive design was used wherein semi-structured interviews and sociodemographic questionnaire were conducted with 12 Mexican Americans who had experienced an MI in the last two years. Qualitative conventional content analysis was used to uncover unique perceptions of Mexican Americans seeking emergency care. The overall theme that arose was degree of perceived threat leads to action. This theme was comprised five categories: perceived susceptibility, perceived severity, perceived barriers, perceived benefits, and learned behavior. Perceived severity was closely intertwined with perceived susceptibility. Recent appointments with HCPs facilitated low perceived susceptibility to an MI and acted as a barrier leading to ix decreased initiation of emergency services for MI. Participants attempted self-treatment and evaluation which was a barrier to immediate emergency care. Perceived benefits to initiation of emergency care were using EMS to achieve rapid treatment of MI symptoms. Though several participants initially stated they would activate EMS, further inquiry revealed calling EMS was considered a last resort if the participant were alone. The findings suggest education of lay people and HCPs needs to emphasize that MIs can present in a variety of ways from slow-onset to fast-onset. A goal for nursing practice is to include regular screening on cardiac risk factors along with interventions and evaluation among patients and family. Future research should aim at finding the most successful format to provide public education to Mexican Americans on MI symptom and rapid initiation of EMS. / text

Despite multiple campaigns by the American Cancer Society, reports indicate that Latinas living in the United States who contract breast cancer are more likely than Anglos to die. These findings correlate with low participation in breast cancer screenings among Latinas. The objective of this study was to identify key obstacles that influence Latinas' low participation in breast cancer screenings, based on their health beliefs, knowledge of screenings, acculturation, and socio-economic factors.The study was a face-to-face informal interview, combined with a survey questionnaire conducted at churches, social clubs and/or at the participants' homes in a southwest Florida urban community. The sample consisted of a total of 50 women: all of the participants were Latinas 40 years of age and over; they had to be fluent in Spanish or English or both. A Spanish-English bilingual individual conducted a personal interview in the preferred language of each participant. The first part of the interview was to identify barriers that affect screenings. The second part used a survey to weigh the identified factors in order to determine their importance to the participants' health decisions. This study used a health belief model scale to evaluate women's beliefs about breast cancer, and the benefits of screenings.The research results revealed that Latinas who participated in this study were acculturated to the United States culture; the largest group of participants reported being from Colombia, followed by Cuba and Puerto Rico; only two of the participants were Mexican. Seventy-eight percent of the participants self- reported having yearly mammograms, and 74% performed monthly breast self examination BSE; 60% were bilingual; 68% had some kind of health insurance. These results differ from earlier studies from the western United States where the majority of Latinas were of Mexican or Central American origin. This suggested that Latinas from Southwest Florida are different from Latinas in other areas of the United States. A weak but significant correlation was found between acculturation and perceived barriers to breast cancer screenings, (r = 0.45, p = .01); Latinas who are more acculturated perceived more barriers than those who are less acculturated. There was not significant difference between participants who had health insurance and those who did not (t = 0.96, p = .35). The results of this study are significant for nurses and especially for advanced practice nurses, who can assess patients' knowledge about cancer in general, and breast cancer in particular when caring for Latinas; of particular concern should be the evaluation of patients' levels of acculturation, health beliefs, and understanding of the English language. Still the fundamental barrier to Latinas not bilingual in Spanish and English may be the lack of resources and information in Spanish.

Colorectal cancer (CRC) is the third most common cancer in the United States (U.S.) and is the second leading cause of cancer deaths. Although the incidence of CRC has been decreasing with CRC screenings, disparities of CRC and screening prevalence exist for racial and ethnic groups. The CRC incidence rates have dramatically increased in Korean Americans, however, there is little known about their CRC screening behaviors and the factors that may predict screening behaviors have not been fully investigated. The purposes of this study were to describe CRC screening behaviors and identify the predictors and barriers influencing CRC screening behaviors among Korean Americans. A sample of 254 Korean Americans participated in this study. Correlation, Multiple logistic regression, and Chi-square were used to analyze data. In this study, Korean American had lower rates of CRC screenings compared to the general U.S. population. Only 20% of the sample had ever had a fecal occult blood Test (FOBT), 49% had ever had a colonoscopy, and 19% responded they had ever had a sigmoidoscopy in their lifetime. Korean Americans had low rates of perception of cancer screening (annual physical exam and periodic cancer screening), moderate CRC knowledge, low cancer fatalism, limited CRC literacy, lack of health care access, and a low rate of receiving the physician's recommendation of CRC screenings. The greatest predictors influencing CRC screening were perception of cancer screening for a FOBT, and the physician's recommendation for a colonoscopy and a sigmoidoscopy. There were no significant differences by gender in CRC screening behaviors. However, significant differences were found between the two groups divided by length of U.S. residence. Compared to those who have lived in the U.S.>10 years, new immigrants had lower rates of all three CRC screening, lower perception of cancer screening, higher uninsured, less receiving physician's recommendation, and higher perceived barriers to CRC screening. The findings of this study suggest that improved efforts are needed to increase CRC screenings among Korean Americans. Further research is needed to increase a physician's recommendation for CRC screenings and awareness for the importance of annual checkups and periodic cancer screening among Korean Americans.