Dental caries is the most prevalent childhood illness and disproportionately affects children from low socioeconomic backgrounds. Dental organizations are collaborating within communities to decrease oral health disparities among children by offering free preventive oral health events. These programs face the problem of low enrollment due to lack of informed parental consent. Also, gaps in the literature indicated the need to examine oral health perceptions and dental-care-seeking practices of culturally diverse low-income parents regarding preventive care for their children. The purpose of this qualitative case study was to explore the reasons why parents are not allowing their children to participate in the aforementioned programs. This inquiry examined how perceived barriers impede parents from seeking free preventive dental care for their children. The transtheoretical model and social cognitive theory were used in this study. Open-ended questions were used to interview 20 purposefully sampled parents regarding perceptions of free preventive dental care programs until saturation. Interviews were audio recorded, and all data were transcribed verbatim, coded, and analyzed thematically. The main themes revealed through this analysis were lack of trust and cultural dissimilarities as potential barriers. Additional themes of money, fear, lack of insurance, transportation, time, and access to care were also confirmed. This study may contribute to positive social change by increasing knowledge that may inform the development of clinical and policy solutions aimed at improving parents' awareness regarding children's oral health, ultimately enabling a reduction in childhood caries and oral health disparities.

According to the Centers for Medicare and Medicaid Services (CMS), approximately 1.3 million U.S. residents are residing in nursing homes. CMS enforced regulations in the Nursing Home Reform Act. Training in the use of restraints in nursing homes is monitored through the CMS standards. The purpose of this study was to determine whether there was a correlation between training standards of health care practitioners and their use of restraints in nursing homes based on the patterns of citations by RNs and CNAs. Data were collected from Kansas, Louisiana, and Ohio within the CMS Nursing Home Data Compendium. The key research question examined differences in standard training requirements, policies, and citations regarding restraint use in the selected states. The theoretical framework for this study was the social influence theory. The results of the analysis of variance indicated that between 2008 and 2012, there were significant differences in policy and standards requirements for the training of registered nurses and certified nursing assistants regarding restraint use; there was also a relationship between the training of staff and the number of citations of restraint use in Kansas, Louisiana, and Ohio. There were significant (p < .02) variations throughout the 3 states regarding the policies, procedures, and training expectations. The positive social change that could result from these findings is the standardization of training that may help decrease restraint use and become the foundation of more respectful and caring practices in nursing homes.

Poor oral care is detrimental to the overall health of the population. In the United States, oral health diseases affect millions of individuals, especially children and adolescents. Guided by the health belief model, the purpose of this study was to identify parents' perceived barriers to oral health care access among their 5- to 10-year-old children. A phenomenological approach was used to gather data and thematically analyze interview data from 20 parents who were recruited from a health center in the northeastern United States. All participants had at least one child between 5-10 years old and all identified as under-served. Data were coded and analyzed for emerging themes, with the assistance of Nvivo software. The findings demonstrated that lack of time, the location of dental facilities, and the lack of sensitivity of dental providers were issues for parents in managing their children's oral health. This study might be beneficial in eliciting positive social change at the individual and organizational levels by illuminating the constraints faced by the underserved population in Massachusetts.

The Affordable Care Act expanded insurance coverage to the general population; however, expanding insurance coverage to immigrants might not be sufficient to improve utilization of annual physical preventive exams. This study evaluated adult Michigan immigrants' individual demographics, perceptions, and behaviors, as well as the collective cultural and system characteristics that might act as barriers to the utilization of annual physical preventive exams. Ken Wilber's integral operating system model for medicine conceptual framework was used to create a comprehensive map of factors and bring more clarity and understanding to the barriers to annual physical preventive exam. The quantitative survey was the best approach for this study because of the large numbers of explanatory independent variables identified in the literature review. Snowball sampling was used to increase the credibility of this research by involving different immigrant communities and reaching large numbers of immigrants. Descriptive results indicate immigrants' barriers revolve around difficulty accessing health care and the cultural competency of the health care provider. Logistic regression analysis found that immigrants who are stressed and worried, self-employed, and middle class are less likely to utilize annual physical preventive exams. This study could be a force for social change by promoting healthy behaviors and encouraging immigrants to use annual physical preventive exam to reduce the occurrence of chronic conditions and increase life satisfaction in the community.

Patient falls are an ongoing concern for health systems in the US and in the setting where this project took place. Inpatient falls affect consumers and health providers because falls often result in patient morbidity and mortality, legal risk, increased length of stay, and increased costs. The purpose of this project was to evaluate the existing fall prevention protocol at the site where this project took place and to make recommendations for an evidenced-based fall prevention protocol. The professional practice model was the conceptual model that guided the exploratory descriptive project. A review of the site's fall prevention policies and procedures revealed a new fall prevention protocol was in place and included bed alarms, and chair alarms to ring on nurses' phones although observation of nurses revealed that there were problems maintaining the protocol the entire day and 66% of patient falls occurred when the bed alarms were not set. The resulting recommendation was for additional education and a bundled approach with nurse education, patient and family education and a fall risk assessment that was easy to use. Nurses were then surveyed before and after education on the current protocol and the Morse Fall Risk (MFRs) to determine their willingness to use the simpler version for fall risk assessment. Before education 18 nurses confirmed they would use the protocol and MFR tool and all 20 agreed to use it after the education session. An implementation of a bundled approach to the fall prevention protocol that nurses incorporate into their daily practice will lead to a positive social change and as a result may increase patient safety by reducing patient falls.

When caregivers defer their personal routine dental care (RDC) in order to provide RDC for their children, they risk detrimental consequences in their personal health and the health of their children. The purpose of this qualitative case study was to identify the risk factors that led to the parental dental deferment decision. The oral health and personal care services conceptual models guided the development of the research questions, facilitated the selection of risk factors on the decision-making process, and provided the basis for the data analysis thematic categories. Ten caregivers who made the decision to defer their personal RDC for the sake of their children's RDC participated in the study. Interviews were transcribed verbatim and analyzed thematically. According to the results of the study, the oral health beliefs of caregivers shaped their decision to seek RDC for their children while financial barriers, dental fear, and distrust obstructed their capacity to seek RDC for themselves. Caregivers placed a higher priority on their children's wellbeing--including dental care--than on their own health, despite knowing the association between poor oral health and serious health conditions. These findings indicated, for caregivers, deferring personal RDC was not a lack of desire, education, or care but striving for constant balance between affordability and providing their children with every healthy opportunity in life. The positive social change implications of this study include increasing the proportion of adults receiving RDC yearly through development of targeted interventions that increase caregivers' access to and utilization of dental care services. Such efforts would support the strategies implemented to achieve Healthy People 2020 objectives.

Due to projected growth of the 65-and-older population and concerns of an impending care gap, reliance on informal caregivers is expected to increase. Improving support for informal caregivers is viewed as a national priority, yet research related to the unmet support needs of informal caregivers is limited. The purpose of this cross-sectional correlational study was to examine predictive relationships between contextual factors (caregiving relationship and type of illness) and environmental factors (rurality) and the unmet support needs (classes, service access, support groups, counseling, and respite) of informal caregivers of older adults. The theoretical framework was Bronfenbrenner's ecological systems theory. Archival data were drawn from the 2015 Behavioral Risk Factor Surveillance System optional caregiver module dataset provided by the Centers for Disease Control and Prevention. Findings from multiple logistic regression analysis revealed that spousal caregivers had 42.7% lower odds than adult child caregivers of reporting unmet support needs related to service access. Dementia caregivers had 2.05 times higher odds of reporting unmet support needs of counseling, 1.31 times higher odds of reporting unmet support needs related to service access, and 1.91 times higher odds of reporting unmet support needs for respite care, relative to other caregivers. Caregivers residing in a suburban county had 28.7% lower odds and caregivers not residing in a metropolitan statistical area (MSA) had 30.5% lower odds of reporting unmet support needs related to service access, relative to caregivers residing in the center city of an MSA. Health care leaders and policymakers may use the findings to distribute resources and tailor interventions to better meet the needs of informal caregivers of older adults.

Poor sexual communication among Nigerian youth can create problems for health workers, medical practitioners, and the government in determining what is and is not working in their attempts to reduce sexually-related diseases. This quantitative study used self-administered questionnaires among 107 Nigerian university students, aged 18 to 35, to determine if a statistically significant predictive relationship existed between: (a) beliefs about alcohol, (b) HIV knowledge, (c) risk behaviors, (d) age, (e) religion, (f) gender, (g) sexual activity status, (h) dating status, (i) language, (j) sexual orientation, and (k) tribes of Nigerian university students and their sexual communication with partners. Previous studies did not use the AIDS risk reduction model (ARRM) as a theoretical framework to identify frequent risk factors in this population. This study was guided by the ARRM and used the Sexual Risk Survey (SRS), the HIV-KQ-18, the Revised Alcohol Expectancy Questionnaire (AEQ-3), and the Dyadic Sexual Communication Scale (DSC) to assess the participants. Independent-sample t tests were used to analyze the correlation of study variables and the results showed statistically significant differences only in tribal affiliation (p = .022), gender (p < .001; p =.016), dating status (p = .017), age (p = .006), and sexual activity status (p = .001). Linear regression analyses results showed no statistically significant predictive relationship, R = .322, R2 = .103, F (12, 94) = 0.904, p = .546, between HIV knowledge, beliefs about alcohol and risk behaviors of Nigerian students, and their ability to communicate sexually. These findings justify the need for more culturally sensitive studies and gender/age appropriate HIV intervention strategies in Nigeria.

The rural African American population has a high incidence of severe psychosocial problems and a skewed perception of obesity, despite obesity's extremely high prevalence rate in this population. Despite the acknowledgements of these problems, there is a gap in literature relative to the effective treatments for obese African Americans diagnosed with depression. This study measured correlations between obesity and depression, binge eating, and food culture amongst African American women residing in Jefferson County, MS. The health belief model was used to guide an assessment of beliefs, perceptions, susceptibility, cues to action, and self-efficacy. A cross-sectional design was used based on the sampling method and the associated sites along with distinctive design factors, including: no time factor, existing differences, and no random allocation. The Beck depressive inventory and the Bernice Roberts Kennedy cultural inventory for minority groups were the tools used to measure obesity and depression. Linear regression determined that there was an association between depression and obesity. Analyzation of study findings indicated that the participants responded to culturally sensitive questions surrounding prayer, religious involvement, and regular church attendance, which are common coping responses and mechanisms for depressed African American women. These results show a need to encourage health practitioners and researchers to create and implement individualized health promotion campaigns and interventions that fit with community and cultural realities, which could effectively address the obesity and poor health epidemic among rural African American women.

Knowledge gaps exist related to the care and education of pregnant teens. This project study addressed the problem of an inadequate amount of professional development (PD) and training for healthcare professionals (HCPs) caring for pregnant teens at a maternity clinic in the Southeastern United States. Unless HCPs are appropriately trained, the ability to meet the needs of pregnant teens is deficient and negative health outcomes for these patients are likely to be exacerbated. The humanistic learning theory was used in this phenomenological exploratory study to explore perception of 9 HCPs who had the responsibility for patient teaching, clinical care, and were full time employees at a maternity clinic. The research questions focused on the perceptions of the HCPs regarding their experiences of PD as it relates to the care of pregnant and parenting teens, strengths and weaknesses of their current PD, and how their PD could impact the health outcomes of pregnant and parenting teens. The themes developed from the interview data revealed a need for an expansion of HCP knowledge and skills to improve the healthcare of pregnant and parenting teens, as well as challenges associated with the current PD plan. The resulting project consisted of a 3-day workshop to increase the HCPs' proficiency and efficacy in caring for pregnant and parenting teens. Evaluation of the project will be through formative and summative assessment. The project contributes to positive social change at the local clinic by reinforcing the HCPs' skills in in educating, caring for, and supporting the teen parent population.