Health literacy is a social determinant of health and health disparity and low health literacy contributes to poor health outcomes in ethnic minority young adults (EMYAs). There is a gap in the literature regarding the health literacy readiness (HLR) of EMYAs transitioning to adulthood. The overarching research question concerned the perspectives of EMYAs on HLR for the transition to adulthood. A phenomenological study design was used with a theoretical framework that integrated concepts from the socioecological and health belief models. Twelve purposefully selected EMYAs ages 18-22 from a southern U.S. county participated in the study. Data were collected by telephone using semistructured interviews. The interview questions centered on EMYAs' self-assessed HLR for the transition to adulthood, attitudes and beliefs about HLR, barriers to and benefits from HLR, and facilitators of HLR for the transition to adulthood. Recorded data were transcribed and analyzed, spirally coded, and reduced into overarching themes. Three categories emerged: deficient acumen, access problems, and application challenges. Results showed that EMYAs viewed HLR as vital for the transition to adulthood, though 92% reported low HLR. EMYAs reported individual factors; available time and deficient knowledge; and social factors, family support, and deficient school education as influencing their HLR. The study findings revealed poor HLR in EMYAs but identified areas that can be targeted to improve HLR. Results may contribute to positive social change by providing health educators with knowledge they can use to enhance community health engagement strategies and develop culturally sensitive interventions aimed at improving HLR in EMYAs.

Childhood immunization has been one of the most important public health measures in the 20th century. In the United States, 95% of avoidable childhood diseases have been prevented through vaccinations. However, there have been growing concerns around the safety of vaccines, and this increased uncertainty has led to decreases in vaccination participation and increases in cases of preventable diseases. As such, is it important to understand why parents are not vaccinating their children. A qualitative approach was utilized to conduct this study. Flyers to recruit participants were distributed by healthcare providers and were posted in church facilities. Ten parents of children ages 3 to 8 years volunteered to participate to discuss their refusal to or delay in vaccinating their children. The health belief model functioned as the theoretical context to guide this phenomenological study approach in examining the reasons parents are not vaccinating or delaying vaccination of their children. Analysis included constructing a written description of the phenomenon as experienced by the research participants using their responses to the research question, followed by developing response coding schemes, identifying themes, justifying findings, and ensuring sound analysis and reporting of information. For example, word frequency and common phrases were the first steps of the analysis. Results showed that parents had a negative reaction towards childhood vaccination and felt that either the vaccine schedule was too aggressive or contained dangerous toxins that may have side effects. These findings can be used to assist healthcare providers in the way they provide outreach and education to parents as well as potentially helping develop tools that would encourage parents to vaccinate their children.

Researchers have predicted that by 2020 the United States will experience a severe shortage of registered nurses. The purpose of this correlation study, using the National Sample Survey of Registered Nurses 2008, was to investigate the relationship between nurse job satisfaction and its effect on nurse retention nationwide. Secondary data sets from the 2008 National Sample Survey of Registered Nurses and examining relationships between the variable of nurse retention and job satisfaction. Bivariate (correlation coefficient, chi squares, and simple linear regression) and multivariate (logistic regression) analyses identified and connected associations and examined measurement levels between the dependent and independent variables, including correlation coefficient (r), alpha values, and confidence intervals. Significant inverse relationships, although weak, were found between nurses' age and their job satisfaction level and between the numbers of years since nurses graduated from an initial RN education program and their job satisfaction. In addition, there was a statistically significant relationship between the nurses' highest education level and their job satisfaction. The ordinal regression results showed nurses' age, education, and years practicing since earning the RN were significant predictors of job satisfaction, although other factors might explain changes in satisfaction levels. This study will help bring social change to the health care industry by increasing understanding of what many nurses believe to be important within the nursing field, which could help health care facilities retain qualified nurses. Specifically, the results could help community hospital leaders find innovative ways to support nurses and increase nurse retention in small rural hospitals.

Casual sex culture, also known as hook-up culture, is an experience adversely affecting teens in America. The intent of this study was to test the association between sports participation and sexual risk behaviors among high school males. For the purpose of this study, sports participation, the independent variable, was defined by having played on a sports team in the last 12 months. The sexual risk behaviors, dependent variables, were defined by sexual engagement with multiple partners, drug and alcohol use before intercourse, and sex without condoms. The ecological model provided the theoretical foundation for the study. Secondary analysis of the 2015 Youth Risk Behavioral Surveillance System using logistic regression was employed to test if there was an association between sports participation and sexual risk behaviors in 7,749 high school males. Using regression analysis, a significant association was found between sports participation and abstinence status, number of sexual partners, and drug and alcohol use at last sexual intercourse. As the number of sports teams increased, the number of abstinent participants increased, the number of sexual partners decreased, and the number of participants who used drugs and alcohol at last sexual intercourse decreased. However, there was no association between sports participation and condom use at last sexual intercourse. Recommendations for next steps include using sports programs as a vehicle to influence behavior change. This study aimed to promote social change by improving the understanding of how sports programs benefit individuals, families, and communities from reducing sexual risk behaviors in teen males.

Cognitive impairment is commonly seen in the elderly population. It is unclear if cognitive deficit in heart failure (HF) patients is a primary factor for higher hospital readmission rates in this population. The Centers for Medicare and Medicaid Services have established strict guidelines for reimbursement on readmissions that occur within 30 days. It is imperative that organizations identify and rectify issues that impact readmissions. The aim of this project was to determine if there is a reduction in HF readmission after patients are screened for cognitive impairment. Orem's self-care model guided the project by providing a framework of inquiry regarding the impact of cognitive impairment on self-care deficits and the need for support for persons with heart failure. The project examined the hospital's 30-day readmission rate for the HF patients who received cognitive screening using a chi-square test; this analysis excluded HF patients who were not screened for cognitive impairment. Readmission rates for all patients during a 6-month period were examined. Two hundred sixty-eight patient records were reviewed; 48 patients were readmitted, and of those, 28 patients had completed the cognitive assessment, meeting the criteria for the project. The change in readmission rates was not significant (p = 0.196), suggesting that cognitive screening of patients is not associated with reduced readmission rates. Further research should examine the role of cognitive screening in addition to other resources on the 30-day readmission rate of HF patients. Social change will be improved as a result of the improved quality of life for HF patients and the reduced per-capita cost of health care in the United States.

Health literacy has been recognized as a vital issue in the self-care management of persons living with HIV/AIDS (PLWHA). The purpose of this study was to determine the impact of functional, communicative, and critical health literacy dimensions on positive and negative attitudes toward health decision making. The transtheoretical model of health behavior change (TTM) provided the theoretical framework to explain this association. A culturally-adapted survey was used in this cross-sectional study to measure health literacy dimensions, positive and negatives attitudes toward health decision making, and other factors in 100 Puerto Ricans living with HIV/AIDS. Demographic factors and clinical and immunological variables were obtained from the HIV/AIDS Registry database. Bivariate analyses were conducted to determine associations and multiple logistic regression analyses were used to determine the extent to which health literacy and other factors, while controlling for demographic characteristics, disease duration, and stage of readiness, predicted positive and negative attitudes toward health decision making. Results revealed that Puerto Ricans living with HIV/AIDS with higher health literacy scores are more likely to have positive attitudes toward health decision making. HIV/AIDS disease-specific knowledge and self-report HIV medication adherence showed statistical significance for functional and critical health literacy. Social change implications included the identification of limited health literacy as a potential barrier for an active participation in health decision making. The development of interventions directed to increase health literacy skills to improve HIV medication adherence and disease management are needed.

African Americans living in the Southeastern region of the United States disproportionately contract sexually transmitted infections (STIs), including human immunodeficiency virus (HIV). Facebook and other social media sites are becoming a way to deliver health-related messaging to targeted populations. The purpose of this quantitative, cross-sectional study was to examine the association between selected demographic factors and impact of social media on intent to change sexual behaviors among 112 African Americans between the ages of 18 and 49 in the Southeastern United States who viewed STI/HIV prevention materials on Facebook within 1 year prior to the study. The theory of planned behavior was used to help understand and interpret the findings. Participants completed an online self-report survey containing questions about their exposure to sexual health messages on Facebook and their intent to change behavior. Results of the multiple logistic regression analyses indicated that gender (p =.462), age (p =.122), education (p =.593), and income (p =.200) were not statistically associated with the dependent variable, intent to change risky sexual behaviors. A majority of respondents indicated the intention to change their sexual behaviors as a result of viewing HIV prevention messages on Facebook, and that the messages were the most important factor in their decision to change behavior. Facebook messaging may be an effective platform for reaching African Americans and influencing behavior; however more research is needed to fully understand the use of social media for STI prevention. The social change implication of this research is the potential to decrease HIV/STI associated morbidity and mortality among this population.

The Ebola outbreak in West Africa in 2014 to 2016 had more than 28,000 suspected, probable, and confirmed cases. It was the largest Ebola outbreak in history. Of the 28,000 cases in the three Ebola-affected countries, Liberia had 10,000 cases with almost 5,000 deaths. The Ebola Virus Disease (EVD) entered Liberia along the border of Guinea and moved to the capital city of Monrovia where the virus spread. Ebola Treatment Units (ETUs) were constructed throughout the response in locations where there were available facilities versus distance to care challenges. This study examined the association of distance from villages to ETUs and mortality. Using Geographic Information System (GIS) and statistics framed within the Social Ecological Model and the GIS Framework, this study geolocated the Ebola cases by village, mapped the travel routes and calculated the distance to the ETU. A logistic regression was then used to determine if there was an association between distance and mortality, with and without controlling for age and gender, and, to calculate the odds ratio. A logistic regression model showed there is an association between distance and mortality and that Ebola patients living within 12 kilometers of the ETU were 1.8 times less at risk of mortality (OR = 1.778, 95% CI [1.171 - 2.7]) than those living more than 12 kilometers. In addition, males had a 1.4 times lower risk of death due to EVD. This understanding can inform future outbreak responses and placement of treatment units. In addition, this information can lead to social change with respect to individual understanding of access to care, community expectations, and national health care planning.

Researchers have identified higher incidence rates and mortality rates among African American men (AAM) diagnosed with prostate cancer than they have among urban African American men. This quantitative descriptive study was conducted to measure the association between advanced stage and grade of prostate cancer, demographic location, and prostate specific antigen (PSA) levels over a 5-year period in AAM and European American men (EAM) in rural versus urban communities. This study addressed 4 research questions concerning cancer grade, cancer stage, age, geographic location, PSA level, and the impact that each of these variables had on prostate cancer diagnosis in AAM in the United States. Social cognitive theory was used as a conceptual framework, which was to focus on AAM, and their behavior with prostate cancer diagnosis, in rural versus urban communities. The sample was derived from data collected from the Surveillance, Epidemiology, and End Results Program (SEER) database. The population sample size was greater than 20,000. These data were categorically analyzed using a Chi-square test and a t test. Overall, the results of the study showed that there was a statistical difference in rural versus urban populations between AAM and EAM diagnosed with prostate cancer over a 5-year period, and when comparing AAM with EAM in urban versus rural communities over a 5 year period, there was a significant difference in men diagnosed with prostate cancers as well as a significant change among men annually diagnosed with advanced stage prostate cancer. Information provided may have implications for positive social change affecting both rural and urban AAM in reducing fear and promoting prostate cancer awareness. This awareness may reduce advanced stage or grade diagnosis in AAM in both rural and urban communities.

Many children under the age of 5 die each year of invasive pneumococcal disease. Childhood vaccination against this disease reduces morbidity and mortality. Despite the introduction of a pneumococcal conjugate vaccine (PCV13) in a central African country in 2011, all provinces have not yet been vaccinated. The purpose of this quantitative quasi-experimental study was to determine whether there was an association between the introduction of PCV13 and new cases of pneumococcal disease in 2 provinces in central Africa. The sample size for the study was 380. The theoretical framework for this study was the epidemic model supported by the concept of herd immunity. Key research questions examined the incidence of pneumococcal disease in children by age, gender, and province. The independent variables were age, gender, province, and introduction of PCV13. The dependent variable was incidence of invasive pneumococcal disease. The research questions were evaluated using chi-square test of independence and logistic regression. The results of the study indicated that vaccination with PCV13 significantly reduced incident cases of invasive pneumococcal diseases (aOR 0.333, 95% CI 0.628-0.177, p = 0.001). However, this association was not significant for age (aOR 0.574, 95% CI 1.186-0.278, p = .134), and there were no significant gender differences (aOR 1.047, 95% CI 1.929-0.569, p = 0.882). Positive social change may result by enabling the protection of more children in the central Africa country provinces that have not yet adopted using PCV13 and by introducing the vaccine in other African countries.