Poor oral care is detrimental to the overall health of the population. In the United States, oral health diseases affect millions of individuals, especially children and adolescents. Guided by the health belief model, the purpose of this study was to identify parents' perceived barriers to oral health care access among their 5- to 10-year-old children. A phenomenological approach was used to gather data and thematically analyze interview data from 20 parents who were recruited from a health center in the northeastern United States. All participants had at least one child between 5-10 years old and all identified as under-served. Data were coded and analyzed for emerging themes, with the assistance of Nvivo software. The findings demonstrated that lack of time, the location of dental facilities, and the lack of sensitivity of dental providers were issues for parents in managing their children's oral health. This study might be beneficial in eliciting positive social change at the individual and organizational levels by illuminating the constraints faced by the underserved population in Massachusetts.

Low-income Hispanic women are the fastest growing minority population in the United States, and they have increased risks of obesity and secondary health issues, such as diabetes, related to their obesity. The purpose of this phenomenological study was to explore the barriers to lifestyle change among obese, low-income Hispanic women (OLHW). A health belief model lens was used. The study sample consisted of 15 OLHW who were clinic patients and ranged in age from 20-59. Recruitment occurred in a low-income, Southern California, outpatient clinic setting through volunteer participation from recruitment flyers. Fifteen women took part in 1-hour, in-depth interviews, which were digitally audio-taped with their consent. All interviews were transcribed and analyzed using both NVivo 11, and hand coding to identify common themes after word frequency and concept frequency analysis. Common themes identified included barriers of cost, time, physical health, family care, location, knowledge and education, depression and stress, and sleep issues. These findings contribute to the existing literature by increasing public health researchers' and program planners' knowledge of the experiences and obesity-related barriers to health behavior change within this underrepresented minority group, which can provide guidelines for future public health interventions in addressing these barriers. Obesity reduction efforts may help increase quality of life and create a new paradigm of public health interventions based on the stated needs of OLHW.

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abstract: Background: Healthy eating plays critical roles in the prevention of many chronic diseases, but there are many barriers in life that prevent people from adopting and maintaining healthy diets. Thus, identifications of barriers that people perceive they have in trying to eat healthy can guide the strategies for dietary behavior change interventions by taking account of the barriers. Objective: The purpose of this study was to identify and quantify the perceived barriers to healthy eating (PBHE), to investigate the relationship between socioeconomic factors and PBHE, and to explore the associations between PBHE and dietary intake among parents of elementary-school aged children living in South Phoenix, AZ. Methods: Socioeconomic factors and PBHEs were obtained via survey and diet was assessed by two interviewer-assisted 24 h diet recalls. The associations between employment and PBHEs, education and PBHEs, and household monthly income and PBHEs were analyzed by Mann-Whitney Test, Kruskal Wallis Test, and Spearman’s correlation test, respectively. The relationship between PBHEs and dietary intake were analyzed by Spearman’s correlation test. Linear regression was used to assess the associations between total PBHE, and dietary intake (including added sugar, fruit and vegetable), adjusted by covariates (including socioeconomic status, birth country, age and gender). Results: Of 149 participants who completed the survey (mean age = 38.47±7.08 y), 136 completed the 24 h diet recalls. The mean reported total, social support, emotions and daily mechanics PBHE scores were 2.63±0.91, 2.52±1.16, 2.71±1.06, and 2.58±0.95, respectively, out of a 5-point scale. Daily fruit, vegetable, sugar-sweetened beverage, sweetened foods, and added sugar intake were reported as 1.66±1.56 servings, 2.45±1.43 servings, 1.19±1.30 servings, 2.02±2.12 servings and 49.93±31.17 g, respectively. Employment status was significantly associated with total PBHE (Z = -2.28, p=0.023), and support PBHE (Z = -2.623, p=0.009). Education was significantly related to total PBHE (χ2 = -7.987, p=0.046), and daily mechanics PBHE (χ2= 11.735, p=0.008). Household monthly income levels were significantly correlated to daily mechanics PBHE (r = -0.265, p=0.005). Added sugar was positively correlated with total PBHE (r=0.202, p=0.020), emotions PBHE (r=0.239, p=0.006), and daily mechanics PBHE (r=0.179, p=0.040). Sugar sweetened beverage intake was significantly related to emotions PBHE (r=0.183, p=0.035). When adjusting for socioeconomic factors in the regression analysis, there was no significant association between PBHE and diet intake. Conclusion: Overall, results suggest PBHEs listed in this study are mainly associated with socioeconomic factors, but they are not related to diet intake. Future studies will focus on the precise role of overcoming some identified barriers in improving healthy eating behaviors, and the causality between barriers and healthy eating. / Dissertation/Thesis / Masters Thesis Nutrition 2018

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Free cervical cancer screening services are provided in Malawi’s public healthcare institutionssince 1999. Few women aged 42 and older, utilise these services. Cervical cancer continues to be a major cause of morbidity and mortality among this group of women. Structured interviews were conducted with 381 women who attended three healthcare centers in Blantyre and semi-structured interviews with 14 nurse/midwives working at the same centers. The results for both phases arepresented within the Health Belief Model’s constructs. Phase 1 revealed that women had low levels of perceived susceptibility to cervical cancer. Although the interviewed women perceived cervical cancer to be a serious condition, they did not regard themselves to be at risk of suffering from cervical cancer. Knowledge that cervical cancer screening could detect this cancer at an early stage, embarrassment, stigma, social support, financial costs, traditional practices and available sources of information, influenced women’s intentions to be screened for cervical cancer. In phase 2, the nurse/midwives indicated that Malawian women lacked information about cervical cancer, available screening tests and the purpose of such screening.These women perceived cervical canceras being incurable and linked to witchcraft. Women’s utilisation of cervical screening services was hampered by barriers relating to healthcare institutions, women themselves and nurse/midwives. Local radio and television broadcasts, friends and nurse/midwives motivated individual women to use these screening services.Women preferred receiving information about cervical cancer screening during community activities. Health education should be intensified, nurse/midwives should be more empathetic, clinic days and hours should be extended. Misconceptions should be addressed and more service providers should be trained. This would enable more Malawian women to use cervical screening services, enhancing early detection and treatment of cervical cancer and reducing the morbidity and mortality statistics related to this condition in Malawi. / Health Studies / D. Litt. et Phil. (Health Studies)

Free cervical cancer screening services are provided in Malawi’s public healthcare institutionssince 1999. Few women aged 42 and older, utilise these services. Cervical cancer continues to be a major cause of morbidity and mortality among this group of women. Structured interviews were conducted with 381 women who attended three healthcare centers in Blantyre and semi-structured interviews with 14 nurse/midwives working at the same centers. The results for both phases arepresented within the Health Belief Model’s constructs. Phase 1 revealed that women had low levels of perceived susceptibility to cervical cancer. Although the interviewed women perceived cervical cancer to be a serious condition, they did not regard themselves to be at risk of suffering from cervical cancer. Knowledge that cervical cancer screening could detect this cancer at an early stage, embarrassment, stigma, social support, financial costs, traditional practices and available sources of information, influenced women’s intentions to be screened for cervical cancer. In phase 2, the nurse/midwives indicated that Malawian women lacked information about cervical cancer, available screening tests and the purpose of such screening.These women perceived cervical canceras being incurable and linked to witchcraft. Women’s utilisation of cervical screening services was hampered by barriers relating to healthcare institutions, women themselves and nurse/midwives. Local radio and television broadcasts, friends and nurse/midwives motivated individual women to use these screening services.Women preferred receiving information about cervical cancer screening during community activities. Health education should be intensified, nurse/midwives should be more empathetic, clinic days and hours should be extended. Misconceptions should be addressed and more service providers should be trained. This would enable more Malawian women to use cervical screening services, enhancing early detection and treatment of cervical cancer and reducing the morbidity and mortality statistics related to this condition in Malawi. / Health Studies / D. Litt. et Phil. (Health Studies)