Collective efficacy, time urgency, and health literacy have been a focus of research since the 1970s. Researchers have demonstrated that these factors influence health and decision making. However, researchers have yet to establish how these factors may be connected to the achievement of policy aims that impact holistic or environmental health. This study utilized the health belief model, social cognitive theory, time urgency theory, health education and promotion theory, Bronfenbrenner's ecological systems theory, and the Meikirch model. The purpose of this quantitative study was to determine if the factors of collective efficacy, perceived time urgency, perceived health literacy, ethnicity, age, gender, perceived financial strain, and/or educational level are associated with the perception of the likelihood of reaching 100% renewable energy in North Hawaii County (Hawaii Island) by the year 2045, referred to as REHI45. A sample of 136 residents of North Hawaii County completed a survey to measure these factors. A multiple linear regression analysis was run to test relationships among the variables. Results revealed that collective efficacy, perceived time urgency, and perceived health literacy were significantly associated with the perceived likelihood of REHI45. These findings may inform the design of intervention programs and/or preventative measures to promote overall long-term health and positive social change in North Hawaii County. Individuals, organizations, institutions, cultures, and societies may benefit from the results of this study through its ability to raise awareness of factors that influence the perceived likelihood of achieving REHI45.

The food decisions, dietary patterns, physical activity, and weight-related convictions of African American mothers are affected by their self-perceptions and views of body weight. The gap in the literature regarding the impact of these perceptions on children's food choices, eating habits, and body image is significant. Using the health belief model as the theoretical foundation and a cross-sectional survey as the research design, this study assessed the potential relationship between mothers' and children's eating habits and whether mothers' perceptions of their children's body image were reliable indicators of childhood obesity. Eighty-six mothers provided demographic information and completed the Child Feeding Questionnaire (CFQ) and the Figure Rating Scale (FRS); 86 children completed the FRS. All 172 participants self-reported weight and height. No other measurements were taken. Logistic regression and correlation analysis were used to answer the research questions. Correlation analysis showed a significant relationship between the mothers' perceptions of their children's body image and the children's self-perceptions of their body image. The results of regression analyses indicated that the mothers' perceptions of their weight as children influenced food choices for their children as well as their children's self-perception of body image. Positive social change in the African American community may occur by having community and health care professionals offer awareness programs to African American mothers.

Management of chronic disease requires a different service delivery model from that of acute illness. The uninsured population experience poorer health status and increased incidence of chronic disease than do the insured population. The purpose of this study was to identify the supports and barriers present in providing chronic disease management to patients at Ohio free clinics. Wagner's theory of chronic disease management served as the theoretical lens. The sequential, exploratory mixed methods study collected data from 13 free clinics belonging to the Ohio Association of Free Clinics (OAFC). Quantitative questions focused on processes in clinics with high and low fidelity to the chronic care model (CCM) determined by the Assessment of Chronic Illness Care (ACIC) survey. A backwards stepwise logistic regression was used. The quantitative analysis determined the 3 highest and lowest scoring clinics on the ACIC survey who then participated in a 2 tiered multi-case study series. Qualitative questions examined supports present in high fidelity clinics and barriers present in clinics with low fidelity. Qualitative findings identified 5 support areas that centered on progressive vision and patient-centered care themes that existed in high fidelity clinics. Four barriers were identified in low fidelity clinics that focused on the theme of capacity building. These findings provide evidence to guide the OAFC's work in improving adherence to the CCM constructs, thereby elevating the quality of care to the uninsured with chronic disease to the level of those providers governed by accrediting organizations. Changes in quality of care may result in an improvement to the health status of the individual and the communities in which they live.

The Centers for Medicare and Medicaid Services wanted to ensure that electronic health records were used in a meaningful manner to improve coordination and quality of patient care. In 2011, the federal government began offering monetary incentives to help healthcare facilities and providers adopt technology that supported patient access and increased their ability to manage their own health. The hospital where this project took place encouraged patients’ involvement in their health by providing a patient portal, yet the public has underutilized it. The purpose of this project was to develop an evidence-based strategy for future implementation at the hospital that will increase patients’ use of the hospital’s portal. Education will be provided through an interaction between patients and a designated staff member. An informative video describing the functionality and benefits of the portal will be shown to patients to see if individualized education increases portal enrollment and participation in the portal. Adult learning theory informed this quality improvement project. In addition, the logic model served as the framework for the development of an evaluation strategy that the organization will use post implementation. The project targets social change through patient engagement. Ideally, patient portal education will increase portal enrollment, which will increase patients’ knowledge of their health information. Evidence indicates access to one’s own health information is a first step in improving and strengthening self-care and achieving better clinical outcomes.

Diabetes is an epidemic that has started to capture political attention in the United States because of the devastating health care costs associated with the disease. Researchers in other studies have concluded that additional education face-to-face (FTF) and FTF with alternative forms of diabetes communication (FTF plus) have been beneficial. However, there is very little information on the comparison of the two groups as mentioned above when comparing chronic limitations, self-perception, health status, and healthcare satisfaction as circumscribed by specific demographic population. This study was an investigation of the above variables and explored how specific demographic characteristics (age, gender, educational level, and race/ethnic background) may have an identifiable association with each diabetes education type, either FTF or FTF plus. This research involved the use of the social cognitive theory and the health belief model to help explain self-care behavior changes. This quantitative, cross-sectional study used secondary data from the 2016 National Health Interview Survey for analysis. A simple linear regression was used to understand health status and healthcare satisfaction. A logistical regression was used for chronic limitations, while controlling for demographics for all the variables. The study revealed FTF plus had an association with chronic limitations with race and education level, but age was not significant. After controlling for demographics, a person who has FTF plus has decreased odds of having chronic limitations, in comparison to someone who receives only FTF. The results from this study may aid formulation of future healthcare policies that focus on how to refer patients to multiple forums of diabetes education, while reducing healthcare costs.

The street food sector continues to grow in Nigeria in a largely unregulated environment. The lack of regulation poses a significant public health risk for consuming unsafe street foods such as suya. Quantitative research has revealed high levels of microbiological contamination of suya, despite qualitative findings that suggest that food handlers are knowledgeable about safe food handling practices. This discrepancy reveals a gap in understanding about what influences safe food handling practices besides knowledge. This qualitative study was therefore designed to gain a deeper understanding of the beliefs and attitudes that influence hygienic practices among suya producers. Guided by the social cognitive theory, a phenomenological design was used to investigate and describe the hygiene phenomenon. Ten suya operators were recruited in Abuja, the Federal Capital Territory of Nigeria, to participate in the study. Data were collected from interviews and observation of participants. Semistructured, open-ended questionnaires were used in face-to-face interviews to elicit participants' views on hygiene. Hygiene practices among participants were also observed. Information gathered was recorded, stored, transcribed, and analyzed using the NVivo software and based on emerging themes. The findings revealed that participants' understanding of hygiene was related to popular culture rather than science. Furthermore, findings also revealed that family, religious, and cultural beliefs, as well as environmental factors such as consumer attitude influenced their hygiene practices. These findings may provide evidence-based guidance for public health interventions for safer suya production processes with positive social change implications for improved consumer health.

Breast milk is the optimal source of nourishment for babies, providing positive nutritional and psychosocial benefits for infants' growth and development. Rates for initiation of breastfeeding and exclusive breastfeeding at 6 months in the United States are well below the target rates for the Healthy People 2020 Maternal, Infant, and Children's Health objectives. Using Ajzen's theory of planned behavior, the purpose of this project was to ascertain how knowledge and attitudes influenced a mother's intent to breastfeed during her hospital stay and the likelihood of exclusive breastfeeding continuing after discharge. A convenience sample of 68 postpartum mothers was recruited from women who delivered a viable infant between January and March 2017 at a large urban teaching hospital. Mothers completed the 17-question 5-point Likert scale instrument, the Iowa Infant Feeding Attitude Scale, and demographic information before discharge from the hospital. Mothers who planned to breastfeed and mothers who did not plan to breastfeed scored above the midpoint on the scale; however, women who intended to breastfeed after discharge scored significantly higher (p < .001). Demographic variables were not significant with the exception of education level. Women with higher education levels scored higher on the scale and were more likely to plan to breastfeed after discharge than women with lower levels of education. Findings may promote social change through development and implementation of tailored nursing interventions, such as community prenatal education and clinical reinforcement, which will support initiation of breastfeeding in the hospital setting and exclusivity of breastfeeding upon discharge.

The stroke rate in Virginia is above the national rate. Stroke results in poor quality health, morbidity, and mortality. This quantitative epidemiological study was conducted to investigate whether a significant association exists between stroke and (a) socioeconomic and (b) neighborhood factors among people who were admitted to Virginia hospitals between 2010 and 2015. An ecological design, including ecosocial theory, was used to examine associations between environmental factors and stroke. Data (746 census output areas) were acquired using patients' billing zip codes from the Virginia Health Information System in combination with socioeconomic and neighborhood data by Zip Code Tabulation Area from the U.S. Census Bureau and the U.S. Food and Drug Administration. Results of linear regression analysis showed a significant association between stroke hospitalization rate and educational attainment, per capita income, and Gini coefficient for income distribution. Also, a significant association emerged between stroke and neighborhood risk factors such as food access, Walkability Index, and population density. Findings from a one-way ANOVA showed a significant geographic difference in stroke hospitalization rate with the highest stroke rate in eastern Virginia and the lowest stroke rate in northern Virginia. Results may help stakeholders, policymakers, and public health agencies design, prioritize, and implement community-based prevention programs to reduce stroke rates in Virginia.

Female genital mutilation (FGM) is a public health challenge because it jeopardizes the health of women and girls. FGM is condemned worldwide but, it is still practiced in the Odi community of Nigeria. The literature on women's lived experiences of FGM in other parts of the world was reviewed, but knowledge is lacking on the lived experiences of women from Odi community in Nigeria. The purpose of this phenomenological study was to explore their lived experiences, their perspectives on the current legislation for the prevention of FGM, and their perspectives on the cultural myths surrounding the practice. The phenomenological lens was used both as the study design and as the theoretical framework which states that humans know the world through their experiences. This theory guided the study on how the women of Odi community attached meaning to their experiences with FGM. Nine women, 18 and older, who had experienced FGM, were recruited through a snowball technique. Data were collected through semi-structured, in-depth, face-to-face interviews. Colaizzi's method was used for data analysis. Five major themes emerged: (a) FGM is a traditional rite, (b) challenges of FGM, (c) FGM cultural myth instills fear, (d) ignorance of legislation against FGM, and (e) needs government intervention to halt FGM. Participants recommended the enforcement of the legislation against FGM. The findings of this study will be communicated to stakeholders of FGM in the Odi community and in public health journals to serve as a basis for further research. The implication for social change is that maternal and child health will be improved.

As the global demand for oil increases, human health implications related to its discovery and transport remain a serious concern. The Niger Delta has been the site of severe environmental degradation since the oil boom of the 1970s. While some researchers have examined the environmental effects of oil procurement, few have explored human health implications in this region. This phenomenological study investigated the human physical and mental health consequences of oil-related environmental degradation through the perceptions and lived experiences of villagers in Koluama, Nigeria. The conceptual framework for the study was based on research conducted by Morello-Frosch, Zuk, Jerrett, Shamasunder and Kyle (2011) on the public health consequences of environmental pollution to which marginalized populations are vulnerable. Participants included a random sample of 33 residents of Koluama. Data were collected via individual semistructured interviews and 3 focus groups and analyzed using: interpretative phenomenological analysis. Themes that emerged from analysis included children's health issues, including asthma and other breathing problems; and death rates among the elderly in the area. The villagers, aware of the increase in mortality and illness in the area, also suffered from anxiety and depression. The research findings demonstrated the perception of the participants that the oil companies appeared not to be concerned about the lack of health care in the area; although illness increased in the area of the oil fields. This study might be beneficial in eliciting positive social change at the individual and organizational levels by illuminating oil-related health problems and may lead to better health care access for the population.