Over one million women in the United States are physically, sexually, or emotionally abused by a partner or former partner every year. Women between the ages of 18 and 34 are the most likely to experience intimate partner violence (IPV), with prevalence rates for that group double the overall national average. Although the U.S. Preventive Services Task Force has recommended universal screening for all women of child-bearing age, compliance with this recommendation remains low. The present study examined the effectiveness of an asynchronous educational intervention to increase perceived knowledge, actual knowledge, and screening behaviors among 44 college-based health care providers. Data were collected using the Physician Readiness to Manage Intimate Partner Violence Survey (PREMIS). Results indicated that participation in the educational intervention did not have a significant effect on provider knowledge or screening behaviors. A positive trend was observed for perceived knowledge and knowledge regardless of treatment condition, but not for screening behaviors. The lack of significant findings may have been related to insufficient sample size and low power. Recruitment was challenging, despite multiple strategies and the offer of one free continuing education credit for all participants. Future research should explore how college health care providers prefer to engage in clinically informed research and whether IPV screening is viewed as an important clinical practice.

Modern methods of contraception are freely available in Albania, yet contraceptive prevalence among Albanians is relatively low (11%). Abortion on the other hand has long been the mainstay of family planning in the country. Emergency contraception is not very popular in Albania either, even though two different levonorgestrel-only EC pills (NorLevo® and Postinor®) are widely available in Albanian pharmacies. This study aimed to investigate potential factors that influence women’s choices of contraception. In 2016, we conducted a multi-method qualitative study with women and service providers in Albania. Women were invited to report their knowledge of, attitudes toward, and practices surrounding contraception in an online survey. Also, we conducted in-depth semi-structured interviews with key informants to better understand the current reproductive health landscape in the country. Additionally, we conducted structured interviews with pharmacists in Tirana to assess their training and practices with regard to different available contraceptive methods. Misinformation, lack of awareness, fear of judgement and embarrassment, and lack of infrastructure are the strongest influencers of women’s choice of contraception in Albania. Training of health service providers, as well as development of materials for distribution are warranted to improve knowledge and uptake of contraception among women.

Cancer-related fatigue (CRF) as a distressing, persistent, subjective sense of physical, emotional, and/or cognitive tiredness or exhaustion related to cancer and cancer treatment that is not proportional to recent activity, such as physical activity, that interferes with usual functioning (Howell et al., 2015; National Comprehensive Cancer Network, 2020). CRF is one of the most common symptoms experienced by cancer patients at all stages of the cancer trajectory which significantly impacts patient’s quality of life, return to work, mental health, and can lead to disability (Bower, 2014b; Jones et al., 2016). Much research has focused on the development of CRF assessment and intervention strategies which have promoted the development of comprehensive evidence-based guidelines (Howell et al., 2015; National Comprehensive Cancer Network, 2020). However, previous research has identified many practice gaps in their implementation (Berger et al., 2015; Borneman et al., 2007; Pearson et al., 2015a, 2017b). This thesis’ objectives were to gain a deeper understanding of potential barriers to CRF clinical guideline implementation to identify potential knowledge translation strategies of CRF guidelines into practice following a Knowledge-To-Action (KTA) framework perspective (Graham et al., 2006; Straus et al., 2013). In Study 1, a qualitative research design was used to recruit a total of 62 participants—16 patients, 32 healthcare providers (HCPs), and 15 community support providers (CSPs). Drawing on the KTA model, the goal of the study was to explore key stakeholders’ (patients, HCPs, CSPs) experiences and opinions on CRF assessment and management and to explore underlying causes of CRF treatment gaps. No specific hypothesis were determined given the exploratory nature of the study. The results of this study highlight CRF guideline implementation gaps, patient dissatisfaction with CRF care, and challenges contributing to CRF assessment and management gaps. The results also suggested the presence of two underlying mechanisms contributing to treatment gaps: A Perfect Storm and Patient-Provider Communication Gaps. Understanding these mechanisms provides clarity on the potential causes maintaining CRF treatment gaps and can help direct targeted knowledge translation strategies to improve the implementation of CAPO CRF guidelines into practice. Consistent with a recent Delphi study (Pearson et al., 2017b), the results supported the need for professionals’ training on CRF guidelines to fill knowledge gaps. In Study 2, a mixed-methods pilot study with 18 HCPs and CSPs was used to develop and evaluate the acceptability and feasibility of a one-time training session for HCPs and CSPs on CAPO CRF guidelines, once again flowing the KTA framework (Graham et al., 2006; Straus, 2011). A secondary objective was to evaluate the learning outcomes of the training session including CAPO CRF guidelines knowledge, self-efficacy, and intent to apply CAPO CRF guidelines in practice. Overall, results suggest that offering a brief one-time training for HCPs and CSPs on CRF guidelines may be effective in increasing knowledge, self-efficacy, and intent to apply guidelines into practice. Similarly, that KT tools are appreciated by HCPs/CSPs and may be used in practice to supplement and sustain the knowledge and skills gained in training.

<p>The rising prevalence of developmental disabilities has created an increased demand for service providers capable of delivering behavior-analytic services with high fidelity. As the need for these services continues to grow, ensuring that service providers have easy access to the essential training for delivering high-quality services becomes paramount. This dissertation aimed to evaluate the effectiveness and acceptability of asynchronous training methods in developing service providers' skills to effectively implement trial-based functional analysis (TBFA).</p> <p><br></p> <p>In Study 1, four board-certified behavior analysts (BCBA) were trained using an asynchronous model, which included remote behavior skills training and self-monitoring. Three BCBAs achieved mastery criteria for all TBFA conditions, while one BCBA required additional support through self-monitoring to meet the criteria for the escape condition. While the BCBAs showed improved accuracy in implementing TBFA, they faced challenges in fully generalizing their skills to actual clients, indicating the need for planned support to enhance skill generalization. In Study 2, four BCBA trainees were trained using the same asynchronous model, but with increased mastery criteria and planned supports available during the generalization phase. The findings showed that all BCBA trainees met the mastery criteria when using TBFA with video-annotated feedback, and the inclusion of planned supports during the generalization phase resulted in consistent implementation with 100% fidelity across all TBFA conditions, highlighting the importance of such supports for skill generalization.</p> <p><br></p> <p>Overall, the dissertation suggests that asynchronous training methods hold promise for training service providers, but the availability of planned supports is essential for effective skill generalization. The study's major findings and implications for practice are discussed, along with directions for future research.</p> <p><br></p>

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August 2016 Management of metabolic syndrome (MetS) may be enhanced by promoting patient engagement. Training health care providers in the conceptual and practical application of integrative patient centered care tools may promote patient lifestyle behaviors for better management of MetS. The purpose of this quantitative quasi-experimental study was to assess the impact of training providers in integrative patient centered care for patients with MetS. The biopsychosocial construct provided the conceptual framework for the study. Two groups of physicians were included; one received training in an integrative model (IM) while the second received no training and provided usual care (UC). Following training, patient disease biometrics and medication adherence were monitored for approximately four months. Due to a diminished sample size in the completer data set, an intention to treat (ITT) data set was created with baseline values brought forward. In the ITT set, BMI decreased significantly (p=0.005, d=0.18) with each group over time: (IM: 32.9 -± 7.3 Kg/m2 to 31.6 -± 6.8 Kg/m2) and (UC: 32.1 -± 6.7 to 31.5 -± 6.3 Kg/m2). However, there were no statistically significant differences between these two groups' measures. In the completer set, BMI decreased significantly (p < 0.05, d=0.18) over time with the IM group, but not the UC group: (IM: 35.14 -± 7.9 Kg/m2 to 33.65* -± 7.62 Kg/m2) and (UC: 32.4 -± 6.62 Kg/m2 and (32.4 -± 6.5 Kg/m2); indicating a possible relationship between the intervention training (IM) and improved health outcomes. Thus, providers are assisting patients with important lifestyle choices to better manage MetS, potentially leading to social change around improved patient health care behaviors and advancement in providers' patient centered practices.