This study examined the meaning of feeling fearful for nurses entering community/public health (C/PH) nursing. Nurses are entering the C/PH workforce with less experience and education than ever before, and may feel afraid or fearful in their jobs. Additionally, the autonomous nature of C/PH nursing poses significant challenges for this population such as fear of isolation and/ or abandonment. Therefore, the purpose of this qualitative descriptive study was to explicate the meaning of feeling fearful for new C/PH health nurses. Ten nurses with up to 2 years of C/PH experience volunteered for this study. The research questions were guided by the humanbecoming theory and its objectives. The 3 objectives were to describe the significance of feeling fearful; rhythmical patterns of relating connected to feeling fearful; and the concerns, plans, hopes, and dreams related to feeling fearful. Participants provided narratives via face-to-face and telephone interviews. Data were analyzed using manual coding, analysis-synthesis, and were documented in humanbecoming language. The findings revealed a feeling of fear as a disquieting unease arising with the unforeseen, with unpredictable affiliations surfacing amid diverse encounters, and as pondering possibilities arise with potent assuredness. These findings may influence positive social change by providing an opportunity for hospital administrators, nursing faculty, and public health agencies to dialogue about fearful experiences that new C/PH nurses encounter. Moreover, this study could stimulate ideas that foster nonthreatening learning environments in academic nursing programs, C/PH orientations, and nursing residencies.

Although it is known that the prevalence of type 2 diabetes is on the rise in Canada, more information is needed on how well type 2 diabetes patients living in Cambridge, Ontario self-manage their diabetes and what factors influence their adherence to diabetes medication regimens. The objective of this cross-sectional study based on the theory of planned behavior was to determine if there are predictors of adherence to diabetes medications among patients living with type 2 diabetes in Cambridge. The World Health Organization STEPwise Approach to Surveillance was used to collect demographic data. Adherence and diabetes knowledge were assessed with the 8-item Morisky Medication Adherence Scale and the Michigan Diabetes Knowledge Test, respectively. Research subjects were 56 adults recruited through convenience sampling. Predictor variables that were tested included age, gender, level of education, and diabetes education, and the response variable was adherence to diabetes medication. Level of education (p = .001) was the only strong predictor of adherence to diabetes medication in the bivariate logistic regression analysis. In addition, in the multivariate logistic regression analysis, the following combined variables were significantly associated with adherence to type 2 diabetes medication: age and level of education; age and diabetes knowledge; gender and level of education; gender and diabetes knowledge; and level of education and diabetes knowledge. Application of the findings of this study may help to minimize the risk of diabetes-associated complications and improve quality of life for those with type 2 diabetes, thereby reducing type 2 diabetes healthcare costs for patients, insurance payers, and other stakeholders.

Substance Use Disorder (SUD) is associated with high mortality rates and remains a public health concern in the United States. Although, numerous interventions are offered for adolescents struggling with substance misuse, minimal research is available on the effectiveness of treatments to reduce recidivism. Researching the most effective treatment offered to adolescents is crucial to treatment adherence and recovery. The purpose of this study is to determine the most effective SUD treatment for adolescent patients by exploring the perceptions and experiences of treatment therapists providing treatment. The trans-theoretical model was used with elements of the social cognitive theory as a guide to, adolescent placement in treatment programs and behavior changes. Twenty-three treatment therapists at Community Mental Health Centers from 23 counties in the State of Indiana were interviewed using the Colaizzi phenomenological methodological approach to obtain verification, validation, and validity for this study. Results suggested that assertive post-discharge plans after SUD treatment, motivational interviewing, cognitive-behavioral therapy, higher power faith for strength, and family involvement was evidence of effectiveness. Seven themes emerged from 225 significant statements. Among the dominant themes were understanding of SUD as a disease and the importance of family involvement in the treatment process. The study findings have the potential for positive social change to address the stigma of stereotyping of SUD through educational campaigns.

Access to primary care is limited in rural communities across the United States. Evidence supports primary care as the cornerstone of healthcare. The purpose of this project was to explore community perceptions of barriers to primary care access with the aim of learning about ideas for possible interventions that could improve primary care access for Mifflin County residents. Penchansky and Thomas's model of healthcare access provided the theoretical framework for this qualitative phenomenological study. Using a community-based research approach, semistructured, open-ended telephone interviews and qualitative surveys were conducted with 26 participants, including physicians, nurses, and residents. Data were analyzed using Edward and Welch's extension of Colaizzi's 7-step method for qualitative data analysis. Key findings included perceptions that (a) primary care access is limited in Mifflin County due to inadequate health services emanating from insufficient community health centers, provider shortages, health insurance issues; (b) high cost and poor choice of services discourage residents from seeking preventative care; (c) distance from services reduce residents' ability to access primary care; (d) service problems impact the quality of care received, such as a lack of provider training in opiate addiction; and (e) providers and residents should be involved in primary care service planning since they can provide valuable information to help improve access to services. Positive social change could occur through improvement in access to primary care using a collaborative approach and community involvement, in policy formation and service planning.

End of life hospice services have consistently been underused by African Americans. This disproportionate use of hospice has contributed to poor quality of life and a lack of cost-effective care for patients with terminal illness. Driven by the theory of reasoned action, the purpose of this quantitative study was to test associations between African Americans' perceptions of hospice, decisions to use hospice, and religiosity. A convenience sample of 154 African American adults was surveyed online. The survey instrument combined the AARP End of Life survey, Perception of Hospice survey, and the Religiousness Measure survey. The results of a multiple linear regression showed a significant relationship between religiosity and perception of hospice where those who reported a higher level of religiosity had a more favorable perception of hospice (B = .174, p = .041), whereas there was no support of a relationship in which religiosity was a predictor of intent to use hospice (B = -.019, p = .816). Findings also showed the more positive the perception of hospice the lower the rate of intent to use hospice (B = -.181, p = .002). This research could benefit health care providers, researchers, and community members by increasing public awareness and education of hospice. Focus on the underuse of hospice by African Americans may promote positive social change through discussion within communities and hospice agencies about the barriers to service; these results may also foster implementation of interventions and initiatives that improve service to underserved populations. Such efforts could improve quality of life for individuals, their families, and communities.

Maternal mortality, an example of poor maternal health outcomes, is widely accepted as an indicator of the overall health of a population. One of the Millennium Development Goals was reduction in maternal mortality by 3 quarters by 2015. These goals were not met in Nigeria and it is important to look at some of the reasons why. Education has been shown to have positive impact on pregnancy outcomes; however, the characteristics of pregnant women, their health literacy level, their usage of antenatal care services and how these impact pregnancy outcomes are yet to be analyzed in Lagos, Nigeria. Guided by the social cognitive theory and health belief model, the purpose of this cross-sectional quantitative study was to determine if there is a relationship between maternal health literacy, antenatal care visits, development of medical conditions during pregnancy, and pregnancy outcomes (measured by healthy or unhealthy baby) in Lagos, Nigeria. The research question for this study tested if there was a relationship between these variables. Lisa Chew's health literacy assessment tool was used in a sample of 130 women in Shomolu local government in Nigeria who met the inclusion criteria. Using binary logistic correlations, only problems developed during pregnancy is statistically significant with pregnancy outcomes (p < .05). The results suggested an increase in problems developed during pregnancy most likely will increase the chance of having negative pregnancy outcomes. Results from this study could promote positive social change by helping health professionals identify the characteristics of at-risk women during antenatal education sessions. The results could also help health professionals in the development of targeted antenatal care interventions.

Millions of dollars are spent each year on preventing sexually transmitted diseases (STDs), yet the rates of chlamydia trachomatis (chlamydia) and neisseria gonorrhoeae (gonorrhea) infection continue to be high. Health literacy and its impact have been recognized in diabetes maintenance, control of hypertension, medical adherence, and reproductive health outcomes, yet no research has been conducted regarding the relationship between health literacy and chlamydia and gonorrhea prevalence. This study examined the relationship between health literacy scores and chlamydia and gonorrhea prevalence health literacy scores and reproductive health/STD knowledge, and reproductive health/STD knowledge and chlamydia and gonorrhea prevalence. Participants included 114 women over 18 years of age, who attended community health clinics in the northeastern United States. Health literacy was measured using the Rapid Estimate of Adult Literacy in Medicine instrument, and reproductive health/STD knowledge was assessed using a self-administered questionnaire. Data analysis revealed an inverse correlation between lower health literacy scores and an increase in gonorrhea and combined chlamydia/gonorrhea prevalence. Findings also revealed a positive correlation between health literacy scores and reproductive health/STD knowledge scores. The results of this study suggest that service providers should consider the use of health literacy level with targeted reproductive health and STD messages as a tool to empower clients, decrease the prevalence of chlamydia and gonorrhea, and increase positive reproductive health outcomes.

Children of Hispanic origin have the highest prevalence of asthma of all ethnic groups in the United States, especially Puerto Rican children, who have a prevalence of 12.9%. Treatment nonadherence has been identified as one contributing factor. The purpose of this qualitative study was to explore the reasons for nonadherence to the asthma treatment regimen among Puerto Rican children. Parents and health care providers of asthmatic children were interviewed regarding their beliefs about asthma as a disease, its effect on the child's life, and their experience with asthma treatment. Two models served as the theoretical framework: the health belief model and the Institute of Medicine model framework for asthma disparities. Interview data were collected from 8 parents using a questionnaire, and a focus group was conducted with 3 health care professionals. Data were manually coded to identify emerging themes. Even though parents reported fear of asthma medications and medication side effects, none of the parents stopped the asthma treatment. Results also indicated that lack of education about asthma, asthma treatment, and asthma action plan was evident in 75% of the parents. None of the parents who migrated to the United States from Puerto Rico received education about asthma while living in Puerto Rico. Health care professionals reported that although parents are familiar with asthma, they do not understand that it is a chronic disease that requires daily treatment. Findings may be used to create an asthma education plan tailored to the needs of the Hispanic population.

The progression of End Stage Renal Disease (ESRD) among type II diabetics is preventable, yet complications continue to plague many. Reports show that 29.1 million people (9.3%) in the United States have diabetes, and 40% of those individuals develop ESRD. Four research questions explored the relationship between ESRD, health literacy, and healthcare. Data from 2010-2015 from the National Institute of Health (NIH) was quantitatively analyzed. The conceptual framework was the revised health service utilization theory. The target population included 3939 diverse males and females between the ages of 20-75 diagnosed with type II Diabetes. Results from Chi-square, cross-tabulation, binary, and multinomial logistic regression revealed that there is a statistically significant relationship between inadequate health literacy and ESRD (p= <0.05), inadequate health literacy and healthcare services (p= <0.05), and healthcare services and development of ESRD (p=<.001). Findings exposed significant demographic co-factor differences. Males developed ESRD more than females, and African American and Hispanic populations were almost 2 times more likely than Caucasians to develop ESRD. As participants age, odds for developing ESRD increase about 2-3 times. Both race and education were significant predictors of inadequate health literacy. African Americans and Hispanics were 3 times more likely to have inadequate health literacy than Caucasian participants. Lower education increased the odds of having inadequate health literacy approximately 7.6 times. Results show that Caucasian participants had higher education levels and private health insurance, whereas African Americans and Hispanics had lower education and no insurance or Medicaid. Implications from this research show that social determinants among vulnerable populations are impacting an individual's health literacy and ability to adequately manage their health. Evidence from this study generates social change through recognition that health literacy is fundamental when attempting to prevent chronic disease complications and promote positive health.

Obesity is becoming an increasing health concern for young adults. There have been numerous studies on the potential predictors of obesity. However, few studies have researched the predictors of obesity in young adults. Guided by the health belief model, this quantitative cross sectional study investigated the potential predictors of obesity in young adults. The 2011 Behavioral Risk Factor Surveillance System was used to gather data on the potential predictors of obesity, including physical activity, health care coverage, excessive alcohol consumption, and demographic characteristics on 1,511 young adults, aged 18-34 years, who were living in New York State. Data were analyzed using a combination Pearson correlation and multiple regression analyses. The findings on physical activity were statistically significant and revealed that physical activity had the strongest association to young adult obesity. The study provides information for public health professionals that can be used to develop more effective obesity interventions targeting young adults. The implications for positive social change include improving young adult health through the reduction of obesity rates and the promotion of physical activity.