Infertility is a serious public health issue. Infertile couples may perceive infertility differently based on their own cultural background. There is a paucity of literature about how infertility is perceived among Arab women living in the United States. The purpose of this study was to be able to understand how Arab women who live in Dearborn, Michigan feel about infertility and to understand their concerns and worries about their health status. The primary research questions asked Arab women how they perceive infertility and how infertility may impact their future. This qualitative case study was guided by the social support theory and the choice theory. The social support theory is mainly used in health promotion to describe unmet social, emotional, and informational needs for a certain community or population. The choice theory helped understand the way women perceive their health issue and the way to overcome it. The case study approach was used to interview 10 participants who self-identified as Arab American women with infertility problems. The qualitative data gathered were analyzed for thematic content, using open, axial, and selective coding. Results showed that for these participants, cultural beliefs regarding infertility had affected their well-being, causing feelings of shame and incompleteness. In addition, the study's findings indicated a need for more extensive psychological services and medical resources to be available for infertile couples. Positive social change may be seen in understanding the specific issues faced by Arab American women struggling with infertility and through translating this knowledge into public health programs.

This study addressed an increasing number of peripheral intravenous catheter infiltrations within hospitals, leading to problems such as phlebitis and cellulitis, which may result in a longer length of hospital stay. The purpose of this project was to determine how to reduce infiltrations in order to increase the longevity of the catheter. A quantitative, description design was used, guided by Abdellah's classification framework for identifying nursing problems. The target population was 50 patients experiencing incidents of peripheral intravenous catheter infiltration, identified in a patient safety event log used across a 252-bed hospital. Each incident was assessed for several risk factors, such as age, diagnosis, length of time of catheter use, co-morbidities, size of catheter used for insertion, and how many medications were being administrated intravenously. Using descriptive statistics, the combination of patient co-morbidities had a direct correlation with increased probability of infiltration before 96 hours. Among 82% of patients, co-morbidities included hypertension in 56% of subjects, advancing age, and placement of the catheter in the upper arm. Data play a significant role in decisions to change clinical practice and protocols. Findings from this study related to peripheral intravenous catheter insertions, and their maintenance can drive changes across a healthcare organization.

Immunization has been recognized globally as a cost-effective public health intervention. However, despite its benefits, children in northern Nigeria are still adversely affected by the negative consequences of inadequate uptake of immunization. The purpose of this study was to assess antenatal care and maternal sociocultural determinants that influence childhood immunization within 2 months of birth in northern Nigeria. Constructs of social cognitive theory were applied to this retrospective correlational cross-sectional inquiry involving women 15-49 years old in northern Nigeria. Secondary data (the 2013 Nigeria Demographic and Health Survey) were analyzed using univariate, bivariate and multivariate logistic regression. Statistically significant (p < 0.05) predictors of uptake of childhood immunization within 2 months of birth were the person who delivered antenatal care, the number of antenatal care visits, the number of tetanus injections, maternal educational level, religion, wealth index, husband/partner educational level, and the person who decides on health care. Educated Christian women from middle-class or rich homes, whose husbands/partners were also educated and who jointly decided on health care, made numerous contacts with health care professionals, and received at least one tetanus injection during antenatal care, had a higher likelihood of immunizing their children within 2 months of birth. The positive social change implications for this study include providing evidence of deterrents to childhood immunization that could lead to relevant policies and interventions leading to healthier children, communities, and society.

Many people in the United States have untreated dental disease due to a lack of dental insurance, a lack of oral health knowledge, and a lack of priority placed on dental health. Despite an increase in dental service use by Medicaid recipients as a result of local programs, children enrolled in Medicaid often have low rates of use of dental services. Using the health literacy framework of the Paasche-Orlow and Wolf (POW) model, the purpose of this study was to explore to the relationship between oral health literacy of parents and dental service use for children enrolled in Medicaid and the differences in use rates between preventive and restorative services. A cross-sectional research design was employed within a convenience sample of parents who presented to a nonprofit clinic for a medical appointment. Participants completed a demographic profile, an oral health questionnaire, and REALD-30 survey. Responses were correlated with dental claims retrieved from 1 reference child for each parent. Pearson's correlation revealed no significant relationship between oral health literacy and dental service utilization, r = -.056 (p = .490). An ANOVA revealed no difference in utilization between preventive and restorative services, F (2, 149) = .173, p = .841, ç2 = .002. However, high rates of use for restorative services were observed, suggesting a high prevalence of tooth decay in children. Although this study did not find a significant relationship between oral health literacy and dental utilization, barriers continue to exist that contribute to the high rates of tooth decay in children enrolled in Medicaid. This study impacted social change by highlighting the importance of preventive care in reducing the prevalence of tooth decay.

Human papillomavirus (HPV) is the most common sexually transmitted virus, and is causally related to several cancers. HPV vaccination rates are far below HealthyPeople 2020 targets and vary across geographic, socioeconomic, and demographic populations. The purpose of this research was to test the relationships among socioeconomic and demographic variables, HPV vaccination, social vulnerability, and physician recommendation within select local areas in the United States. Fundamental cause theory and behavioral economics informed this quantitative secondary analysis of National Immunization Survey-Teen and Social Vulnerability Index data (n = 43,271). Statistical analyses included chi-square and binomial logistic regression. Teens whose mothers had less than a college degree were more likely to initiate the HPV vaccine series (p < .01), while teens living in Hidalgo County and Houston were less likely to initiate the series (p < .001). Younger teens (p < .001), males (p < .001) and teens whose mothers had some college (p < .01) were less likely to complete the series, while older teens (p < .001) and teens living in Philadelphia and Houston (p < .01) were more likely to complete the series. Fewer teens in Bexar County received a physician recommendation (p < .01); there was no difference between vaccine initiation and select local area. These findings highlight the need to consider local sociodemographic influences on underlying disparities in health and physician behavior. Informed interventions may produce positive social change by reducing variance in health care quality, tailoring public health efforts to local needs, and moving persons experiencing disparities in health outcomes toward a healthy future.

Cigarette smoking has been a public health concern for many years, and the possible impact of smoking on surgical site infection (SSI) has been studied broadly. However, a gap in understanding has persisted concerning whether there is an association between smoking tobacco and the development of SSI among patients who undergo lower extremity surgery, specifically total knee arthroplasty (TKA). The purpose of this study was to examine the association between smoking and lower extremity SSI. Andersen's behavioral model (BM) was used to understand the risk factors relevant to the interaction between smoking and SSI. Application of the BM categories of predisposing, enabling, need, and behavioral habits facilitated the discussion of surgical outcomes. A quantitative, cross-sectional approach was used to analyze data from a legacy registry of an east coast hospital. The research question addressed whether there was a relationship of the smoking status of three groups (i.e., smokers, nonsmokers, and previous smokers) and the variables in the BM categories (predisposing variables of age, gender, and body mass index [BMI]; enabling variable of health care insurance coverage; and need variables of health diagnoses, diabetes, hypertension, deficiency anemia, rheumatoid arthritis [RA]) to postoperative SSI. Multiple logistic regression test was used and no statistical association was found between smoking status and SSI; however, RA had a significant association with SSI. Positive social change may occur through the dissemination of new knowledge to reduce the financial burden of the prevalence of SSI through behavioral changes and improvements to health wellness.

Complementary and alternative medicine (CAM) refers to a group of diverse medical and healthcare systems, practices, and products not treated as conventional medicine. The body of literature on stress and stress management among young adults has not addressed the use of CAM modalities for stress management among this population. The theoretical foundation of the study was based upon the transactional model of stress and coping, which describes stress as an interaction between an external stressor and the resources available to eliminate the stressor. The purpose of this quantitative study was to examine whether variables such as exposure to CAM, stress level, dispositional coping style, sociodemographic variables, and social support influence young adults' use of CAM modalities for stress management. This study sought to determine to what extent dispositional coping, exposure to and knowledge of CAM, and sociodemographic variables affect young adults' use of CAM modalities for stress management. This study also sought to answer whether there is a difference in the perceived stress of participants who use CAM modalities and those who do not. A quantitative cross-sectional correlational study was employed, using a survey methodology, to identify whether the factors identified in the study influence young adults' use of CAM modalities. Results showed that knowledge of CAM and dispositional coping style significantly influence the use of CAM modalities; sociodemographic variables do not influence the use of these modalities. Furthermore, the use of CAM modalities was found to have a significant relationship to stress level. The findings of the current study suggest the CAM techniques can be adapted and introduced into college settings so that students can better manage their stress levels

In the United States, influenza causes approximately 36,000 deaths and over 200,000 hospitalizations each year with elderly most often affected. Clostridium difficile infection (CDI) is another major health care challenge and pressing public health issue associated with 14,000 deaths and over 335,000 hospitalizations annually. The use of antibiotics has been implicated in the development of CDI. This study's purpose was to test the relationship of seasonal influenza incidence and antiviral/antibiotic use in CDI development among hospitalized patients. Grounded in the epidemiologic wheel model of man-environment interactions, this retrospective observational study described and analyzed data from a proprietary, laboratory, and pharmacy-based system from a cohort of hospitals. The association between 147 patients with a diagnosis and/or positive test for influenza, the independent variables of delivery of antivirals/antibiotics (n = 130) during the patient's hospitalization, and the dependent variable of positive test or diagnosis of CDI (n = 17) was tested using multiple logistic regressions. The study results did not prove to be significant for the 3 research questions, suggesting no impact of antiviral use (R2 = .05, p = .336), antibiotic use (R2 = .05, p = .290), or antiviral and/or antibiotic use (R2 = .04, p = .382) on development of CDI within 60 days of discharge. However, findings indicated that recommended antiviral medication was inconsistently administered to influenza positive patients and that inappropriate prescribing patterns for antimicrobial agents coincided with seasonal influenza. Implications for positive social change include confirming the importance of antibiotic stewardship as an essential aspect of quality healthcare.

This project study addressed the problem of a decline in retention of students at a local allied health college. The need for allied health professionals is projected to exceed the availability by 2020, so it is important to identify strategies to help allied health students succeed. The purpose of this case study was to explore perceptions of students and faculty about motivating factors and learning strategies that foster successful progression in allied health programs. Ryan and Deci's self-determination theory, focused on the relationship between motivation and success, served as the framework for the study. Research questions addressed intrinsic and extrinsic factors that students and faculty identified as significant in motivating successful completion of core courses. Data collection included information from the college effective plan from the research site and face-to-face audio-recorded interviews with 10 allied health students and 5 faculty. Students were 18 years or older and enrolled in at least 1 core course in an allied health program; faculty taught at least 1 core course with at least 1 year of experience with allied health students. Interview data were analyzed through open coding to identify themes related to motivating student success in core courses. Significant motivating factors included improved quality of life (intrinsic) and a supportive learning environment (extrinsic). Motivating strategies for student success were active involvement in the learning process and hands-on learning. Findings from the study guided development of a 3-day learning community designed to support student success in core allied health courses. Positive social change may be impacted by motivating allied health students to succeed in order to meet the health care needs of clients.

Malaria is the main cause of mortality for children under the age of 5 in Burundi. The access to malaria diagnostics and treatment is hampered not only because of logistical issues, but also due to the lack of qualified human resources and their inequitable distribution across the country. To mitigate the lack of human resources for health, the government of Burundi, along with its partners, shifted some tasks to community health workers (CHWs) to cover unmet healthcare needs for selected diseases such as malaria, diarrhea, and pneumonia. The purpose of this study was to determine whether the social support provided to CHWs had an impact on morbidity due to malaria for children under the age of 5. The social networks and social support theoretical framework was used to explore the type of social support received by CHWs and its impact on the number of children treated. The 88 CHWs who participated in this cross sectional survey, were randomly selected from a pool of 719 CHWs who were part of a pilot project that was implemented in the districts of Gahombo, Gashoho, and Mabayi, from 2011 to 2014. The study findings showed mixed results with a positive correlation between the instrumental support received and the number of children under the age of 5 treated. However, a statistically significant correlation was not established between the emotional, informational, and appraisal support received and the number of children under the age of 5 treated. The positive social change implications of the study include providing evidence to build and enhance human resource capacity for improving the health of children living in Burundi, an under-resourced country, through the development of a support package that can be offered to CHWs to help them perform their duties in a more effective way.