The prevalence and incidence of breast cancer is an important issue that is affecting all women, but African American women have the lowest survival rates after breast cancer diagnosis. Historically, the Black church and faith leaders have been essential in promoting health in the African American community. Moreover, faith-based interventions have become more common within the African American community in addressing factors that affect survival rates such as early detection, cultural barriers, and education. Currently, there is not clear information on the perspectives faith leaders have on their experiences with implementing breast health interventions in their places of worship. This phenomenological study used interpretivism as the conceptual framework to understand the experiences of the faith leaders of African American congregations who participated in Worship in Pink, a faith-based breast health program implemented among congregations in metropolitan Atlanta. The research questions sought to answer what faith leaders' experiences were with participating in this intervention and what situations or contexts may have influenced their experiences. In depth, semistructured interviews were administered to a sample of 5 faith leaders who participated in Worship in Pink. There were 3 themes and 1 subtheme that emerged because of the study. The themes included partnership with Komen Atlanta, increased awareness, impact on the community, and resources. The positive social change implications include knowledge useful for faith leaders, program developers, health policy makers, health educators, and other researchers who are seeking to understand experiences of faith leaders in order to improve breast health and awareness of African American women.

The Hispanic population has a higher incidence of diabetes and poorer health outcomes compared to other populations in the United States. Although previous research has reported that cultural and ethnic beliefs play a role in poorer diabetes self-management by Hispanic individuals, limited studies have been focused on the barriers to self-management from the perspectives of Hispanic immigrants. The purpose of this qualitative study was to gain an understanding, through oral history narrative, of the experiences of Hispanic immigrants living with diabetes. In this study, the influence of cultural and ethnic beliefs on diabetes self-management in Hispanic immigrants in the Bronx in New York was explored. Semistructured interviews were conducted with 7 Hispanic immigrants who narrated their lived experiences regarding how they self-manage their conditions. The theory of reasoned action/theory of planned behavior guided this research. Data from in-depth interviews were coded and analyzed for themes. Six themes emerged from these interviews: knowledge of diabetes, diabetes self-management, strong cultural beliefs, social support, lifestyle changes, and strong cultural influence on diabetes management. The results from this study can lead to social change by providing information to health care providers and policy makers who need to deliver culturally sensitive education to both diabetic individuals and their families, which can help in the self-management of the disease.

Acute bacterial skin and skin structure infections (ABSSSI) are common infections within the local community, and they result in higher morbidity and health care costs. While risk factors for skin and soft tissue infections have been previously evaluated, risk factors associated with secondary bloodstream infections (BSI) has not been investigated, especially in an intercity patient population with limited health care resources. In this case control investigation, 392 patients consisting of 196 cases (ABSSSI + BSI) and 196 controls (ABSSSI) were investigated to determine risk for BSI. Both sociodemographic and underlying conditions were evaluated. According to bivariate analysis of cases and controls, individuals with ABSSSI + BSI were significantly older (p < 0.001), more often male (p = 0.008), and had a higher percentage of abnormal symptoms, such as elevated temperature, white blood cell count, and acute renal failure on hospital admission (p < 0.001). Individuals with ABSSSI + BSI also had a higher percentage of chronic renal failure (p = 0.002), diabetes (p = 0.005), congestive heart failure (p = 0.012), intravenous drug use (p =0.012), and a history of prior hospitalization (p < 0.001). Several of these factors remained statistically significant by logistic regression analysis, such as male gender aOR of 1.85, 95% CI 1.11-3.66; acute renal failure aOR 2.08, 95% CI 1.18-3.67; intravenous drug use aOR 4.38, 2.22-8.62; and prior hospitalization aOR 2.41, 95% CI 1.24-4.93. This study contributes to positive social change by identifying patient characteristics that are associated with ABSSSI-related BSI, thus providing health care providers the ability to improve patient outcomes in this underserved patient population.

Diabetes is a disease that affects the Hispanic population in disproportionate numbers. With larger numbers of immigrants coming to the United States who are of Hispanic origin, the individual risk and health burden of this disease will have a major impact on the quality of life and the health care system. Research into the influence of the timing of changes in lifestyle suggested an association between specific levels of socioecological exposures and certain health conditions. This study examined that possibility. The use of the National Health Interview Survey, 2005-2011, provided adequate data for examining whether age at migration was associated with self-reported diabetes; if there was a relationship between age at migration, diabetes, and obesity; and, if the age at migration-diabetes relationship differed depending on the Hispanic subgroup. It was a quantitative, cross-sectional study using a logistic regression. The outcomes indicated that migration early in life influenced diabetes diagnosis in later life and, with the addition of obesity to the model, the relationship between age at migration and diabetes persisted. This research can be a catalyst for social change in allowing for the identification of individuals most at risk, the timeframes for that increased risk, and a better understanding of the factors that predispose individual to diabetes. Public policy initiatives to target specific time periods can provide avenues for social change among this population with preventive measures to reduce long-term negative consequences of diabetes, thus improving quality of life and providing a more effective use of the health care system.

Low-income populations in the United States consume less healthful diets than higher-income populations, specifically relating to fruit and vegetable consumption. The supplemental nutrition program Women, Infants, and Children (WIC) is intended to bridge this gap by providing nutrition education and vouchers for nutritious foods. The purpose of this study was to determine if the 2009 WIC food package revisions impacted fruit and green vegetable consumption in 18 to 24-year-old females in California. Using the social ecological model as a guide, a population of WIC (N = 115) and non-WIC (N = 276) participants from the California Behavioral Risk Factor Surveillance System survey were analyzed for trends on daily fruit and green vegetable consumption over the period of years 2009, 2011, 2013, and 2015. ANCOVA analysis showed that WIC and non-WIC populations did not consume significantly different amounts of green vegetables, but did consume significantly different amounts of fruits, p = .120 and p = .028 respectively. Additionally, WIC participant fruit consumption did not significantly increase over the years, p = .376. However, a decrease of .031 (95%CI [.019,.584], p = .037) was identified in green vegetable consumption between 2009 and 2015. Due to mean differences between samples and years it is evident that there are influencing factors driving fruit and vegetable consumption outside of income barriers, such as possible social or environmental factors. This study adds to the literature regarding the WIC food package revisions and may promote positive social change by encouraging future researchers to identify barriers to healthful diets in WIC populations and determine if additional food package revisions may be needed to increase healthful diets in low-income populations.

One in every 4 people living with the Human Immunodeficiency Virus (HIV) are women. The leading cause of infection is heterosexual contact. The purpose of this quantitative, correlational study was to examine the relationship between gender ratio perception and masculine ideology and a woman's decision to use condoms during her sexual activity. The theory of gender and power and the theory of planned behavior served as the theoretical frameworks for this study. The perceptions of gender ratios, as measured by the Gender Ratio Imbalance Beliefs and Behaviors Scale (GRIBBS) subscale, GRIBeliefs, and masculine ideologies, as measured by the Gender Role Beliefs Scale (GRBS), served as independent variables, while condom use behaviors, as measured by the Gender Ratio Imbalance Beliefs and Behaviors Scale (GRIBBS) subscale, GRIBehaviors, served as the dependent variable. Covariates included demographic factors, as well as behavioral factors. A purposeful, convenience sample (n=55) via the Walden University research pool was utilized, enabling researchers to use readily available data that represented college educated women. Descriptive statistics, independent t-tests, correlational analysis, as well as multiple linear regression were used to examine the aforementioned perceptions of study participants. Correlation analyses and multiple regression indicated no statistically significant correlations between gender ratio imbalance, masculine ideology, and condom use, while controlling for race, employment status, religion, religious devoutness, sexual orientation, relationship status, STD history (self), and partner STD history. Social change is indicated via the results illustrating the possible empowerment of women regarding their sexual health.

This study was conducted to gain a better understanding of HIV/AIDS-related stigma within religious communities in rural Gujarat, India. This study used the hidden distress model of HIV stigma and the HIV peer education model as conceptual frameworks to examine a rural population sample of 100 participants. Regression analysis was conducted to test if school education had a moderating effect on the relationship between illness as punishment for sin (IPS) and HIV stigma. Religiosity was tested for mediating effects on the relationship between early religious involvement (ERI) and HIV stigma. The results of this study indicated that single unemployed men under the age of 28 were more likely to relate religiosity, IPS, and ERI to HIV stigma. Furthermore, education did not significantly moderate the relationship between IPS and HIV Stigma, and religiosity also did not mediate the relationship between ERI and HIV stigma. However, an additional mediation analysis showed that IPS did mediate the relationship between religiosity and HIV stigma in this study. The results of this study suggested that HIV/AIDS awareness programs may need to focus on young unemployed men because they may be the most susceptible to stigmatic thinking. It can be concluded that IPS was a major contributor in the proliferation of HIV stigma for participants in this study. Further research is needed to understand how belief in an authoritarian God could increase IPS, and how education initiatives may aid in decreasing IPS among inhabitants. This study strived to add to the existing body of knowledge and help improve the lives of those infected with HIV in rural parts of India.

The prevalence of maternal morbidities continues to increase in U.S. women of lower socioeconomic status and non-Hispanic Black women despite the efforts of health care practitioners to reduce the disparities. Two decades of research has shown that physicians avoid patients based on insurance and socioeconomic status or their malpractice history. Reducing maternal illness and complications is one of the federal government's top 10 maternal health indicators in the Healthy People 2020 initiative. The purpose of this study was to evaluate the influence of malpractice allegations on patients at high-risk for maternal morbidity. Supported by the theoretical foundation of human factor theory, the focus of the research questions was on the relationship between obstetrics-related malpractice allegations and maternal and severe maternal morbidities in Black/African American women or women who have Medicaid or Medicare. The study involved a retrospective secondary analysis of data from the National Practitioner Data Bank, years 2006 and 2007 and the National Hospital Discharge Survey, years 2006-2008, from the Inter-University Consortium for Political and Social Research, as well as National Plan and Provider data from the Centers for Medicare and Medicaid Services. A logistic regression analysis indicated an association between bed size and days of care with maternal morbidities and severe maternal morbidities; however, no association with malpractice allegations was found. This study contributes to social change by raising awareness of continued morbidity disparities in women of lower social economic status and non-Hispanic Black women and contributes to the current literature.

Tuberculosis (TB) is a deadly, yet curable, infectious disease that continues to be a global health threat. Armenia suffers from rising TB incidence and mortality rates. Armenians living in Los Angeles (LA) County, where TB incidence is higher than national averages, is the second largest Armenian community in the world; therefore implications are that many TB cases are attributed to this group. Using the social ecological model as a theoretical framework, this concurrent, mixed-methods study compared Armenians to non-Armenians in LA County about their knowledge of TB and perceived barriers to seeking and adhering to treatment. Bivariate chi-square analysis from online surveys of 55 Armenians and 72 non-Armenians revealed significant differences in their source of TB knowledge and compliance upon diagnosis. Multinomial logistic regression analysis was completed using the following significant predictor factors: classification, home remedy use, age, education, and primary household language. Parallel, in-depth interviews of 10 Armenians and 8 non-Armenians further corroborated that, although both populations were aware that TB exists, knowledge relating to TB mode of transmission, global incidence, and treatment options was generally lacking. However, the Armenian population was more eager to help others and urge seeking treatment when receiving a positive diagnosis, whereas non-Armenians expressed lack of willingness to physically assist patients. These findings have implications for positive social change, as they can inform the efforts of public health and health care entities in more effective disease management, resource allocation, and patient care. Such efforts should help decrease TB prevalence in the U. S. Armenian population and potentially Armenia.

Tuberculosis (TB) is a major public health problem in many parts of the world. Nigeria is one of the 30 countries in the world that has the highest burden of TB. Private medical practitioners in Nigeria play an important role in health care delivery. Motivating them to adhere to TB treatment guidelines in managing persons suspected of having TB or diagnosed with the disease is one of the strategies employed by the National Tuberculosis Program to Reduce the Burden of TB. Few studies were identified which used qualitative study approaches to study the perceptions of these practitioners towards the TB treatment guidelines. The overarching question asked the study participants centered on eliciting their perceptions towards the guidelines. Guided by the theory of planned behavior, this qualitative narrative study explored the perceptions of private medical practitioners in Anambra State, Nigeria towards the Nigerian National TB Treatment Guidelines. To elicit these perceptions, in-depth interviews were conducted on 11 purposefully selected practitioners. Data analysis comprised coding of data obtained and extracting themes from them. The QSR Nvivo 11 helped to manage data. The main finding of the study was that the practitioners perceived the treatment guidelines to be adequate to meet most of their needs in the diagnosis and treatment of TB patients. Other key findings were that provision of financial incentives and regular training will motivate collaboration with the TB program and adherence to the guidelines. Positive social change may occur by insight being gained into how private medical practitioners view the treatment guidelines and how this knowledge will lead to improved management of TB patients. This may in turn result in the reduction in the morbidity and mortality associated with TB in Nigeria.