Maternal health services (MHS) provide primary, secondary, and tertiary levels of prevention to achieve better pregnancy outcomes. However, use of prenatal and natal services among Nigerian women has been ranked among the lowest in the world and, consequently, the country is among the 10 countries with the highest maternal mortality ratio. Moreover, nationwide community-based studies on the use of maternal health services in Nigeria are limited. To address this gap, this quantitative, cross-sectional study analyzed the 2008 Nigerian Demographic and Health Survey (NDHS) data to identify whether Nigerian women's biological, cultural, and socioeconomic characteristics are associated with their use of MHS and pregnancy outcome as measured by number of antenatal visits, place of delivery, and fetal outcome. The Anderson's health behavior model was used as the theoretical framework for this study. Respondents were women aged 15 - 49 years (N= 31,985), who had given birth between January 2003 and December 2008. Bivariate and multiple logistic regressions were conducted. The results indicated that religion, education, income, and availability of skilled health workers showed consistent significant statistical association with both the number of ante natal care (ANC) visits and place of delivery even after controlling for covariates. Overall, these findings have potential for social change on the choice of public health interventions with collaboration with social services such as education, community, and labor sectors. Further, a systematic involvement of local communities is needed to drive specific culturally-sensitive interventions.

With the number of people living longer and with more chronic problems, it is important that health educators examine who they are educating as well as the methods and circumstances of the education. The purpose of this study was to identify the relationship between self-directedness and health promotion in the elderly. A convenience sample of 108 elders who use Senior Centers in rural East Tennessee comprised the study group. The sample was asked to complete the Self-Directed Learning Readiness Scale, the Health Promoting Lifestyle Profile II, and a demographic information survey at a regular meeting of a Senior Center. A positive relationship (r=.394; p<.005) was found between self-directedness as a measure of intrinsic motivation with participation in health promoting behaviors. Demographic information was used to describe the sample and was also used to determine if there was a relationship between any of the demographic items and health promotion practices or self-directed learning readiness. Participation in religious/spiritual activities was significant for both self-directed learning readiness and health promotion practices. Pender’s Revised Health Promotion Model and the Personal Responsibility Orientation Model provided an excellent basis for this study. The study confirmed the need for personal motivation in the elderly to accomplish increased participation in health promotion practices. Both self-directed learning readiness and health promoting behaviors were reviewed for consideration of previous research in the area, and theoretical perspectives. The key implication for practice is that health educators need to understand the motivation of their client prior to educating them regarding an aspect of health promotion. Recommendations for research include more qualitative studies. Almost all the studies available at present are quantitative and the reason for participation needs further investigation. Qualitative studies would enhance the information regarding the reasons for participation in health promotion.

Parents' refusal to immunize their children with the measles, mumps, and rubella (MMR) vaccine has resulted in a surge of measles outbreaks in the United States. The purpose of this correlational study was to examine the relationships between parental knowledge and trust of the MMR vaccine, and their trust in government and medical authorities. The theoretical foundation for this study was the health belief model (HBM). This study determined if there was any relationship between general trust in doctors/governments (i.e., the predictor variable) and attitudes toward MMR vaccine (i.e., the sole dependent variable), and whether gender, age group, or level of education moderated that general trust. A Survey Monkey subscriber database and researcher-developed survey was used to identify and email 2,500 parents of immunization-aged children, resulting in 237 respondents who met the required parameters. The analysis revealed a significant, positive relationship between the criterion and predictor variables, R = .32, R2 = .10, F(1, 235) = 26.39, p. < .001, regardless of gender, age, or education, suggesting an association between higher trust and greater likelihood of a parent allowing vaccination. This study offers significant insights for positive social change by providing pediatricians, primary health care providers, and vaccine educators, with information for communicating with vaccine-hesitant parents: It is not enough to address parental concerns of vaccine safety, efficacy, and necessity. It is also not enough to provide evidence-based scientific data, as doing so has been proven to be ineffectiveâ??and for some parents counter-productiveâ??when government and medical authorities are sited as the source. What we need to do is start focusing upon the role of parental trust, including how to best establish that trust, and equally important, what steps are necessary to sustain that trust.

<p> This study investigates how heterosexual young people understand and manage risks related to meeting sexual partners online in the United States. The purpose of this study is to help inform the development of culturally-appropriate sexual risk communication and health promotion messages for young people by linking public health knowledge of adolescent sexual health and eHealth with anthropological theories of risk. With qualitative data from two rounds of semi-structured interviews and two group interviews with university students in central Florida, this study shows how young people experience and prioritize more social-emotional risks in meeting online-to-offline sexual partners compared to physical risks. The prominence of these social-emotional risks implies the need for more health promotion messages that incorporate both physical and social-emotional health risk communication.</p>

<p> The implementation of telehealth applications is resource intensive and fraught with challenges unique to the people and places involved. The use of telehealth to provide clinical care to patients, educate patients and providers, and conduct research studies to advance medical science has been shown to positively affect issues of access and the quality of care. Previous research has focused on the use of specific technologies, known barriers to adoption and diffusion, and the general efficacy of these applications. Few studies have researched the role champions play in the deployment and operation of telehealth networks. The researcher proposed conducting an interpretative phenomenological analysis (IPA) of clinicians, educators and technical professionals within a successful telehealth network to determine the lived experiences that identify them as champions in the field. </p><p> Three research questions were studied: 1) What do telehealth champions believe to be the human elements necessary to advance telehealth systems?; 2) How do these telehealth champions explain their empowerment during the creation and use of telehealth networks?; and 3) How do these champions use shared processes and experiences to help spur engagement? Semi-structured interviews with 16 champions from the three disciplines were conducted to explore their lived experiences as part of a telehealth network. Seven champion themes&mdash;<i>modern pioneers; champion teams; agents of change; knowledge brokers; supported by management; advocates, not champions; and well-prepared visionaries</i>&mdash;emerged from the iterative review and analysis of data. Findings suggest that telehealth champions are not born but instead created. They are modern pioneers who function as part of innovative telehealth teams. Champions also serve as agents of change who utilize their knowledge of disruptive technologies to advocate for improvement in established healthcare systems. They are problem solvers who serve as resources for their colleagues, organizations and collaborative networks. Telehealth champions channel the universal goals of improving patient care and expanding healthcare access to overcome adoption barriers. Applying the ideals of what it means to be champions and how they overcome barriers to new telehealth applications could prove to be very beneficial for those tasked with developing new networks. </p>

<p> More than half of the incidents and mortality rates from cervical cancer occur among minority groups, including immigrant women from continental Africa living in the United States. Although researchers have examined cervical cancer screening practices among minority populations, including Black women in Africa and in the United States, there are few studies on cervical cancer screening and associated risk factors, specifically among African women living in the United States. The purpose of this study was to investigate the association between selected factors and cervical cancer screening practices among African immigrant women living in the United States. Using the behavioral model for vulnerable populations as a theoretical basis, this cross-sectional quantitative study was focused on determining the association between family income, level of education, language of interview, insurance status, age, and perceived health status and cancer screening practices. Data on 572 African immigrant women from the National Health Interview Survey in 2005, 2008, and 2010 were used for the study. Chi-square tests and logistic regression were used to analyze the data. Key findings indicate that family income, education level, and age were significantly associated with cervical cancer screening practices among African immigrant women in the United States. Findings from the study support positive social change by targeting at-risk groups for cervical cancer screening programs. The long-term goal of early cervical cancer screening is to lower cervical cancer rates among African immigrant women in the United States. The findings from the study can be used by community health professionals to provide education that can lead to utilization of cervical cancer screening services based on guidelines and recommendations.</p>

<p>Medical education helps ensure doctors acquire skills and knowledge needed to care for patients. However, resident duty hour restrictions have impacted time residents have for medical education, leaving resident educators searching for innovative options for effective medical education. Classroom situated e-learning, a blended learning delivery method, was created to find an effective option for medical education. Research has been conducted on the use of e-learning with residents. More limited research has been reported on the use of blended learning with residents. Research is needed regarding the use of classroom situated e-learning for resident education. Qualitative phenomenological research was used to understand residents' perceptions of the effectiveness of, and interactions in, classroom situated e-learning and traditional lectures. In-depth interviews were used for data collection. Research participants were nine residents who had participated in classroom situated e-learning and lecture based learning. Analysis of the data revealed all participants found classroom situated e-learning effective because it was problem based, provided access to an expert, was interactive, and conducted in a small group. Six of the nine participants provided an example of an effective lecture, which they found effective due to the inclusion of practical or applicable content and an engaging educator. Residents were asked to describe their interactions with the content, the educator, and other learners for classroom situated e-learning and traditional lectures. Their responses were analyzed and themes identified. The themes identified for interaction in classroom situated e-learning were, through the computer for interaction with the content; providing real world content, asking questions of the educator, and feedback for interaction with the educator; and discussion for interaction with other learners. The theme identified for traditional lectures was asking questions of the educator for interaction with the educator. The findings from this study demonstrated that participants' perceived classroom situated e-learning to be effective, and had a preference for interaction that included discussion with the educator and other learners. Recommendations for future research include a replication of this study with residents in other residency programs, and quantitative research comparing the learning outcomes of classroom situated e-learning with traditional lecture based learning. </p>

<p> The purpose of this study was to develop an education-based curriculum comprised of three sessions, 1 hour each, to educate Registered Dietitians and Dietetic Interns about vegetarian eating patterns and the benefits of soy in vegetarian diets. Specific objectives of the study were: (a) To review the literature and depth of the problem, (b) To review existing similar curriculum, (c) To develop an education-based curriculum to educate RDs and DIs about vegetarianism and soy, and (d) To develop tools to measure learner comprehension of the information presented in the curriculum.</p><p> The nutrition curriculum was developed to help RDs and DIs understand vegetarianism and benefits of soy in a vegetarian eating pattern. An expert panel reviewed the curriculum and modifications were made based on their suggestions. PowerPoint slides, discussions and handouts were used to educate 12 DIs. An increase in knowledge and positive comments occurred.</p><p> The curriculum will help RDs and DIs educate their vegetarian clients in an evidence-based manner.</p>

<p> The purpose of this project was to create a cardiac rehabilitation nutrition education program with relevant nutrition topics. This program aimed to educate cardiac rehabilitation participants about Eating Heart Healthy as it relates to various topics leading to successful lifestyle changes. Therefore, this program may be used as a secondary prevention tool for post-cardiac event patients.</p><p> The eight-week nutrition education program consists of three modules: general dietary guidelines, dietary factors associated with heart disease, and food selection and preparation. Each lesson includes research-based curriculum, in-class activities, take home activities, and supplemental handouts to foster multiple learning styles. Evaluation forms for each session and the program overall were included.</p>

<p> This pre-experimental, participatory action research study investigated the impact of Cardiopulmonary Resuscitation (CPR) training on participants' perceived confidence and willingness to initiate CPR. Parents of seventh and eighth grade students were surveyed. Parent participants were asked to watch the American Heart Association's Family and Friend CPR Anytime training DVD. A pretest-posttest design was used to determine the differences in perceived confidence and willingness to initiate CPR before and after CPR training. The study used both descriptive and inferential statistics. The analysis of survey responses revealed: (1) Video-based self-instruction CPR training does increase perceived confidence in initiating CPR, (2) Knowing the victim and the presence of body fluid does have an impact on participants' expressed willingness to initiate CPR, and (3) CPR training increased the likelihood that CPR would be initiated in all scenarios with the greatest increase being with victims with body fluids on their face.</p>