Every year, thousands of congestive heart failure (CHF) patients are readmitted to the hospital within 30 days of discharge. There is a gap in practice in the care continuum of patients with CHF within the transition from hospital to home. One of the factors known to increase a patient's risk for readmission is the lack of patient engagement and self-efficacy regarding the treatment plan. The purpose of this project was to implement a transition of care practice guideline that consisted of the use of a risk identification tool, a customized care plan for patients at high risk for readmission, and a discharge checklist crafted specifically for CHF patients who are at risk for readmission. The practice initiative utilized the Iowa model of Evidence Based Practice as a framework and the teach-back method for discharge education. A sample of 193 patients admitted during a 1-month timeframe fit the inclusion criteria and was generated from the electronic health record. Descriptive statistics were used to analyze the data collected during implementation. In fact, of the 106 CHF patients who benefited from the CHF checklist only 2 required readmission within 30 days, a 1.8% 30 day readmission rate. As compared to the 22% readmission rate experienced in 2017, this represented a considerable improvement, albeit preliminary. Efforts to improve the lives of patients and their families will ultimately serve society well, making a significant contribution to positive social change. Providing comprehensive discharge education to patients using the teach-back method to assess the retention of knowledge will help close the gap in the transition of care between hospital and home, ultimately reducing CHF readmissions.

An improved understanding of the role of housing in asthma prevalence among African-American children is essential to addressing the issues associated with asthma and housing that perpetuate racial and ethnic health disparities. This study was conducted to examine the influence of substandard housing on the odds of asthma among low-income African-American children. The social ecological model was used as the theoretical framework for this study, that allowed consideration of the housing environment where African-American children live as an influential determinant of respiratory health. A cross-sectional research design using data obtained from the 2012 National Health Interview Survey and Comprehensive Housing Affordability Strategy were used to examine the association between income level and asthma and substandard housing and asthma among African-American children. Odds ratios derived from logistic regressions were used to determine the significance of the association between family income level and asthma diagnosis among African-American children. Linear regression was used to assess the strength of the association between an affirmative asthma diagnosis and substandard housing among low-income African-American children. The findings derived from this study suggest that income level was the most significant predictor of asthma risk among African-American children between the ages of 5-14 regardless of the absence or presence of housing issues within the child's home environment. The conclusions of this study have the potential to enact social change by demonstrating the need for improved population health data and additional research into other variables, beyond the scope of housing, that contribute to asthma risk in African-American children.

Dementia is a neurological disorder primarily diagnosed in the geriatric population. A problem for paid caregivers of patients diagnosed with stage-4 dementia is that they may experience caregiving stress while rendering care. However, there was no research that described the lived experiences of paid caregivers. Caregiving stress can be accompanied by behaviors or comorbid conditions and specific symptoms of stress can have a differential wellness impact. This phenomenological study explored the lived experiences of paid caregivers of patients with dementia through Vroom's expectancy theory. Data were gathered through interpretative interviews from a sample of 10 to 15 purposefully selected nursing home paid caregivers. Research questions on the lived experiences and perceptions of caregivers when experiencing stress working with stage-4 dementia patients were explored. Responses to the open-ended questions were recorded and themes emerging from the interview questions were developed. Findings indicated that caregivers cope with their stress in part by coping with challenging patients through empathizing and being ready for anything. Results further showed that caregivers cope with stress by briefly withdrawing from the stress trigger, either physically or mentally. Caregiver stress can be reduced, and health maintained by other caregivers who learn from the coping methods of caregivers involved within this study.

In the United States, adolescent obesity rates continue to increase unabated, yet there is a paucity of programs to address these conditions for this population. The current study evaluated an after-school program in California high schools that uses a mentoring model with youth to promote regular exercise and healthy food choices. It is grounded in Social Cognitive Theory which focuses on both the impact of the environment on shaping behaviors and the ability of an individual to construct his or her own suitable environment. A quantitative single-group pretest-posttest design using archived participant responses was utilized in order to determine whether the program was effective in changing nutrition and fitness behaviors. Data from The Food Behavior Checklist, The Perceived Self-Descriptive Questionnaire, and the Nutrition Knowledge Checklist (N = 93) was used to obtain the answers to 5 research hypotheses. Paired sample t-tests and mediational analyses (using multiple regression) were conducted. The findings showed that participants in the program increased fruit and vegetable consumption, levels of physical activity, and the quality of their diet but had no significant effect on their perception of general fitness. It is clear that programs such as this one can be effective in altering the health behaviors of adolescents. The results of this study will positively contribute to social change by providing empirical support for the effectiveness of an intervention to improve nutrition and fitness activities in adolescents and modeling healthy behaviors to families and communities in an effort to reduce not only early-age mortality but also the increased health care costs associated with obesity.

Breast cancer is a widespread public health issue in the United States which affects all women. Although mammography is a proven screening tool, screening rates vary widely. Self-reported health status may play a role in how women perceive their risks for developing breast cancer, which may affect mammography use. The purpose of this cross-sectional survey study was to assess the association between self-reported health status and perceived risk for developing breast cancer, as well as perceived barriers towards mammography screening and use. Social action theory, which holds that social and the psychological factors influence health behaviors, served as the theoretical foundation of the study. A convenience sample of 309 African American, non-Hispanic White, and Hispanic women, aged 30+, was recruited to participate in the study. Linear and logistic regression analyses revealed the model including all variables were significance between self-reported health status, demographic characteristics, and the dependent variables perceived risk of breast cancer, receipt of a mammogram in the last 2 years, and barriers (personal, economic, and health). However, self-reported health status was not a significant individual predictor in any of the analyses, and the null hypotheses for the research questions were not rejected. This study may promote positive social change by providing information on the necessity of interdisciplinary and interrelated educational and intervention approaches to address the challenges of women from diverse populations receiving regular mammograms.

Herpes simplex viruses (HSVs), are among the most virulent and widespread pathogens; they affect 60-90% of the population worldwide. Substantial evidence indicates a possible association between pathogens and chronic disease. HSVs, among other viruses, have been associated with increased risk for inflammatory diseases. However, prior findings have been inconsistent on the role of infection in triggering autoimmune response and chronic disease. This study builds on the premise that pathogens can induce an inflammatory response and increase the risk for disease development. A representative U.S. sample from NHANES, a national population-based cross-sectional survey, was used to examine the relationship between HSVs infection and type 2 diabetes mellitus (T2DM) and cardiovascular disease (CVD). Results from the two-tailed, Pearson chi-square test and multiple logistic regression analyses found no significant association between HSV or multiple herpes virus infections and T2DM or CVD, which suggest rather a secondary phenomenon. However, all the risk factors examined in this study indicated an association with either T2DM, CVD or both. Two inflammatory markers, C-reactive protein (CRP) and serum ferritin, were significantly associated with T2DM and CVD. These findings have potential implications for social change as they support the premise that high levels of CRP and ferritin may be associated with T2DM and CVD. Existing guidelines for primary and secondary prevention of T2DM and CVD could be expanded (a) to include CRP and ferritin as part of the health assessment for T2DM and CVD in high-risk populations, and (b) to explore the effectiveness of CRP and ferritin as predictive biomarkers and prognostic tools for T2DM and CVD.

Hispanics are at increased risk for diabetes and are 40% more likely to die from the condition than are non-Hispanic Caucasians. The purpose of this project was to determine the effects of diabetes education conducted in Spanish by bilingual staff on the self-management and self-efficacy of a sample of 50 volunteer adult Hispanic clinic patients with diabetes. The education intervention incorporated the American Diabetes Association's Diabetes Self-Management Education program materials. Bandura's self-efficacy theory was selected as the theoretical support for the project that relied on self-management education of the patients to improve their self-efficacy to undertake the interventions necessary to manage their disease. The Diabetes Self-Management Questionnaire measured patient understanding and self-care management of diabetes before and after the education intervention, and the Diabetes Self-Efficacy Scale measured the self-efficacy of the patients before and after the intervention. Paired sample t tests were calculated to compare the pretest to posttest scores on the full questionnaire and subscales. The full scale and the glucose monitoring control and physical activity subscales showed statistically significant improvement pretest to posttest. An increase in the pretest to posttest Diabetes Self-Efficacy Scale scores was not significant. Results indicated that the diabetes education was an effective way to improve self-reported daily blood glucose monitoring and physical activity. The project may result in positive social change from the better self-management of some diabetes control skills among Hispanic adult patients when education is delivered in Spanish.

Violence is among the most serious threats to the health and safety of young people between the ages of 10 and 24 in the United States. The purpose of this cross-sectional quantitative study using secondary data from the CDC's 2015 National Hospital Ambulatory Medical Care Survey (NHAMCS) data set was to examine the characteristics (age, sex, race and ethnicity, insurance or payer source, and housing status) of young people between the ages of 10 and 24 who seek medical care for assault-related injuries through the emergency department (ED). The social ecological model was used to examine the complex interplay between individual, relationship, community, and societal factors, which allows for a better understanding of the range of factors that put people at risk for or protect them from being a victim of or engaging in violence. Chi-square and logistic regression with clustered robust standard errors was used to analyze the differences and the relationships between 6 characteristic variables and the likelihood of ED visits among young people between the ages of 10 and 24 for assault-related injuries. The results of this study provide researchers with a better understanding of the demographics of young people who seek care in the ED for assault-related injuries. Understanding this population is critical in examining the effectiveness of ED-based youth violence prevention programs. Future research is needed to understand the value and outcomes of existing ED-based youth violence prevention programs. Should public health practitioners use these results, positive social change can occur by empowering social norms that value equality, safety, and human rights instead of valuing power over another and the acceptance of violent behaviors as normal.

Numerous quantitative studies have assessed caregiver burden in multiple chronic diseases, but an identified gap and underrepresentation exists in the literature regarding studies using an inductive approach that allow informal caregivers to describe the lived experiences of caring for Black men receiving hemodialysis. The transactional model of stress and coping and the stress process model guided this study. The key research questions centered on the experiences, psychological, physical, and financial limitations associated with caregiving. This phenomenological study used a purposive sample of 15 unpaid primary caregivers over the age of 18 caring for a Black male on hemodialysis from Mecklenburg County. Semi-structured face-to-face interviews were audio-recorded, transcribed, and analyzed for significant themes. The findings indicated majority of the participants experienced psychological reactions, a decline in their physical health, and financial stressors. The participants noticed a change in their loved one and felt caregiving was hard work but found the experience meaningful from a cultural perspective. Although, majority of the participants had family and healthcare providers supported them, they reported the need for additional resources to assist with providing adequate care for their loved one. This study can contribute to social change by providing healthcare professionals with the knowledge to better identify changes in practice necessary to support the needs of informal caregivers. Further research should include implementing informal caregiver support programs, studies addressing the cultural differences and needs of informal caregivers, and the perceptions of Black male patients receiving hemodialysis to address the underrepresentation of Black men in research.

A series of psychiatric hospital closures has led to a movement of care for individuals with mental illness from state-run facilities to managed care centers. Many of the individuals who no longer reside in psychiatric hospitals have become ensnared in the criminal justice system. Correctional facilities have an increased burden to care for the needs of the mentally ill, but lack the training and facilities to do so adequately. In this study, the lived experiences of correctional staff who have experienced the process of a hospital closure were examined. Psychiatric rehabilitation and gatekeeper theories served as the theoretical framework for the study. Data were collected using focus group interviews with 17 correctional officers and individual interviews with 3 administrative staffers at a jail in a southern U.S. state. Data were recorded and transcribed and then analyzed for themes. Six themes emerged: (a) open the psychiatric hospital back up, (b) training, (c) they don't need to be here, (d) mental health housing/they can't function in general population, (e) public awareness, and (f) they didn't think it through. Analysis of study data resulted in the identification of several gaps in community supports that can improve the lives of mentally ill individuals. These include avoiding future hospital closures, improving correctional mental health bed space, and providing correctional-specific training for staff at the jail. The study has positive social change implications for both correctional staff and mentally ill inmates in that the study can inform the improvement of officer training and the development of new community supports, which can reduce negative outcomes for mentally ill individuals.