Doctor of Nursing Practice Degree Program in Population Health Leadership DNP, Xavier University, 2018, Nursing

As the United States (U.S.) health care system moves towards a health promotion model, identifying those at risk for common health conditions is crucial. Comprehensive family health history (FHH) data collection and analysis has been proposed as a low cost, highly efficient and effective way to screen for common health conditions. However, patients' electronic health records (EHRs) currently do not contain enough FHH information to adequately assess for health risks. The purpose of this DNP Scholarly project was to implement a parent completed electronic family health history (eFHH) tool in a socially disadvantage, pediatric population receiving care in an urban primary care clinic. A descriptive observation study design was used to evaluate parents' use of My Family Health Portrait (MFHP), an eFHH tool. Forty parent participants were observed for ease of MFHP use to determine the feasibility of using a parent completed FHH tool. The majority of parents (85%) were able to complete the MFHP tool prior to completing provider evaluations, with 70% of parents completing a four generation family history assessment using MFHP. Facilitators for completion included: desire to enter their own information, perceived positive benefit, ease of use, internet access and enjoyed entering information. Barriers to completing the MFHP tool were: program was not intuitive, issues with unknown information, clinic interruptions, complexity of health categories, and the tool is not pediatric focused. Results support the possibility of using a parent-generated electronic family health history tool in a pediatric care setting.

Committee: Elizabeth Bragg PhD (Committee Chair); Kelly Bohnhoff PhD (Committee Member) Subjects: Genetics; Health Care; Information Technology

MS, University of Cincinnati, 2010, Allied Health Sciences : Genetic Counseling

Introduction: FHH is a risk factor for chronic diseases. Pediatric practice is an optimal setting to incorporate FHH because risk factors may be identified and preventive measures implemented earlier in life, resulting in sustained and improved health outcomes. My Family Health Portrait (MFHP) is a web-based tool to help families collect and share their FHH with their health care provider. To our knowledge, providers' views about the clinical utility of MFHP, or other parent-generated FHH tools, have not been assessed in a pediatric setting. Purpose: The purpose of this study was to describe how pediatric providers collect and use FHH in practice and to collect data about the perceived clinical utility of MFHP as a pediatric health promotion and disease prevention tool. Methods: A random sample of 148 pediatric providers was invited to participate in a semi-structured qualitative interview. All transcripts were reviewed and coded inductively by two coders, and inter-rater reliability was determined. Results: 21 providers completed study interviews. Participants unanimously collected FHH at new patient visits and when patients present with a symptom or complaint. Most providers believed that collecting FHH of chronic disease benefits the pediatric population. The most commonly cited barrier to FHH collection was the short visit time, and the most frequently suggested idea for improving FHH was collecting it prior to the office visit. Providers believed that the use of MFHP would improve FHH collection and allow for targeted education and preventive recommendations. Respondents also identified logistical and patient characteristic issues that must be resolved to integrate MFHP into clinical practice. Conclusions: Our research suggests that pediatric primary care presents many opportunities to collect and discuss FHH with patients, and that providers are optimistic about the clinical use of a parent-generated FHH collection tool. Future research should assess par (open full item for complete abstract)

Committee: Melanie Myers PhD (Committee Chair); John Lynch PhD (Committee Member); Cynthia Prows (Committee Member); Robert Siegel (Committee Member) Subjects: Public Health

MS, University of Cincinnati, 2011, Medicine: Genetic Counseling

Purpose: To learn about parents' 1) perceptions of the meaning of family health history (FHH) 2) prior experience with FHH, and 3) impressions of and willingness to complete the Surgeon General's FHH tool called My Family Health Portrait (MFHP). Methods: Qualitative in-depth interviews were conducted with parents recruited through a newsletter and advertisements at Cincinnati Children's Hospital Medical Center. Themes were developed using deductive codes based on pre-determined interview questions and inductive codes based on interviewee responses. Interviews were transcribed and then coded by two coders. Inter-rater reliability was determined using Cohen's Kappa. Results: Twenty-five respondents were interviewed. Nineteen (76%) mothers described FHH as being aware of the diseases that run in families. When asked about value of FHH six mothers (24%) discussed prevention of disease or diagnosing at an early stage. Sixteen (64%) mothers reported talking to their pediatrician about health problems that run in their family. All participants had positive impressions of MFHP after being shown the tool. Most participants felt MFHP was user-friendly and an easy program that facilitated FHH collection (n=17; 68%). The most commonly expressed challenge to completing MFHP was a lack of knowledge about health conditions within the family. Most respondents (n=23; 92%) stated they would be able to complete MFHP prior to their child's medical appointment. Conclusion: These findings suggest parents are interested in FHH and may be motivated to complete a parent-generated FHH outside of a pediatric appointment. Future research should focus on implementation and usability of parent-generated FHH in clinical practice.

Committee: Melanie Myers PhD (Committee Chair); Cynthia Prows , (Committee Member); Robert Siegel , (Committee Member); John Lynch PhD (Committee Member) Subjects: Public Health

Master of Arts, Miami University, 2018, History

This thesis considers the origins of the embourgeoisement of the mid-nineteenth-century German aristocracy through the lens of the summer 1855 travel diary of twenty-year-old Landedelfraulein (country noble maiden) Marie von Bonin, the oldest daughter of Maria Keller and landowner and politician Gustav von Bonin. Scholars of German history have often contended that the influence of middle-class values on German nobles originated with print culture and socio-political movements. While this thesis neither contradicts, nor focuses on these claims, it examines the ways that the lived experiences of everyday people also gave birth to middle-class values. Focusing on the themes of Heimat (home), travel and education, and romantic courtship, this thesis concludes that Marie's bourgeois views were not revolutionary; rather, they exemplified the influence of middle-class values on the mid-nineteenth century German aristocracy.

Committee: Erik Jensen PhD (Advisor); Steven Conn PhD (Committee Member); Nicole Thesz PhD (Committee Member) Subjects: Education History; European History; Families and Family Life; Foreign Language; Gender; Gender Studies; Germanic Literature; History; Language; Literature; Modern History; Modern Language; Modern Literature; Pedagogy

MS, University of Cincinnati, 2017, Medicine: Genetic Counseling

The paper-based pedigree is the current standard for family health history (FHH) documentation in genetic counseling. Several tools for electronic capture of family health data have been developed to improve re-use and accessibility, data quality and standardization, ease of updating, and integration with electronic medical records. One such tool, the tablet-based Proband application, provides a flexible approach to data capture in dynamic and diverse clinical settings and represents a potential means to address these points. This study compared Proband FHH collection to paper-based methods and investigated the usability of Proband in a clinical setting. After one use by 23 genetic counselors or students, Proband had 91% accuracy with a FHH audio scenario, which was significantly less (p < 0.001) than paper's 96% accuracy. These differences were attributed to incorrect or missing ages of grandparents (p < 0.001) and great-aunts/uncles (p = 0.012) and missing documentation of consanguinity (p < 0.001). Possible explanations for these differences include greater experience with paper FHH documentation and pre-populated prompts for consanguinity on the paper template used. Proband's perceived usability increased with use, with individual System Usability Scores increasing between first and last use (p = 0.033). We conclude that tools for dynamic, provider-driven FHH documentation such as Proband show promise for improving risk assessment accuracy and quality patient care.

Committee: Melanie Myers Ph.D. (Committee Chair); Richard Ittenbach (Committee Member); Christine Spaeth M.S. C.G.C. (Committee Member); Peter White Ph.D. (Committee Member) Subjects: Health Sciences

MS, University of Cincinnati, 2016, Medicine: Genetic Counseling

Type 2 diabetes (T2DM) is an important health concern for individuals of Appalachian background, contributing significantly to morbidity and mortality. Early promotion of risk recognition and behavior adaptations can be beneficial to mitigate health consequences, yet culturally tailored resources may not be readily available for this population. In this multi-phase study, a community-driven approach was implemented to explore the use of story circles to facilitate familial communication about T2DM. In Phase I, a group of ten individuals from a low income urban Appalachian community participated in a focus group to discuss and further tailor the study plan. In phase II, 18 individuals participated in one or more of three story circles to discuss T2DM experiences and conversations. Story circles were recorded and transcribed to allow for content analysis. Major themes identified included diabetes experiences, thoughts and attitudes about diabetes, conversations about diabetes, and sharing of information about diabetes. In addition, we found that a sense of support was generated between story circle participants. Phase III consisted of seven follow-up interviews with story circle participants that were part of family pairs that attended together. Transcription and content analysis revealed that all participants reacted positively to their participation and many described ways participating led to changes in their communication or behavior patterns or supported their previous efforts toward diabetes management/prevention and communication with family members. Asking people of urban Appalachian cultural background to share stories about T2DM experiences and conversations led to dynamic discussions that allowed participants to both develop a sense of mutual support and share their experiences and knowledge about diabetes. Although support may be needed to facilitate and monitor the accuracy of information shared, incorporating group storytelling can be an effective way t (open full item for complete abstract)

Committee: Lora Arduser M.F.A. (Committee Chair); Rebecca Lee Ph.D. (Committee Member); Melanie Myers Ph.D. (Committee Member) Subjects: Health Sciences

MS, University of Cincinnati, 2005, Allied Health Sciences : Genetic Counseling

The US Surgeon General's office encourages people to use their family health history as a screening tool for disease prevention and health promotion. When preparing health awareness materials, it is important to consider that 47% of the US population demonstrates limited literacy. We developed a brochure written at a 5th grade reading level about the importance of family history and then assessed peoples' responses to this brochure as compared to a brochure with similar information written at an 11th grade reading level. Study participants (n=351), adults from 16 to 65 years old, were recruited from community settings. 179 participants (51%) had some high school education; 172 (49%) had some college education. Each participant read one brochure and completed a 10 question survey assessing participants' attitudes about family health history and their intentions to act on the information they had read. Overall, participants who read the 5th grade literacy brochure were more likely to agree with each positively worded statement on the survey. A brochure written at a 5th grade level is an effective method of teaching adults of all education levels about the importance of family health history and is more effective than a higher literacy brochure, especially for individuals with less education.

Committee: Dr. Nancy Warren (Advisor) Subjects: Health Sciences, Education

Doctor of Education (Ed.D.), Bowling Green State University, 2008, Leadership Studies

This life history study provides insight into the career paths of six females who attained the highest career level – president – in their organizations by exploring the influence of mentoring, family support, and networking in their career trajectories.Three female senior leaders from Health Care and three female senior leaders from Higher Education in the Midwest participated in the study. The leaders' personal experiences were captured in narrative form through personal interviews with the researcher and coded and analyzed for patterns and themes. Daniel J. Levinson's adult development stages (Levinson, Darrow, Klein, Levinson and McKee, 1978) were used to frame the four phases of career progression in the participant's lives and provide a foundation for a conceptual model depicting the influence of mentoring, family support and networking. Findings showed that the support of family was apparent throughout the female senior leaders' lives and their career trajectories. Mentors were most prevalent during pre-adult, early adult and the first part of middle adult stages. As the careers of the female leaders progressed into the later parts of early adult and throughout the middle adult stages, the importance and active use of networking was critical to obtain and maintain their current senior leadership position. Three themes emerged in this study: (1) Informal mentoring facilitated the women's climb up the administrative ladder to senior levels, (2) Strong family support was essential throughout the women's career trajectories, and (3) Networking was important as a career management strategy. Recommendations include that employers integrate mentoring and networking programs into their human resource policies. Secondly, that educators integrate these findings into course curriculum to inform females of the importance of mentoring, strong family support and networking in their career progression. Recommendations for future research include interviewing women who ar (open full item for complete abstract)

Committee: Dr. Julie H. Edmister (Advisor); Dr. Mark A. Earley (Committee Member); Dr. Diane Frey (Committee Member); Dr. Judy Jackson May (Committee Member); Dr. Martha Shouldis (Committee Member) Subjects: Community Colleges; Education; Gender; Health Care; Higher Education; Management; Womens Studies