Many researchers have documented the trend of decreasing financial support from donors for human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS) responses in Ethiopia. Less information is available regarding the correlation between trends of HIV prevalence and external funding and ways to address the impact that funding scarcity could cause. The purpose of this study was to examine the trend of HIV prevalence and donor funding levels, analyzing how the 2 are correlated, and opportunities to improve responses. Using the proximate determinant framework, the research questions examined the changes in HIV prevalence in Ethiopia during the past 10 years; the association between the trends of HIV prevalence, funding levels, and services provided; and the effect of different characteristics on the trend of the prevalence. A paired sample t-test, time series forecasting, Pearson correlation, chi-square test, and multiple regression were employed using a secondary data of sampled 1,067 people from the Demographic and Health Surveys and data from donors. Results indicated that the change in prevalence was statistically significant (t [10] = 4.59, p = .001), and correlated with the funding levels(r (10) = .635*, p = .027), a significant relationship between funding level and type of services, Ï?2 (2, N = 1067) = 1425.7, p <.001 and a significant regression equation to predict HIV prevalence (F (9, 1056) = 12.639, p < .001). The results from this study could be used to inform the Ministry of Health of Ethiopia and HIV project implementers to plan for domestic sustainable financing initiatives, invest based upon evidence-based HIV prevention strategies that could most directly impact quality of life and guide future research.

No-show appointments, also referred to as missed appointments, occur 23% to 34% annually in general practice care settings. Missed appointments can lead to reduction in appointment availability, decrease in provider/staff productivity, patient/provider discordance, disruption in continuity of care, and reduced quality of care. There is a gap in the nursing literature regarding effective interventions to reduce missed appointments. The purpose of this quality improvement, secondary analysis project was to determine whether implementation of an evidence-based no-show, nurse-led intervention would reduce missed appointment rates in a family medicine practice. The health belief model and the plan, do, study, act model guided this no-show project. Convenience sampled, password-secured quantitative data from nurse practitioner schedules were analyzed using a check-sheet tool and spreadsheet software. Data showed that after implementation of the evidence-based, nurse-led interventions, there was a reduction of no-shows with a decline from 23.5% in September and November 2017 to 17% in September and November 2018. Results of this no-show project might promote positive social change by increasing awareness of evidence-based interventions that are effective for reducing missed appointments in primary care practices.

Human immunodeficiency virus (HIV) has become one of the world's most serious health and development challenges. It is important for African American female students who attend Historically Black Colleges and Universities (HBCUs), to engage in routine HIV testing and know their HIV status based on the high prevalence rate of HIV/AIDS among African American women and the risk of engaging in risky sexual behavior in a college. This qualitative study was developed to help gain a better understanding of how African American female students who attend HBCUs make the decision to engage in HIV testing and their attitudes toward HIV testing. Face-to-face individual interviews were conducted to collect data from African American female students who attend a HBCU. By using the theory of reasoned action and planned behavior (TRA/TPB), behaviors, intentions, attitudes, subjective norms and perceived behavioral control were explored by addressing questions and topics related to attitudes and decision making toward HIV testing. The women interviewed in this study had accepting and positive attitudes toward HIV testing. Perceived risk level was the leading a factor in making the decision to be tested for HIV among participating women. Understanding how these factors affect communities will help public health professionals, educators, community leaders, university personnel, policy makers, community organizations, and researchers develop the most effective strategies for the development and delivery of HIV testing messages that target African American female students who attend HBCUs.

In 2012, 48,277 cases of pertussis were diagnosed in the United States. Pertussis, otherwise known as whooping cough, is a highly contagious, often debilitating, sometimes deadly, vaccine-preventable disease with an increasing incidence and death rate in the U.S, which may be due to vaccine exemptions. The purpose of this project was to determine if a relationship exists between immunization policies and immunization exemption rates, immunization exemption rates and pertussis rates, and immunization policies and pertussis rates in each state. Bronfenbrenner's bio-ecological framework was used to guide the project. Publically available data from the Centers for Disease Control and Prevention (CDC), schools of public health, state health departments, and public health officials were retrieved for this cross-sectional, ecological comparison study. Spearman's r product-moment correlation coefficient was used to investigate the relationship between the variables. States with lenient vaccine laws had higher exemption rates (r = .359, p < .01), and states with higher exemption rates had higher pertussis rates (r = .470, p < .01). Finally, states with lenient vaccine laws had higher pertussis rates (r = .111, p = 0.439). This project should be added to the literature used to inform and educate the public as well as influence policy makers. As a result of this study, arguments for eliminating non-medical vaccine exemptions should be strengthened. As policies are changed, social change should follow in the form of decreased immunization exemption rates and decreased pertussis rates.

The carrier frequency for sickle cell anemia among Nigerians, who account for a high percentage of African immigrants in the United States, is high, according to the World Health Organization. Even though sickle cell disease contributes $2.4 billion annually to U.S. health care expenditures, ascertaining the number of affected individuals in the U.S. is difficult because sickle cell is not a reportable genetic disease. However, according to the Census Bureau, the number of African immigrants continues to grow at a steady pace among the foreign-born immigrant population in the U.S. There is a lack of research on the contribution of the immigrant population to the sickle cell incidence and mortality rates in the U.S. The purpose of this study was to examine the level of awareness and attitude of young Nigerian immigrants in the United States to sickle cell screening and premarital genetic testing. The health belief model constituted the study's theoretical foundation. It was assumed that the level of awareness of sickle cell disease and the romantic choices among young Nigerian college and graduate students in the United States would have a direct relationship. A sample of undergraduate and graduate students of Nigerian origin completed an online survey developed for the study. The results from SPSS analyses indicated that even though this population sample has a high knowledge and awareness of sickle cell disease, they are non-committal about adapting and implementing such knowledge when making romantic choices. In order to continue to reduce the burden of sickle cell disease on healthcare delivery in the United States, public health education programs that address the adaptation and implementation of knowledge about sickle cell disease are needed.

Low-income immigrants in the United States experience declining health with increasing length of stay in the country. Their declining health over time has been associated with increased smoking, obesity prevalence, and higher risk for developing diabetes and heart disease. How immigrants perceive their body weight and size, influenced by social interaction, culture, gender, and acculturation is also significant to healthy weight maintenance. Not knowing one's healthy weight could result in body weight misperception and resistance to attaining a healthy weight. The aim of this qualitative study, based on the social constructivist framework, was to understand Nigerian women immigrants' (NWI's) body weight self-perceptions (BWSPs), their experiences with weight changes after immigration, and what it meant to them within their historical, immigration, and cultural contexts. Data were collected from audio recorded interviews of 8 purposefully selected NWIs living in Middle Tennessee. After a process of content analysis of transcribed interviews using NVivo, participants' BWSPs were described and interpreted using hermeneutic phenomenology. The key findings of this research were that participants perceived themselves overweight compared to when they had just immigrated to the United States; believed that age, marriage, change in environment and food contributed to their weight gain; and were not accepting of their weight gain, which led them to eating healthier and moving more in order to lose weight. Findings from this research have social change implications for reducing health disparities by disseminating timely health information accessible to immigrants to educate them about nutrition and physical activity behaviors for healthy weight maintenance.

Preventive quality ordering is a provider intervention aimed at disease prevention through the ordering of industry-recommended health maintenance tests. This pilot study evaluated the effectiveness of provider mentoring/coaching to improve preventive quality ordering using the 2014 Agency for Healthcare Research and Quality best practice preventive clinical services guidelines. Literature indicates provider inconsistency in preventive and quality ordering as the primary cause of disparate health outcomes. Guided by theories of modeling and role-modeling, as well as the theory of cognitive continuum, this pilot study offered provider mentoring/coaching to encourage timely preventative quality ordering. Routinely monitored historic provider practice patterns in a proprietary database were analyzed; 10 providers with the lowest ordering patterns were identified for participation. Mentoring/coaching interventions were provided to improve preventive quality measure ordering. This process included a review of the 2014 Adult Healthcare Effectiveness Data and Information Set documentation criteria, a preventive measures clinical checklist, medical record preparation guidance, clinical shadowing, and post-training discussions. Following the pilot, a 5-person subject matter expert panel of key organizational leaders used on-site observations and standardized semi-structured interviews to evaluate the usefulness of mentoring/coaching and the developed documents to improve timely quality ordering. This small-scale pilot study (a) improved providers' awareness of quality ordering through peer mentoring, communication, and training; and (b) provided a platform for future initiatives. A larger follow-up study will allow healthcare leaders/providers to address disparate health outcomes, and patients will likely benefit from optimal delivery of preventive care.

Several artifacts of federal policy address the connection between health literacy of patients and health outcomes. These laws include The Plain Writing Act, Health Information Technology for Economic and Clinical Health, and the Health Insurance Portability and Accountability Act. Even with this policy structure, little is known about how nurses' knowledge of health literacy may influence patient understanding of medical information and health outcomes. Using Knowles' principles of effective communication, the purpose of this mixed-methods study was to concurrently examine the relationship between nurse knowledge of health literacy and communication techniques used by nurses to identify any causal relationships in the provider-patient-interaction linking health literacy and health outcomes. Quantitative and qualitative data were gathered from 47 registered nurses in south Florida using an online survey. These data were analyzed using descriptive statistics and a content analysis procedure. Descriptive statistics revealed that there is a lack of health literacy knowledge among nurses and nurses rarely or never use Knowles' communication techniques to relay health information to patients. By contrast, content analysis of qualitative data revealed that nurses have a basic understanding of the complexities of health literacy. No correlation existed between a nurse's knowledge of health literacy and the use of appropriate and varied communication techniques when the data sets were merged. This finding suggests that there may be another root cause of low health literacy that requires additional research to fully explore. The positive social change implications stemming from this study include recommendations to policy makers to encourages changes to existing law and policy that supports patient communication training to nurses in order to improve health outcomes for patients.

Expansion of Medicaid and private health insurance coverage through passage of the Affordable Care Act of 2010 was expected to increase primary care access and reduce emergency department (ED) use by reducing financial burden and improving affordability of care. The aim of this study was to examine the differences in utilization patterns that exist among the Medicaid population that participated in an optimal level of care (OLC) intervention inclusive of appointments scheduled to primary care providers. Using the integrated behavior model as a theoretical framework, the key research question focused on determining if there was a difference in ED use among Medicaid individuals who scheduled follow-up appointments compared to those that did not schedule follow-up appointments. The sample population consisted of 176 Medicaid enrollees who presented to the ED for treatment of nonurgent conditions and participated in an OLC intervention from June 2016 to July 2017. The results showed that there were no differences in ED utilization between the population that had scheduled appointments compared to the population that did not have scheduled appointments. A bivariate analysis on demographic variables also showed no differences in ED utilization among the variables. The social change implications of this study are that the practice of scheduling appointments with primary care providers does not reduce or affect ED utilization in the Medicaid population. This study contributes to positive social change through the findings that reducing ED utilization requires more than follow-up appointment scheduling with primary care providers. Further studies are warranted to understand the potential barriers and factors that affect ED utilization.

Most individuals with chronic diseases, such as cardiovascular disease, stroke, cancer, and type 2 diabetes, were diagnosed in their late adulthood. The fact that these chronic diseases is a consequence of long-term unhealthy behaviors is often ignored. The unhealthy behaviors are often traced back to the young adulthood (age 18-25). Some young adults may participate in unhealthy behaviors, such as unhealthy diet, under the perception that they are “still young”. However, it is often overlooked that once a habit is established, it is difficult to eliminate or modify it. Furthermore, the awareness that the development of the chronic disease is a gradual progress is deficient. This enhances the perception that doing unhealthy behaviors is benign to the “young body”. Additionally, individuals in this age group start to live independently. Their existing behaviors may change due to the changes in the available resources. Lack of capability to cope with the transition from living at home to living independently has been shown to contribute to an unhealthy diet, especially among college students. Given that unhealthy diet behaviors in young adulthood often remains over the lifetime, there is a need in identifying the factors that motivate the food choices during the transition from high school into college life. The findings of this research suggest that the campus environment is not conducive to a healthy diet. When compared to the students who live on-campus, students who live offcampus (either live with or without family) reported a better dietary quality.