Obesity is an increasingly prevalent health issue, especially among children who live in high poverty, low income, and low education areas that lack needed resources and health care to promote quality of life. African American youth have a higher rate of obesity than other populations. The purpose of this project was to address an identified gap in practice by improving health care professionals' ability to provide culturally competent care to African American youth. An educational intervention framed by the Purnell model for cultural competence was developed to address the question, Will cultural competency staff education improve knowledge to prevent and manage childhood obesity among African American youth ages 2 to 19? Health care professionals (n = 10) in 5 community clinics completed the 17-item, 5-point Likert response Cultural Competence Assessment before and after an online education module. The higher the sum of the scores on the items, the higher the self-assessed cultural competence. Using Cohen's d statistic to calculate effect size, a small effect size was found on 1 item, a medium effect size was found on 1 item, and a large effect size was found on 15 items, indicating an increase in self-assessment of cultural competency after the education intervention. The findings demonstrate that education can increase health care professionals' knowledge about how to provide culturally competent management of African American childhood obesity. Practicing culturally competent preventive care in ethnic communities can reduce the gap in practice, which may bring about positive social change in society by decreasing chronic health care comorbidities and disparities in ethnic populations. The project may be of particular interest to nurse providers in primary care and community settings.

Individuals infected with HIV through heterosexual contact made up 24% (9,578) of all new infections in the United States. Female sex workers are at increased risk of getting HIV and other sexually transmitted infections (STI) because they may be more likely to participate in risky sexual behaviors including sex with multiple partners and condom-less anal/vaginal sex. Guided by the syndemic theory, the purpose of this study was to explore the relationships between social and structural factors (homelessness, substance use, immigration status, and use of healthcare) and risky sexual behaviors (condom-less vaginal sex and multiple sex partners) among female sex workers while controlling for age and sexual violence. This study was conducted using a quantitative research approach with a correlational method. Multiple linear regression statistical testing was performed using data from 534 participants from the National HIV Behavioral Surveillance study. Immigration status was not significantly associated with condom-less vaginal sex or multiple sex partners. However, homelessness and substance use were positively associated with condom-less vaginal sex and multiple sex partners. In addition, utilization of healthcare was negatively associated with condom-less vaginal sex. The results from this study can increase awareness and knowledge of challenges and barriers among female sex workers living in Illinois. In addition, the results of this study may contribute to establishing baseline epidemiology of this population and guidelines on addressing the factors associated with unsafe sexual behaviors that can potentially lead to HIV and other STIs.

The intention-behavior gap between receiving professional health information and transitioning to improved health behaviors prior to conception is not well understood. In order to improve preconception health across the board, a more integrative understanding of the problem must present itself. This study combined elements from the theory of planned behavior, self-determination theory, and the bioecological model of human development as it's foundation. Qualitative phenomenology and semistructured face-to-face interviews were used to gain a deeper understanding of the ways in which nine overweight and obese women described preconception intentions and beliefs and the bioecological experiences leading to those beliefs. Interpretation of the results suggested socio-environmental conditions that affect the development of beliefs, intentions, and attitudes toward preconception health. Key discoveries regarding planning intention and behavior included laissez faire attitudes toward preconception planning, advice-seeking methods, perceived need to change behaviors, and ability to navigate the healthcare system and social programs. Future recommendations include using the more complex bioecological view to improve the global preconception health imperative. This study's potential for positive social change includes opportunities to hold important conversations about preconception health by disseminating study results locally and the expansion of knowledge in a field dedicated to the improvement of women and infant health worldwide through publication.

This qualitative case study explored faculty perceptions regarding best practices and uses of assessment in a dental hygiene program at a small northwestern college. It was discovered that faculty in the program were assessing students in their clinical courses using widely varied methods, designs, and scoring tools. Faculty neither calibrated processes nor communicated about this problem. In addition, a review of the assessments in this local setting indicated a significant gap in the current guidelines for best practices in clinical assessment procedures. Knowles' adult learning theory served as the foundation for this study. Research questions were designed to obtain clinical faculty's perceptions of their knowledge of best practices in assessment, assessment design, methods including scoring tools, and how faculty could work collaboratively to implement clearly and consistently designed best-practice assessments in their clinical courses. Interviews and reviews of assessment documents were conducted with a purposeful sample of 8 faculty participants. Data were coded and analyzed for common themes. Results indicated that instructors did not collaborate and had little knowledge of assessment criteria based on best practices, administration, and scoring procedures. At the request of the dean, a position paper was created as a project. The paper outlined strategies for designing clinical skills assessments with criteria that is consistent, clear, and based on best practices. Also included were procedures for ongoing faculty professional development and collaboration, insuring that faculty are calibrated and that assessments are valid and reliable. The results of this study can promote positive social change as faculty in this program will be increasingly confident in assessment practices, and graduates will consistently provide greater quality patient and community care.

Many investigators have documented high levels of stress in the U.S. workplace and the underutilization of employee assistance programs (EAP). Researchers in other studies have concluded that an employee's perception of a service influences participation and service use. However, the perceptions of geographically distributed employees, who represent a growing population, have not been sufficiently examined. The purpose of this study was to investigate geographically distributed employees' perceptions regarding access to EAP stress management services to address the problem of EAP underutilization. Organizational justice theory served as the theoretical framework. The study design was generic qualitative. A purposeful sample of 15 geographically distributed employees provided rich data through semi structured interviews and online questionnaires. The use of generic inductive coding yielded emergent themes regarding geographically distributed employees. Results indicated that geographically distributed employee's perceived access to EAP stress management services as unclear, time-consuming, and inconvenient due to physical separation. This research is significant for human service, employee assistance, and human resource professionals who want to improve geographically distributed employees' perceptions of access to EAP stress management programs. More effective marketing may increase employee use of EAP services and alleviate workplace stress, thus positively impacting social change by helping to cultivate a healthy workforce.

Racial/ethnic minority groups experience a higher mortality rate, a lower life expectancy, and worse mental health outcomes than non-Hispanic in the United States. There is a scarcity of qualitative studies on racial/ethnic health disparities. The purpose of this hermeneutic phenomenological study was to explore the personal experiences, attitudes, and perspectives of 6 African American adults with chronic health issues related to diabetes through a face-to-face interview. Social cognitive theory and health belief model guided the study. The participants were recruited through purposeful sampling. The data were coded using axial and thematic coding and subsequently analyzed through phenomenological interpretive inquiry. The participants' perceived experiences were summarized in 7 themes (Beliefs and perceptions, denial, attitudes, treatment cost, neighborhood effect, juggling work and family related stress, and need for positive motivation and support). The participants' experiences with their health outcomes were influenced by internal and some external factors that were beyond their control. Social change implications include public policy makers integrating health policies that are designed for socioeconomic inequality in the neighborhood and improving health insurance company policies on treatment copays. Public health and other human services professionals can develop health intervention to assist minorities with chronic health issues to manage their disease and overcome barriers related to the disease.

Breastfeeding offers numerous health benefits to both the mother and infant, yet it is not routinely practiced due to a number of internal and external factors that influence the mother's decision. Guided by the social ecological model, the purpose of this study was to examine the effect of required reporting to The Joint Commission on perinatal measures, a proxy measure for maternity care practices, and those professional effects on breastfeeding initiation and exclusivity for first-time mothers. The hypotheses were that the mandatory reporting, and thus an increase in maternity care practices, would increase the initiation of breastfeeding and exclusive breastfeeding on discharge in first-time mothers. This study was a quantitative retrospective study design that included data collected from the medical records of 1,000 mothers from Southeast Alabama Medical Center who gave birth between 2013 and 2014. The multiple logistic regression analysis indicated that the odds ratio for initiation of breastfeeding was greater among first-time mothers after implementation of mandatory reporting measures (OR = 2.07; p = 0.0007); however, the odds for exclusive breastfeeding on discharge did not show a statistically significant change (OR = 0.94; p = 0.7507). These findings may inform the work of healthcare providers at hospitals, community centers, and public health workers, guiding their maternity care practices to increase the number of first-time mothers who will breastfeed for longer periods of time and improving children's health outcomes.

Health care administrators in Ontario want to transform health care with a focus on improving efficiency and quality of care, yet they pay little attention to increasing revenue. The purpose of this qualitative case study was to explore strategies Ontario hospital administrators apply to generate nongovernment revenue to remain sustainable. The target study population consisted of 2 chief executive officers and 2 chief financial officers at Ontario academic research hospitals. The conceptual framework for this study included radical organizational change theory supported by complexity leadership theory, and grounded in an evidence-based approach. The researcher conducted open-ended semi-structured interviews and made efforts to collect relevant documents. The data analysis process included coding of the interviews followed by identifying themes and aggregate dimensions. Five themes emerged including working within the fiscal reality, the impact of the political environment, the focus on the mission, nongovernment revenue generation, and opportunities for the Ontario academic research hospital. The application of the findings from this study may contribute to social change by encouraging hospital executives to adopt a more coordinated and consistent approach to generating nongovernment revenue to support the mission of their hospitals.

Stroke is associated with significant health disparity and predominantly affects the elderly. Stroke outcome is significantly improved if an individual is able to get "clot-bursting" medication. A significant predictor of an on-time arrival to the emergency room for treatment in the event of a stroke is the ability to accurately recognize stroke signs and symptoms. The purpose of this study was to determine the factors (demographic, socioeconomic, and educational) that predict the knowledge of stroke signs/symptoms and intent to call 911 in the event of a stroke. The study was grounded in the social ecological theoretical model and analyzed archived data from 11,537 African Americans to answer the research questions. Multivariable analysis and chi-square analysis for trend were done to determine the predictors of knowledge of stroke signs and symptoms, intent to call 911, and their respective trends. Results show that respondents who were 18-39 years of age were less likely to have a low to no knowledge (OR = 0.46, CI = 0.27 - 0.80), while those who had a high school (OR = 1.95, CI = 1.28 - 2.96) or less than high school (OR = 2.83, CI = 2.03 - 3.96) level of education were more likely to have low to no knowledge of stroke signs and symptoms. Further, while males were less likely (OR = 0.65, CI = 0.64 - 0.66), respondents age 40-64 years (OR = 1.87, CI = 1.14 - 3.09), and those with moderate to adequate knowledge of stroke (OR = 1.39, CI = 1.18 - 1.65), were more likely to say they intend to call 911 in the event of a stroke. This study may lead to policies to improve stroke knowledge among the elderly. Targeted stroke education based on age, education, and socioeconomic status should be a component of such policy. Additionally, this study may lead to the provision of sidewalks and health education programs to improve risk factor control and could thus impact stroke incidence.

Intimate partner abuse has been and remains a pervasive problem that has been documented in every race, religion, class, and level of education. This study presented the rationale for achieving positive social change by examining the problem through prevention rather than reaction and intervention. Although many theories of causation have been presented at various times, none has been proven or offers a complete explanation. Social ecological theory examines the interaction of individual, community, relational, and societal influences on the development of attitudes and behavior acceptance. This pre and post-survey group, quasi-experimental study examined the effects of an intervention on attitudes about intimate partner abuse, specifically in young adults. The intervention was a 30-minute drama about dating abuse. Seventy-nine young adults from an online participant pool completed the Domestic Violence Myth Acceptance Scale (DVMAS) just prior to and after the intervention. Cronbach's alpha test of reliability was conducted on the 4 subscales of the DVMAS. Demographic data were presented on age, marital status, gender, and church attendance. A MANOVA did not demonstrate a significant difference between the overall scores on the DVMAS or the 4 sub scales before and after the intervention (p = .230). This research contributes to social change by adding to the body of knowledge about applications of social ecological theory to intimate partner abuse prevention. Attitudes and behaviors that lead to the perpetration or acceptance of intimate partner abuse do not arise from a single incident, discussion, or point in time. Multiple levels of exposures and multiple exposures contribute to the behavior and ultimately will be necessary for its prevention.