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  • 1. Hale, Brook The Anatomy of Physician Fulfillment: Strategies Beyond Burnout

    Ph.D., Antioch University, 2024, Leadership and Change

    The persistent tension and power struggle between healthcare executives and physicians is a prevalent issue in healthcare organizations, often leading to a culture of organizational mistrust. This dynamic stems from perceived conflicting goals: executives are frequently seen as primarily focused on financial outcomes, while physicians are viewed as resistant to change. This study explored how physician fulfillment is experienced at work, with the ultimate goal of identifying potential interventions to bridge the gap between these groups. There is vast research and literature available regarding burnout in healthcare; this research focused on understanding what physicians find fulfilling in their work and identifying actionable factors healthcare system leaders can address to enhance their fulfillment. Key factors identified from the literature include meaningful patient contact, quality of professional relationships, and organizational decision-making input. At the same time, challenges such as administrative burden and loss of autonomy were noted as detriments to fulfillment. After conducting and transcribing semi-structured phenomenological interviews with physicians, the data were coded for meaning, resulting in 169 codes. The prevalence of these broad themes varied concerning each research question, reflecting the complex and multifaceted nature of physician fulfillment. By identifying patterns and connections in the physicians' experiences, this study highlighted the importance of addressing both systemic and individual factors to enhance professional fulfillment. Key findings of the study include the importance of humanizing healthcare goals and several directions for iv healthcare organizations: addressing moral injury, improving patient outcomes, obtaining and utilizing physician input consistently, fostering a supportive culture, and creating time and space for peer support. Targeted interventions to enhance physi (open full item for complete abstract)

    Committee: Mitch Kusy PhD (Committee Chair); Beth Mabry PhD (Committee Member); Alan Rosenstein MD (Committee Member) Subjects: Ethics; Health Care; Health Care Management; Health Sciences; Management; Medicine; Public Health
  • 2. White, A. Caregivers and Healthcare Providers on Resources, Gaps in Care, and the Value of Down Syndrome Centers.

    Ph.D., Antioch University, 2022, Leadership and Change

    The facilitation of healthcare for people with Down syndrome offers a unique challenge to healthcare systems. Both caregivers and healthcare providers often need to navigate a complex system of specialties in care, resources, and expertise to optimize treatment and care plans for children with Down syndrome, whose needs vary widely and extend beyond the walls of a hospital. This study identified seven domains of care based on conceptualizations of integrated care in the literature: coordination, communication, continuity, dignity, information, shared decision-making, and resources. Groups of survey items intended to capture these domains were used with a sample of caregivers and healthcare providers to explore the medical and social gaps that limit the facilitation of whole-person care for children with Down syndrome. This study further examines differences in caregiver perceptions of care depending on whether their child has received care in a Down syndrome Center (DSC) or specialized clinic. Finally, the study examines the level of the burden associated with navigating the health care system and critical resources for caregivers while examining the amount of stress healthcare providers experience in facilitating care for people with Down syndrome. Key findings in this study indicate the value of DSCs for both caregivers and healthcare providers about integrated care values and satisfaction in care delivery. Additionally, the study identifies critical gaps in resources and awareness of the challenges caregivers and healthcare providers experience in managing and coordinating care. These findings have implications for future directions in improving healthcare for children with Down syndrome.

    Committee: J. Beth Mabry PhD (Committee Chair); Elizabeth Holloway PhD (Committee Member); Priya Chandan MD, MPH, PhD (Committee Member) Subjects: Health Care; Health Care Management; Social Research
  • 3. Kazungu, Francis Cost structure of healthcare in Kaloleni Subcounty (Kilifi, Kenya) from the patient perspective: Measuring the impact of direct healthcare costs on patients

    Master of Science, Miami University, 2022, Kinesiology, Nutrition, and Health

    Access to quality, affordable, and reliable healthcare has been a long-standing challenge in rural areas of developing countries. Rural households often incur high out-of-pocket expenditure for healthcare, resulting in a significant cost burden when seeking treatment for an illness. This study aimed to examine the cost structure of healthcare in a rural, underserved community in the Kaloleni Subcounty of Kilifi, Kenya. We measured the impact of direct healthcare costs on a sample of 37 households, along with the coping strategies and treatment-seeking behavior arising from these costs. Direct healthcare costs were grouped into 3 categories: consultation, diagnostic, and medicine fees. Results show that medicine was the highest direct healthcare cost, accounting for 64% of all expenses paid during an episode of illness. Direct healthcare costs also comprised over 12% of the monthly household expenditure in these households, with the lowest-earning homes being disproportionately affected. Malaria was the most common illness reported in the study area, accounting for 37% of all illness cases. Several strategies are proposed to ease the burden of direct healthcare costs. These include government subsidies for community-level healthcare facilities, increasing the availability of medicines, and improving the distribution/use of treated mosquito bed nets to prevent malaria transmission.

    Committee: Philip Smith (Advisor); Paul Branscum (Committee Member); Helaine Alessio (Committee Member) Subjects: Health Care; Health Sciences; Public Health
  • 4. Ryan, Miller Integrated Simulation Model for Patient Flow Between Operating Rooms and Progressive Care Units Using Custom Objects

    Master of Science (MS), Ohio University, 2020, Industrial and Systems Engineering (Engineering and Technology)

    Process improvements in hospitals usually focus on a single department (eg. emergency department, operating theater, specialty clinic, etc). However, actions taken in one department inevitably affect the performance of other departments. Therefore, higher efficiency improvements can be obtained by considering the patient care process as one synergetic activity involving several departments and various sets of resources. In this research we propose an integrated approach for modeling the patient lifecycle for multiple departments. First we describe a patient flow from his/her entry into the hospital through a progressive care unit until the patient has fully recovered. We use process mapping methods to address value added activities and other necessary activities in the patient lifecycle. Then, a simulation model is developed in Simio using customized objects created in previous works. Those customized objects carry their own logic and behavior. For example, the Bed object includes logic for a patient recovering while using several hospital resources (nurses, therapist) in his/her hospital stay. Those objects were used to build several configurations of an integrated model with multiple departments. Data about patient arrival patterns, their health acuity, and procedure needs were obtained from a real hospital in order to test our approach. The procedures duration data (which were different for different levels of patient acuity and for different surgical and other procedures) were used to obtain service distribution using statistical analysis methods. Modular simulation objects and data distributions from real hospitals allowed us to build an integrated simulation model with several configurations of the process flow. Simulation experiments were performed on these models and performance recorded. The recommendation for implementations in the hospitals is also reported.

    Committee: Dusan Sormaz (Advisor); Gursel Suer (Committee Member); Diana Schwerha (Committee Member); Vic Matta (Committee Member) Subjects: Engineering; Health Care; Industrial Engineering
  • 5. Murawsky, Stef Navigating the Medicalization of Gender Identity: A Qualitative Study of Transgender People's Experiences of Healthcare in the American Midwest

    PhD, University of Cincinnati, 2022, Arts and Sciences: Sociology

    Transgender Americans experience high rates of medical discrimination. As a result, they frequently avoid getting medical care, even when needed, for fear of mistreatment. While most trans people want to leverage medicalization to embody their gender identities, finding gender-affirming healthcare is challenging because competent providers are rare, care is geographically inaccessible, and insurers commonly refuse to cover medical interventions. This dissertation describes how trans people access and navigate medicine given the multitude of healthcare constraints and barriers they face. I investigate how trans Americans decide whether and how to medicalize their gender identities. Specifically, people considering or engaged in medicalized body projects described healthcare experiences related to their information-seeking behaviors and practices, receipt of diagnoses, and navigation of provider interactions, medical institutions, and insurance policies. I analyzed 70 hours of indepth interviews with 34 transgender people who live in the greater Cincinnati, Ohio area, using a grounded theory methodology. Interviews were transcribed and thematically coded using NVivo. Emergent analytic categories center on themes related to experiences of medicalization, how trans individuals operationalize community networks to prepare for medicalization, and experiences of gender delegitimation in medicine. This research reveals that: 1) binary-oriented and non-binary trans people experience medicalization differently, particularly when trying to make sense of the diagnosis of gender dysphoria; 2) transgender people cultivate subcultural health capital via community networks, which allows them to gather informational and navigational capital to anticipate and mitigate medical discrimination, mistreatment, and gatekeeping; and 3) trans people experience institutional, interpersonal, and internalized gender delegitimation in medical settings. I present my findings in three jou (open full item for complete abstract)

    Committee: Danielle Bessett Ph.D. (Committee Member); Ashley Currier Ph.D. (Committee Member); Erynn Casanova Ph.D. (Committee Member) Subjects: Sociology
  • 6. Chrest, K. Tyler Employee Motivation Related to Leadership Behaviors in Rural Outpatient Healthcare Settings

    Doctor of Healthcare Administration (D.H.A.), Franklin University, 2020, Health Programs

    The healthcare industry is continuously faced with increasingly difficult challenges. This is especially true in rural healthcare environments where additional challenges make leading healthcare organizations even more complex. Part of this challenge in effective healthcare leadership is maintaining a motivated and engaged front line workforce within the organization. There are a multitude of benefits to having more highly motivated frontline employees, many of which are discussed in this dissertation. Employee motivation can be strongly impacted, either positively or negatively, by the leadership qualities possessed by the leaders overseeing frontline employees. A gap in academic research was identified in the field of leadership behaviors related to their impacts on employee motivation in rural outpatient healthcare delivery. Therefore, this qualitative study was developed, conducted, and the data were analyzed to attempt to close that gap in research. This qualitative research study analyzed the leadership behaviors and techniques that are currently employed within the population, as well as analyzed the most effective motivational strategies for employees working in rural outpatient healthcare environments. The study concluded that leadership qualities that are personal in nature and focused on leader-follower relationships are more effective in motivating and driving employees than other factors. This study also provides guidance for future potential research within this environment to gain an even better understanding of how to overcome motivational challenges faced by leaders in rural healthcare settings.

    Committee: George Velez (Committee Chair); David Meckstroth (Committee Member); Dail Fields (Committee Member) Subjects: Health Care; Health Care Management; Health Sciences
  • 7. Bedal, Kyle Systems Process Engineering for Renal Transplants at The University of Toledo Medical Center Utilizing the Six Sigma Approach

    Master of Science in Industrial Engineering, University of Toledo, 2008, Industrial Engineering

    Six Sigma is a comprehensive and flexible system for achieving, sustaining andmaximizing business success. It strives to improve quality, productivity, and bottom line success using statistical tools. Six Sigma's methodology consists of five phases: Define, Measure, Analyze, Improve, and Control (DMAIC). In manufacturing, Six Sigma has been used extensively with great success. The application of Six Sigma to the healthcare field is in its early stages and, hence, has not been fully explored. This research investigated the use of Six Sigma with the goal of improving the renal implant process and demonstrating the positive impact of Six Sigma on the healthcare industry. The objective of the research was to improve the process for renal transplants at The University of Toledo Medical Center utilizing Six Sigma. This included aligning and optimizing processes and the removal of process-generated defects and errors. Improvements will primarily focus on: optimizing cycle times, enhancing customer satisfaction, improving efficiencies, reducing costs, streamlining administrative processes, elimination of errors, and improving protocol execution and effectiveness. This research identified ten improvements which could be applied to the renal transplant process. Implementing improvements could reduce the total process time by 45 days (20%) from 227 days to 182 days, and could also improve productivity, communication, and customer satisfaction.

    Committee: Steven Kramer PhD (Advisor); Matthew Franchetti PhD (Other); Afjeh Abdollah PhD (Committee Member) Subjects: Engineering; Health Care
  • 8. James, Jameszetta A Narrative Inquiry Approach to Improving African American Representation in Health Care Careers

    Doctor of Education , University of Dayton, 2024, Educational Administration

    African Americans are underrepresented in health professional careers that require an undergraduate or graduate degree (Toretsky et al., 2018). Diversity in the healthcare workforce is essential for the underserved population to help reduce health disparities (Pittman et al., 2021). Health care organizations must take steps in creating a more inclusive workforce that includes representation for African Americans. The primary purpose of this narrative inquiry design study that used qualitative interviews and focus groups was to understand the lived experiences of African American healthcare practitioners and how they were introduced to healthcare careers. This study used purposeful sampling, recruiting participants who voluntarily wanted to participate in telling their lived narrative through semi-structured interviews and focus groups of their experiences about landing a professional career in healthcare The data analysis in this study was a narrative thematic analysis using common themes and comparison of themes to one another, after the different interviews. The twelve interviews and three focus groups provided key insights into how each African American healthcare practitioner landed a professional healthcare careers, In synthesizing the findings, the four main themes found during the interviews were: none of the high schools prepared one to go into a healthcare career, lack of financial resources to fund these healthcare programs, little to no exposure in healthcare careers, and family were sick or the participants had a childhood illness which spark their interest into healthcare. The results of the narrative inquiry interviews were important as they helped determine the area of focus for the action plan to develop the Institute of Healthcare Connections (IHC) that empower African American youth to go into healthcare careers by providing more mentors and exposure opportunities for students in elementary school through college.

    Committee: Dr. Derrick Kimbrough (Committee Member); Dr. Charles Lu (Committee Member); Dr. Aaliyah Baker (Committee Chair) Subjects: African Americans; Educational Leadership; Elementary Education; Health Care; Health Education; Higher Education; Vocational Education
  • 9. Leonard-Jean Charles, Antoinette Unmasking the nexus of race, ethnicity, and health: An intersectional analysis of the epistemology of race in medicine, medical curricula, and health disparities

    Ed.D., Antioch University, 2025, Education

    The persistent health disparities faced by Black, Indigenous, and People of Color (BIPOC) in the United States are deeply rooted in systemic racism embedded within medical education and clinical practice. Historical acceptance of racial supremacy in the United States has shaped both the foundations and continued practices of medical education, leading to entrenched biases that affect healthcare delivery and patient outcomes. This dissertation critically examines the intersection of race, education, and health by analyzing how historical and contemporary understandings of race and ethnicity shape medical curricula, healthcare practices, and patient care. Through the integration of Critical Race Theory (CRT), Social Cognitive Theory (SCT), and ScT, this study deconstructs racialized knowledge systems in medicine and examines their impact on health equity. CRT provides a lens to analyze how systemic racism is embedded within medical education and practice, illuminating the ways racial bias is institutionalized and perpetuated in healthcare structures. SCT contributes by exploring how individuals internalize societal norms and beliefs, which influence the attitudes and behaviors of both medical practitioners and patients. Finally, ScT emphasizes the role of social networks and relationships, highlighting how disparities in access to healthcare resources and support systems affect health outcomes in marginalized communities. Together, these theories offer a comprehensive framework for understanding the layered and interconnected influences of race, education, and healthcare, guiding the study's aim to challenge and dismantle biased practices within medical training and clinical care. Chapters I and II introduce the research problem and establish a comprehensive foundation, outlining key theoretical frameworks—CRT, SCT, and ScT—while exploring the historical roots of racialized practices in medicine, including the legacy of unethical experimentation and the Flexner Report (open full item for complete abstract)

    Committee: Tony Kashani Ph.D. (Committee Chair); Cristy Sugarman Ph.D. (Committee Member); Lauren Mitchell Ph.D. (Committee Member) Subjects: African Americans; American History; Black History; Black Studies; Cultural Anthropology; Education History; Education Policy; Educational Evaluation; Educational Leadership; Educational Theory; Ethics; Evolution and Development; Health; Health Care; Health Education; Health Sciences; Higher Education; Higher Education Administration; Medical Ethics; Medicine; Organization Theory; Organizational Behavior; Public Administration; Public Health; Public Health Education; School Administration; Science Education; Secondary Education; Social Research; Social Structure
  • 10. Bolarinwa, Motolani Examining The Utilization Of Preventative Colorectal Cancer Screening Among Americans Since The Passage Of The Affordable Care Act From The Providers' Point Of View

    Doctor of Healthcare Administration (D.H.A.), Franklin University, 2025, Health Programs

    This dissertation investigates the impact of the Affordable Care Act (ACA) on the utilization of preventive colorectal cancer (CRC) screening among Americans under 65, focusing on healthcare providers' perspectives. The ACA, a significant healthcare reform, aimed to expand access to preventive services, including CRC screenings, vital for early detection and improved outcomes. This study employed quantitative analysis with a component of qualitative analysis utilizing a modified version of the Survey of Physician Attitudes Regarding the Care of Cancer Survivors (SPARCCS) to gather quantitative and qualitative data from healthcare providers in Maryland, Virginia, and the District of Columbia. The quantitative analysis assessed changes in CRC screening rates, patient compliance, and the effects of ACA-related policy changes, while the qualitative analysis explored providers' insights on barriers to screening, the role of patient education, and the overall effectiveness of the ACA in improving preventive care. Findings indicate a substantial increase in CRC screening utilization and frequency since the ACA's passage, with healthcare providers perceiving significant improvements in patient access and compliance. However, the study also highlights ongoing challenges, including financial barriers and enhanced patient education. These insights are critical for informing future healthcare policies and practices to reduce disparities in CRC screening and improve overall preventive care outcomes. This research contributes to the growing body of literature on healthcare reform and preventive care, offering valuable perspectives from those directly involved in delivering care. The findings underscore the importance of continued efforts to address disparities and optimize the benefits of healthcare policies like the ACA.

    Committee: Rachel Tate (Committee Chair); Jesse Florang (Committee Member); Jennifer Harris (Committee Member) Subjects: Health; Health Care Management; Health Education; Health Sciences
  • 11. Thompson, Leonetta Under-recognition of African American Women Healthcare Leaders: A Phenomenological Qualitative Analysis in Greater Houston, Texas

    Doctor of Healthcare Administration (D.H.A.), Franklin University, 2023, Health Programs

    Houston, Texas, a sprawling metropolis known for its diverse population, is home to a vibrant and thriving healthcare industry. Within this sector, African American women have emerged as influential leaders, catalyzing change and innovation. Nevertheless, Black women leaders in healthcare continue to encounter obstacles such as gender bias and racial discrimination. Overcoming these challenges requires resilience, mentorship, and a commitment to dismantling systemic barriers. African American women in healthcare leadership roles in Houston, Texas, are instrumental in shaping the healthcare landscape and advancing health equity. This work sheds light on the experiences, achievements, and challenges faced by Black women in healthcare leadership roles.

    Committee: Mary Bynum (Committee Chair); Treasure Miller (Committee Member); Crissie Jameson (Committee Member) Subjects: African American Studies; African Americans; Business Administration; Gender Studies; Health; Health Care; Health Care Management; Organizational Behavior; Public Administration; Womens Studies
  • 12. Hernandez, Christian Behavioral Intention to Use Healthcare Chatbots: A Patient Perspective

    Master of Science (M.S.), Xavier University, 2023, Psychology

    The current study aimed to understand U.S. patient perceptions of healthcare chatbots, an emerging form of artificial intelligence (AI) in modern healthcare systems. The research involved perceptions of empathy, social influence, and overall health status influenced patient intentions to use healthcare chatbots. In alignment to hypotheses, patient perceptions of empathy and social influence significantly predicted behavioral intention to use healthcare chatbots. However, patient overall health status did not significantly predict behavioral intention. The study's results call attention to meaningful psychological constructs and demographic data that can assist healthcare organizations in improving patient retention and the customer experience. Limitations and future research areas are discussed.

    Committee: Morrie Mullins (Committee Chair); Eric Barrett (Committee Member); Leann Caudill (Committee Member) Subjects: Health Care; Information Technology; Psychology
  • 13. Miller, Emilie Experiences of Rural Caregivers in Care Coordination for Students with Traumatic Brain Injuries

    Specialist in Education (Ed.S.), University of Dayton, 2023, School Psychology

    Traumatic Brain Injuries (TBI) can have a devastating impact on victims and their families. Families living in rural communities experience unique barriers to receiving care for complex medical needs. While little research exists surrounding TBI specifically, medical staff, school staff, and caregivers for children with complex medical conditions report a range of barriers and facilitators to coordinating care for their child. The current study explored the experiences of rural caregivers for children with TBI, gaining the insights of caregivers, school staff, and medical professionals who cared for a child with a TBI who transitioned to public school after the injury. Themes included the need to navigate complex situations, support from small communities, isolation and loneliness, differences in experience based on severity of injury, and feelings of hope. Barriers to quality care coordination included navigating complex situations, access to transportation, and lack of communication or education from agencies. Facilitators included support from small communities and interagency communication. Based on information from the interviews, more comprehensive coordination between agencies is recommended, including care coordination that was not limited to that covered by insurance. Implications for practitioners include being cognizant of the difficulties caregivers face, providing flexibility due to transportation barriers, creating more comprehensive care for students with mild TBI, and providing more education.

    Committee: Susan Davies (Committee Chair) Subjects: Developmental Psychology; Early Childhood Education; Education Policy; Educational Psychology; Families and Family Life; Health Care; Health Care Management; Physical Therapy; Psychology; School Administration; School Counseling; Special Education; Sports Medicine
  • 14. Mike-Simko, Monica Perspectives of Respiratory Therapists on Trust in Healthcare Leadership Amid the COVID-19 Pandemic

    Doctor of Education (Educational Leadership), Youngstown State University, 2023, Department of Teacher Education and Leadership Studies

    The COVID-19 pandemic created massive amounts of stress for frontline healthcare providers. The purpose of this study was to examine perspectives of respiratory therapists, student respiratory therapists, and respiratory therapy managers on trust in leadership during the COVID-19 pandemic. The United States' healthcare and government systems were not prepared for the burden caused by the SARS-CoV-2 virus. High levels of prolonged stress, along with significant amounts of death, can cause burnout and moral injury for frontline healthcare providers. Healthcare leaders must provide effective communication, support, and proper amounts of personal protective equipment to help diminish the effects of burnout and moral injury. This study used Q-methodology, which is a mixed-methods research design, that included 203 staff respiratory therapists, student respiratory therapists, and respiratory therapy managers in the state of Ohio who worked the frontlines, or managed respiratory therapists working the frontlines, during the COVID-19 pandemic. Five distinct groups emerged from perspectives of participants: I'll be There for You, Won't You Please, Please Help Me?, I'll Get You There, What's Going On?, and Show Must Go On. The quality of the leader has profound effect on participants' perspective of how their institution handled the COVID-19 pandemic. The more daily contact and communication with their leaders, the less guilt the participants felt during the COVID-19 pandemic. Harold Kelley's covariation model conceptualizes the entity and circumstance of the COVID-19 pandemic by sharing perceptions of frontline respiratory therapists. Though the United States government considers the COVID-19 pandemic over, frontline respiratory therapists will endure the effects of the COVID-19 virus for years to come.

    Committee: Karen Larwin PhD (Committee Chair); Sal Sanders PhD (Committee Member); Kelly Colwell EdD (Committee Member) Subjects: American History; Behavioral Sciences; Communication; Continuing Education; Cultural Resources Management; Demographics; Education; Educational Leadership; Environmental Health; Health Care; Health Care Management; Health Sciences; Higher Education; Higher Education Administration; Management; Medical Ethics; Medicine; Organizational Behavior; Pathology; Personal Relationships; Philosophy of Science; Public Health; Public Health Education; Social Research; World History
  • 15. Fox, Stephanie What does it Look Like for Mental Healthcare Organizations to be Healthy Places to Work? An Action Research Study

    Ph.D., Antioch University, 2023, Leadership and Change

    Mental healthcare organizations have a reputation for being unhealthy places to work. The irony of this reputation is keenly felt by its workforce who report unsustainable workloads, high levels of stress, and lack of support or engagement from higher-level leadership. As a mental healthcare provider now in a position of leadership, who has worked across all levels of care within the sector, it was of interest to me to explore how a mental health organization can become a healthier and more sustainable place to work. I approached this study with the assumption that if an organization was healthy and intentional about health in its operation, this would be beneficial to the members of that organization, to the individuals whom the organization serves, and to the organization itself. This study endeavored to answer the question of how mental health organizations can become healthier places to work, considering both the factors that are within the control of mental healthcare organizations as well as those that are not. This study built on prior research by considering multiple factors identified in the research as functioning in relationship to each other. This is a development on previous research which has predominantly investigated aspects of work environment, mental healthcare worker experience, and patient care as siloed elements. Informed by the literature review, an Action Research study was developed and conducted. Study participants represented a cross-section of work experiences within mental healthcare organizations ranging from direct care providers to program directors and administrators. Participants engaged in discussion groups for the purpose of perspective sharing across experiences in order to collaboratively investigate the question of how mental health organizations could become healthier places to work. Key findings of the study were that practical solutions to improve the work environment are feasible and accessible, and not n (open full item for complete abstract)

    Committee: Donna Ladkin Ph.D. (Committee Chair); Lize Booysen DBL (Committee Member); Michelle Pensec-Salyers Ph.D. (Committee Member) Subjects: Health Care; Health Care Management; Management; Mental Health
  • 16. Masterson, Kaleb Mammography Concordance among Sexual Minority Individuals at Elevated Risk of Breast/Chest Cancer: Examining the Roles of Race and Healthcare System Distrust

    Master of Science, The Ohio State University, 2023, Public Health

    Background: In the United States, individuals assigned female at birth have about a 13% lifetime risk of breast/chest cancer. Those with a family history of breast/chest cancer or a BRCA gene mutation are at elevated risk of the disease, with greater than or equal to 20% lifetime risk. However, only a small proportion of individuals at high risk utilize available preventive services like mammography screening. Individuals of sexual minority identity and Black individuals experience increased levels of healthcare distrust. Healthcare distrust in turn is associated with lower rates of mammography screening utilization. Aim: Our study aim was to examine the relationship between healthcare distrust, sexual minority identity, and Black race to determine how they are related to mammography screening concordance rates among individuals at objectively elevated risk. We further sought to determine if healthcare distrust mediated the relationship between sexual minority identity and mammography discordance. Methods: We used survey data from The Daughter Sister Mother Project, a cross-sectional web survey conducted from 2018 to 2019 that used convenience sampling methods. Eligible participants were 18 to 75 years of age, identified as non-Hispanic White or non-Hispanic Black/African American, identified their sex as “female”, had a family history of breast/chest cancer or a BRCA gene mutation, and had no prior history of cancer. Our analysis focused on the high-risk subsample of participants, defined as individuals with a self-reported BRCA mutation or greater than 20% lifetime risk according to 1 or more risk prediction models. The primary exposure for this analysis was sexual minority identity and the primary outcome was mammography concordance, defined as reporting receipt of a mammogram within the last year if recommended according to National Comprehensive Cancer Network (NCCN) screening guidelines for women at high risk. Healthcare distrust was measured using the Rev (open full item for complete abstract)

    Committee: Tasleem Padamsee (Committee Member); Alison Norris (Advisor) Subjects: Black Studies; Epidemiology; Glbt Studies; Health; Health Care; Health Care Management; Health Sciences; Public Health
  • 17. Ginder, Brenda The Use of a Pre-Operative Checklist to Decrease Delays and Cancellations in the Cardiac Catheterization Laboratory

    DNP, Kent State University, 2023, College of Nursing

    Heart disease is the leading cause of death for men, women, and most races and ethnic groups in the United States (US), and costs over 363 billion dollars a year (American Heart Association [AHA], 2021). Every 40 seconds an American will suffer a heart attack, with over one million heart catheterizations performed each year in the US (Virani et al., 2021). Cardiac catheterization is a common procedure used to diagnose and treat those patients suffering a heart attack to identify a blockage(s) that requires either angioplasty with or without stent placement (Virani et al., 2021). With the increase in patient comorbidities coupled with the need for a left heart catheterization (LHC), heart catheterization must be completed as scheduled to prevent the worsening of the patient's condition without unnecessary delays. One way to prevent delays or cancellations of the scheduled heart catheterization is optimizing patients' comorbidities before the heart catheterization to allow the catheterization to proceed as scheduled. Implementation of a pre-operative checklist in the operative setting has been proven to decrease morbidity and mortality when consistently used (Jain et al., 2018). This pilot quality improvement (QI) project investigated the effect a pre-operative cardiovascular catheterization checklist has on delays and cancellations of scheduled heart catheterizations. The development of the checklist was based on chart reviews of previous patients scheduled to undergo a heart catheterization that was delayed and canceled. The reasons for the delays and cancellations were compiled and were the items used to create the original checklist. The checklist was implemented in an affiliate community hospital. The checklist goals were to prevent delays and cancellations and increase communication between the sending facility and the receiving facility. The pilot QI project lasted five months. Data was collected five months before the initiation of the checklist and five m (open full item for complete abstract)

    Committee: Dr. Lisa Onesko (Advisor); Dr. Gina Severino (Committee Member); Dr. Tracey Motter (Committee Member) Subjects: Finance; Health; Health Care; Health Care Management; Nursing; Surgery
  • 18. Neifert, Heather Depression, Anxiety, and Utilization of Mental Healthcare Services Among Individuals with Chronic Obstructive Pulmonary Disease

    MA, Kent State University, 2022, College of Arts and Sciences / Department of Psychological Sciences

    Depression and anxiety are common, debilitating comorbidities in chronic obstructive pulmonary disease (COPD) that are associated with poorer medical and psychological outcomes, but early evidence suggests that this population largely does not receive appropriate psychological treatment. The present study examines prevalence of depression and anxiety among individuals with COPD in the general United States population and their patterns of mental healthcare utilization. Cross-sectional data from 14,784 individuals in the 2019 National Health Interview Survey were analyzed. Depression and anxiety were measured using the Patient Health Questionnaire (PHQ-8) and Generalized Anxiety Disorder Scale (GAD-7). Hierarchical linear regression was used to predict PHQ-8 and GAD-7 scores based on COPD diagnosis. Chi-square tests were used to compare group differences in clinically significant depression and anxiety, mental healthcare utilization, and type of mental health intervention used. Significant findings were further analyzed using exploratory logistic regression. After controlling for covariates, COPD diagnosis was associated with higher depression and anxiety. In individuals with clinical depression and anxiety, COPD diagnosis was associated with greater mental healthcare utilization compared to those without COPD, with individuals with COPD using antidepressants and anti-anxiety medications at higher rates than talk therapy. The present study adds to the current literature noting high levels of depression and anxiety among individuals with COPD, drawing from a large community sample. Findings suggest, given the high levels of psychological comorbidities in COPD, a need for psychological screening and intervention as part of COPD treatment, as well as evaluation of the efficacy of psychopharmacological and psychotherapeutic interventions in COPD. Further study of patterns of mental healthcare utilization in COPD is also required, particularly with attention to how diseas (open full item for complete abstract)

    Committee: Joel Hughes (Advisor); John Updegraff (Committee Member); Jennifer Taber (Committee Member); William Lechner (Committee Member) Subjects: Clinical Psychology; Epidemiology; Health Care; Mental Health; Psychology
  • 19. Fortney, Stoni Client-Level Barriers to Successful Utilization of Telehealth for Clients with Autism Spectrum Disorder

    Doctor of Philosophy, The Ohio State University, 2021, Psychology

    Autism spectrum disorder (ASD) is a neurodevelopmental disorder characterized by deficits in social communication and repetitive, restricted behaviors, with a current estimated prevalence of 1:54. Individuals with ASD typically benefit from a range of medical, psychological, and other services due to impairments caused by ASD as well as high rates of comorbid conditions. Despite this increased need, individuals with ASD and their families often report significant difficulty accessing services, an issue which is compounded for some groups including minoritized racial groups and people living in rural areas. The current study sought to identify challenges faced by clients with ASD and their families when attempting to access behavioral health services via telehealth within the context of the COVID-19 pandemic. Specific research questions were: (1) What are the most common challenges faced by clients with ASD and their families when attempting to access telehealth services? (2) What are the most problematic barriers (i.e., barriers most associated with being unable to access telehealth) faced by clients with ASD and their families when attempting access telehealth services? and (3) Which demographic groups (e.g., race, age, comorbidities) are least likely to be able to access telehealth? Data were extracted from client records of a multi-site provider of developmental disability (DD) services in Ohio following Institutional Review Board (IRB) approval. Results of our analyses suggest that the most common challenges faced by clients with ASD and their families were issues related to client behavior, including client inattention, client noncompliance, and need for in-person support. In regard to ability versus inability to access telehealth services, need for in-person support was found to be related to decreased likelihood of receiving telehealth services, and client inattention was found to be related to increased likelihood of receiving telehealth services. Demogra (open full item for complete abstract)

    Committee: Marc Tasse' (Advisor); Andrea Witwer (Committee Member); Susan Havercamp (Committee Member) Subjects: Psychology
  • 20. Cauhorn, Mary Adaptive Coping and Leader versus Follower Identity: A Correlation Analysis

    Doctor of Education (Ed.D.) in Leadership Studies, Xavier University, 2021, Leadership Studies and Human Resource Development

    This correlational analysis study tested the hypothesis and answered the research questions. The theoretical framework revealed the relationship between the predictor and outcome variables through a correlational investigation into how an individual identifies on the leader and follower distinction and if that identity affects adaptive coping responses. The study utilized survey instrumentation, which was distributed to the population of healthcare professionals. The study's findings supported the indication that there is a positive correlation between leader identity and adaptive coping. The finding of a significant, positive correlation between leader identity and adaptive coping does have predictive value. These results indicate that health care workers who score higher in leader identity are predicted to have higher levels of adaptive coping. The data did not support the prediction of a negative correlation between follower identity and adaptive coping. No correlation was found between follower identity and adaptive coping in this study. Variations in adaptive coping do not co-vary with follower identity. Therefore, higher levels of follower identity do not predict lower levels of adaptive coping. Additionally, the research revealed no significant interaction effect between leader and follower identity and adaptive coping responses.

    Committee: Gail F. Latta Ph.D. (Committee Chair); Saul Schneider J.D. (Committee Member) Subjects: Behavioral Sciences; Health Care