Diabetes is a growing health concern among those in rural locations. Rural residents smoke more, exercise less, have less nutritious diets and are more likely to be obese than urban residents. Evidence-based diabetes prevention programs targeting behavior change are available to this population yet participation remains low. This study examined the self-reported barriers and health beliefs of those who declined participation in a diabetes prevention program (DPP). Of 269 clients identified to be at risk for developing Type II Diabetes (T2D), only 85 answered the phone and 33 were interviewed to discuss their health beliefs and reasons for not participating in a diabetes prevention program. Almost half of the participants who expressed their lack of desire to participate in the DPP cited a low level of interest and not seeing any personal benefit as their primary reasons. Participants were closed off when asked what it would take to get them to participate in the program with 63% citing “nothing” as the most common answer when questioned as to what would encourage their participation. In order to limit barriers to participation in prevention-based programs for rural populations special attention needs to address improving general interest and knowledge about the efficacy of a DPP.

Type 2 diabetes mellitus (T2DM) is a disease that affects the body's ability to metabolize glucose effectively. The disease is predicted to be prevalent in over 300 million people by the year 2030. African Americans (AA) have the highest prevalence rates in the United States. Lifestyle modification and awareness of risk factors, including family history, are important aspects for prevention of developing T2DM. The purpose of this study was to understand if a family history of T2DM played an influential role in individuals making positive health behavior changes for T2DM prevention. The phenomenological study was grounded in the health belief model. Participants selected for this study were at least 18 years of age, self-identified as AA, self-reported a family history of T2DM, and were not diagnosed with the disease themselves. Transcriptions of 20 face-to-face interviews were stored and organized via a qualitative research software NVivo Version 12 for Mac and later analyzed for data outcome. Participants demonstrated a strong awareness of T2DM with an accurate definition of T2DM and explanation of signs, symptoms, and prevention. Participants recognized family history as a risk factor in only 55% of the responses. However, family history played a major role in prevention in the lives of the participants. The participants reflected on personal barriers to health behavior changes and were encouraged to incorporate better life choices in their own lives. This research offers communities, healthcare providers, and stakeholders a better understanding of the importance of family history as a risk factor to T2DM as programs are developed to mitigate health disparities in the AA community.

Routine blood glucose monitoring by patients with Type 2 diabetes mellitus (T2DM) is needed for effective management of T2DM; however, 75% of monitoring logs are returned incomplete during monthly provider follow-up appointments. As a result, effective management of the patient's medical condition is limited. To better understand the reasons for noncompliance, a quality improvement project (QIP) was initiated between July 01, 2017 and September 30, 2017, to identify barriers that prevented patients from self-monitoring of blood glucose (SMBG). No formal assessment of the patients' responses had been done, and, as a result, the deidentified, qualitative responses from the QIP were obtained for this project. The purpose of this project was to explore barriers to SMBG and to use a literature search to identify strategies for improving compliance with SMBG. The health belief model was the framework used to guide the project. Secondary data obtained from the QIP (n = 19) were analyzed and coded. Results indicated that patients' financial concerns, social support, emotional needs, and lack of diabetes education were the main barriers to daily SMBG. Recommendations to the providers were to consider each barrier before ordering the use and frequency of SMBG and to consider an appropriate strategy for promoting SMBG adherence. Addressing low compliance with SMBG may promote positive social change through improved T2DM management, self-care, adherence to daily SMBG and treatment, and improved patient quality of life.

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.

From the viewpoint of the public, academic work is relatively autonomous, stable, and stress-free as opposed to other professions. However, as the societal environment evolves, high satisfaction is no more an absolute consequence of academic work. Even in comparison to other professionals, the academics experienced longer working hours and heavier occupational stress; hence the events of ¡§Karoshi¡¨ among university academics happened from time to time. Actually, the reason resulting in ¡§Karoshi¡¨ has been proved related to health behavior, and the health behavior also has been proved associated with health belief. Following this concept, a study based upon ¡§health belief model¡¨ was carried out to investigate the health belief, health behavior, and health status of university academics, respectively, and the possible relationships among the aforementioned health related concepts. In total, 4,000 subjects were selected from among the 43,050 or so university academics nationwide based on stratified sampling approach. Data were collected through survey questionnaires which include personal demographics, health belief, health behavior, and health status information. From June through August 2004, 1,778 questionnaires returned with a response rate of 44.45%. SPSS was used for descriptive analysis and basic hypothesis test, and then the software package AMOS was used for structural equation modeling examination. Compared to the general population with the same age, the health status of university academics was worse in both physical and psychological function. Further, it was found that the factor work significantly contributed to each component of health belief (i.e. perceived susceptibility, perceived seriousness, perceived barriers, and perceived benefits). In terms of health behavior, although the academics had no unhealthy habits (i.e. smoking or excessive drinking), the average working hour after 10 pm was more than one hour and one in three teachers didn¡¦t take exercise regularly, which altogether are definitely harmful to health. The structural equation modeling showed that an academic¡¦s health belief would influence his/her health behavior and then influence the health status indirectly. In other words, positive health belief will lead to healthy status in the long run, and negative health belief will conduce to unhealthy status. To sum up, the issue on improving the health status of academics is on edge and the responsibility for taking this issue would be shouldered by teamwork¡X individuals, educational authorities, and public health agencies. An academic should try his/her best to improve the health; the educational authorities should assess the job loading on academic population from time to time and draw up a better educational system; and finally, the public health agency should play the role of information disseminator and catalyst for strengthening the health belief and then improving the health behavior and health status among the academics.