Doctor of Philosophy, Case Western Reserve University, 2021, Anthropology

In an effort to combat the staggeringly high rates of opioid overdose deaths in the US, Overdose Education and Naloxone Distribution (OEND) clinics were established. This study was a collaborative partnership with a local urban hospital committed to harm reduction through their community-based OEND clinic. This study's purpose was twofold. First, to understand who utilized OEND clinics and the factors affecting their HSB (i.e. number of Naloxone kits). Second, to understand how OEND clients framed their understanding of their SUD and if their model of addiction affected HSB. The study was comprised of three distinct phases. Phase 1 Quantitative assessment examined the demographic characteristics (i.e., gender, race, education, SES, occupation), mental health concerns (i.e., anxiety, depression & general distress), breadth and satisfaction of social support, and addiction beliefs in 235 clients from a local OEND clinic in Cleveland, Ohio. Since all participants in this study were already a part the OEND clinic, the number of naloxone kits will serve as a proxy for HSB. Phase 2 Qualitative Assessment explored how 61 of the enrolled clients framed their understanding of their substance use disorder (SUD). Qualitative interviews were coded for themes related to SUD beliefs, the type of stigma experienced by clients as a function of their drug use, and their motivation behind the decisions to seek out Naloxone. Phase 3 involved informal clinic observations to understand clients' experiences and interactions with OEND clinic staff. Gaining a better understanding of patients' health-seeking behaviors (HSB) at OEND clinics is a critical first step along the road to combatting the opioid epidemic. Phase 1 data revealed that clients who chose to engage in the HSB of OEND clinic were primarily unemployed, Caucasian males who were approximately 38 years of age. They were highly anxious, depressed, and in need of more social support to assist in their recovery. The majorit (open full item for complete abstract)

Committee: Lee Hoffer (Committee Chair); Janet McGrath (Committee Member); Jill Korbin (Committee Member); Brian Gran (Committee Member) Subjects: Behavioral Sciences; Cultural Anthropology; Health; Mental Health; Public Health; Social Research

PHD, Kent State University, 2024, College of Public Health

The purpose of this sequential explanatory mixed methods study was to explore HIV risk perception, the meaning of HIV testing, and HIV risk behavior among college students following a negative HIV test. An extended version of the theoretical framework of the health belief model (HBM) aided in the exploration of college students' perceptions of HIV, rationales for HIV risk behavior, and the meaning they attached to HIV testing. Following the sequential explanatory mixed methods design, the initial phase involved collecting quantitative data to assess HIV risk perception among college students who received a negative HIV test in the last 12 months. In the second phase, interpretative phenomenological analysis (IPA) was applied to gather data through individual semi-structured interviews to help explain HIV risk behavior in the context of HIV testing. Findings indicated that college students' perception of their HIV risk is aligned with their risk behavior. Results showed a statistically significant difference in HIV risk perception based on sexual orientation. Before HIV testing, college students justified their HIV risk behavior based on partner trust, not wanting to feel restrained, and acting on the need to fulfill their desire, lust, or temptation. After receiving a negative HIV test result, college students still experienced fear of contracting HIV. However, some students became more cautious and adopted preventive measures, while others continued with previous behavior patterns. Implications of the research findings include examining risk perception across college students of different sexual orientations to understand the impact of risk perception in HIV testing and exploring the differing needs of college students to remain HIV-negative. Participants recommended that colleges address access to free HIV testing, increase information dissemination regarding HIV risk and HIV testing services, and continue research that explores college students' lived experiences (open full item for complete abstract)

Committee: Jeffrey Hallam (Committee Co-Chair); Jo Dowell (Committee Member); Deric Kenne (Committee Member); Eric Jefferis (Committee Co-Chair) Subjects: Behaviorial Sciences; Epidemiology; Higher Education; Public Health; Social Research

Doctor of Philosophy, University of Toledo, 2023, Health Education

Introduction: Racism plays an important role in the everyday lives of many Black people. These experiences can influence health and health behaviors. Racism can also affect decisions to seek out needed health care. African Americans had more positive attitudes toward seeking professional mental health services compared to other racial/ethnic groups however, they were less likely to utilize these services (Diala et al., 2000). This could be due to many reasons including incidences of racism, a lack of Black mental health professionals, privacy concerns, and religious beliefs. Racial identity also plays a key role in accessing services and as perceived racism increases, intentions to seek counseling decrease (Mosley, 2014). It is important for nurse midwives and other health providers to seek out the help they need for self-care so they can continue to provide high quality care to their patients. Purpose: This study examines whether perceived racism influences self-reported health and mental health help-seeking behaviors of Black nurse midwives and subsequently impacts their perceived ability to provide quality care. The Health Belief Model, a theoretical framework in the field of health that helps explain health behaviors and direct health promotion interventions, will guide the study. The specific purpose of this study is to measure the effect of perceived racism and constructs of the Health Belief Model (perceived barriers to help-seeking, cues to help-seeking) on self-reported health and mental health help-seeking behaviors which could potentially affect the ability of Black nurse midwives to provide quality care to their patients. Methods: A quantitative, cross-sectional study was conducted utilizing midwives who identify as Black from the American College of Nurse Midwives (N=26). Utilizing the Health Belief Model (HBM), an 86-item questionnaire was developed to gain a better understanding of how perceived racism affects self-reported health, help seeking (open full item for complete abstract)

Committee: Victoria Steiner (Committee Co-Chair); Mounika Polavarapu (Committee Member); Colleen Taylor (Committee Co-Chair); Barbara Saltzman (Committee Member) Subjects: African Americans; Health; Health Education; Mental Health; Nursing

DNP, Walsh University, 2023, Nursing

Diabetes is an expensive and debilitating chronic disease that requires a complex regimen of team-based care, medication, lifestyle management, and monitoring to avoid complications. As part of this regimen, health care providers frequently prescribe diabetes education. While this education has routinely been performed at in-person appointments with a Certified Diabetes Care and Education Specialist, covid restrictions on in-person appointments required that education be performed via telemedicine. Little evidence exists to assist providers in determining if telemedicine diabetes education is associated with similar health benefits compared to in-person diabetes education. This multi-site, randomized trial compared diabetes education delivered via telemedicine to diabetes education delivered at an in-person appointment. There was a statistically significant increase in pre- to post-intervention diabetes knowledge in the in-person group compared to the telemedicine group. There was no significant difference between groups in pre- to post-intervention mean measures of body weight, hemoglobin A1c, or systolic blood pressure. Both groups experienced significant decreases in pre- to post-intervention within-group measures of body weight, hemoglobin A1c, and systolic blood pressure. Both groups experienced a significant increase in pre- to post-intervention within-group measures of diabetes knowledge.

Committee: Shelly Amato-Curran (Committee Co-Chair); Tracy Herstich (Committee Chair) Subjects: Education; Endocrinology; Health; Health Care; Nursing; Nutrition

Doctor of Philosophy, The Ohio State University, 2022, Human Ecology: Human Nutrition

Approximately 48 million people, per year, are estimated to contract some form of foodborne disease[1], but foodborne infection is a risk which can be mitigated with appropriate food safety behaviors. [2]. Cancer patients experience a compromised immune system, both due to the mechanisms of cancer and due to the means by which treatments for cancer act upon the body[3]. This means that patients receiving treatment are at significantly higher risk of acquiring a foodborne infection than people living without cancer[4], and the Centers for Disease Control (CDC) has issued specialized guidelines for immunocompromised people [5]. Currently, approximately 5% of the US population are cancer survivors, with the raw number anticipated to increase from the current 16.9 million to 22.2 million, by 2030[6]. A person's risk of developing foodborne disease depends on a number of factors related to the host, their environment, and the pathogen is question. In 1998, Coleman et al. posited the design of the Disease Triangle, a framework whereby microbial risk analysis could be performed by assessing the host, pathogen, and environment[7]; an updated version of this model, now called the Health Triangle, expands upon what, explicitly, might be controlled within each of these three categories[8]. Environmental factors include aspects such as diet, nutrition, exposure (i.e., through air, occupational exposure, and the indoor/outdoor environment). Host factors depend on the general host of the health, with factors such as age, genetics, immune system, and underlying illness being harder or even impossible to change. Coleman et al. add a third aspect to the Health Triangle, which includes the microbiota and modulators. Use of antibiotics, chemotherapy, fecal transplants, and pre-, pro-, and syn-biotics can all impact the microbiome, and some can be modulated with diet or treatment. By performing appropriate food safety behaviors, cancer patients are able to decrease their ris (open full item for complete abstract)

Committee: Sanja Ilic (Advisor); Tonya Orchard (Committee Member); Ellen Evans (Committee Member); Dayssy Diaz Pardo (Committee Member); Irene Hatsu (Committee Member) Subjects: Behavioral Sciences; Biology; Health Education; Health Sciences; Microbiology; Nutrition

PHD, Kent State University, 2022, College of Public Health

Background: Type 2 diabetes, known as non-insulin-dependent diabetes, has increased among the adult population in Saudi Arabia. Diabetes affects 18.3% of Saudi individuals, and about $7 billion (13.9% of the total health care budget) is utilized for all diabetes patients. The problem affects people of all ages, and college students often fail to follow the recommended diabetes prevention behaviors, increasing their risk of T2DM. Evidence shows that people's health behaviors are influenced by their health beliefs and other personal and environmental factors. From a prevention viewpoint, a few studies have explored the association between health beliefs and people's behaviors; however, those studies were on patients with T2DM. The association of environmental factors on physical activity and dietary behaviors among Saudi college students in the United States was not previously assessed. Therefore, using the Health Beliefs Model, this study examines the association between college students' health beliefs, other risk factors, and their physical activity and dietary behavior. Method: A cross-sectional survey was conducted through social media targeting Saudi international students living in the United States. Descriptive analysis was utilized to identify participant characteristics and describe the frequencies of physical activity and healthy diet per week. Logistic regression analysis examined the association between multiple factors and health behaviors. Results: Among the 410 participants, overweight and obese participants represented 32.4% and 14.6%, respectively. Participants with T2DM family history were 57.2%, and 22% were current smokers. The majority of participants reported moderate levels of stress (93.9%), and 61% had a lack of T2DM knowledge. Most participants did not feel susceptible to T2DM and did not feel it was serious; however, most (56.5%) believed in the benefits of engaging in healthy behaviors. About 59.5% had low levels of perceived susceptibilit (open full item for complete abstract)

Committee: Jeffrey Hallam Dr. (Committee Chair); Kele Ding Dr. (Committee Member); Peggy Stephens Dr. (Committee Member); Eric Jefferis Dr. (Committee Member) Subjects: Health; Health Sciences; Public Health

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

Parental vaccine hesitancy causes lower childhood vaccination rates and higher instances of vaccine preventable diseases spreading. Thus, understanding why parents are vaccine hesitant can provide insight into their beliefs, and thus, supply health care providers a point of entry into how to talk about parents' vaccine hesitant beliefs. This is especially true for parents of children with Down syndrome, who have been shown to have lower vaccination rates than the general population (Langkamp et al 2020). Furthermore, with the COVID pandemic in full swing and a COVID vaccine widely available, parental vaccine hesitancy surrounding the COVID vaccine is of importance. No studies have conducted research on the perception of the COVID vaccine by parents of children with DS. Therefore, this study aims to understand factors related to parents' vaccine acceptance, vaccine hesitancy and vaccine refusal through a Health Belief Model lens in order to inform interventions to improve vaccine adherence and decrease the spread and/or severity of COVID among children with DS and society as a whole. An internet survey was disseminated to parents of adolescents with DS with questions pertaining to vaccines, vaccine hesitancy, and trust in different sources. Parents with less trust in doctors, scientists, and government agencies (i.e., the CDC, FDA, NIH, etc.) were more likely to be vaccine hesitant, compared to vaccine accepting parents. Perceived benefits and perceived barriers also significantly account for variance of parental vaccine hesitancy—with parents who perceive fewer benefits to COVID vaccination, and more barriers to COVID vaccinations being significantly more likely to be vaccine hesitant compared to parents who perceive more benefits to COVID vaccination, and less barriers to COVID vaccinations. Preliminary findings of the vaccine hesitant parents also suggest they are heterogenous in their beliefs. Future research should investigate the differences in beliefs among v (open full item for complete abstract)

Committee: Beth Wildman (Advisor); Jennifer Taber (Committee Member); Amy Sato (Committee Member); Diane Langkamp (Committee Member) Subjects: Clinical Psychology; Psychology

Doctor of Healthcare Administration (D.H.A.), Franklin University, 2021, Health Programs

Routine HIV testing for adults 65 years and older is imperative for prevention and treatment efforts among the vulnerable population. To date, limited research exists that examines associations between sex in HIV testing, HIV risk perception, and HIV risk among adults who are 65 years and older. Certain risk behaviors can lead to missed testing opportunities for some Medicare beneficiaries aged 65 and older, increasing the likelihood of new HIV transmissions and late-stage diagnoses. A federal mandate requires that Medicare Part B (outpatient insurance) cover annual wellness visits, which allow providers and beneficiaries to develop personalized prevention plans of care. However, Medicare does not offer routine HIV testing to beneficiaries 65 years and older, unless they specifically ask for a test (risk perception) or considered at risk (actual risk). This quantitative, cross-sectional, causal-comparative research design was guided by the health belief model (HBM) and theory of gender and power (TGP). Chi-square tests analyzed secondary data from the 2018 National Health Interview Survey, Adult Sample file regarding HIV testing, HIV risk perception and HIV risk among non-institutionalized adults, 65 years and older. The significance of statistical tests was determined at the .05 alpha level. Study findings revealed a significant association between sex and HIV testing prevalence, with men (24.3%) testing more frequently than do women (20.1%). Findings also revealed a significant association between sex and HIV risk. Men (41%), when compared to women (22%), were almost twice as likely to have at least one factor increasing HIV risk. There was no significant association between sex and HIV risk perception. Findings revealed that both men (99.6%) and women (99.6%) equally lacked HIV risk perception.

Committee: Mary Bynum DHA (Committee Chair); Cynthia Smoak DHA (Committee Member); Chenelle Jones PhD (Committee Member) Subjects: Aging; Gender Studies; Gerontology; Health; Health Care; Health Care Management; Health Education; Public Administration; Public Health; Public Health Education

Master of Science, The Ohio State University, 2020, Vision Science

Purpose: The Health Belief Model (HBM) has been widely used to predict and explain health related behaviors. We used this model to develop a survey that examines daily disposable (DD) soft contact lens (SCL) attitudes and beliefs, and we administered it to a group of young adult wearers in order to evaluate its measurement properties. The ultimate intention is that the results of this study will be used by clinicians to enhance the understanding of patients' feelings about lens wear to improve education and intervention. Methods: A convenience sample of confirmed DD SCL wearers between the ages of 18 and 33 years was enrolled at two academic health centers. Subjects completed a demographic survey, information about their DD SCL wear and use, and questions embodying HBM constructs: self-efficacy, susceptibility, severity, benefits, barriers, and cues to action. Responses were recorded electronically using a five-point Likert scale with Qualtrics software (Provo, Utah). Rasch Analysis was used to assess the psychometric properties of the survey instrument as well as to generate scores for each of the six HBM subscales and ANOVA was used to determine relationships among the HBM constructs, subject demographics, and DD SCL-related health behaviors. Results: One hundred people participated (mean ± SD age = 24.2 ± 3.9 years, 76% female). Thirty-seven percent of subjects reported sleeping in DD SCLs and 25% reported reusing DD SCLs. No significant differences in attitudes and beliefs were found between males and females on any subscale. There were also no significant differences by age or between study sites. Education level was associated with scores on the benefits (p=0.019), barriers (p=0.035), and self-efficacy (p=0.047) subscales. Self-report of reusing DD SCLs was associated with scores on the benefits (p=0.036) and barriers (p=0.007) subscales, and sleeping in lenses was associated with scores on the susceptibility (p=0.037), benefits (p=0.024), and barriers (open full item for complete abstract)

Committee: Heidi Wagner OD, MPH (Advisor); Bradley Dougherty OD, PhD (Committee Member); Aaron Zimmerman OD, MS (Committee Member) Subjects: Public Health

Doctor of Nursing Practice , Case Western Reserve University, 2019, School of Nursing

Problem Statement: Staying physically active is essential to healthy aging, however, older adults are the least active segment of the population. Little is known about differences in the demographics and motivation of older people to remain active by mall walking compared with adults from a generation ago. Aims: This study aimed to determine the similarities and differences in the characteristics and motivation of mall walkers in 1995 and 2018. Which health problems do older adults perceive they are most and least susceptible to and which health threats do they report will have the greatest impact on their lives? What do older adults perceive to be the benefits and barriers of mall walking and which factors trigger or cue mall walking behavior? Are people motivated by health or are they focused on preventing disease? Methods: This descriptive comparative study utilized a questionnaire framed by the Health Belief Model to explore the characteristics and motivations of older adults who engage in mall walking. Results were compared with findings from a 1995 study to determine if significant differences existed between two generation's motivation to exercise, perceptions of the impact of disease, benefits and barriers to walking in malls, and cues that may trigger exercise behavior. Data were analyzed with SPSS software to determine the impact of demographics on motivation to exercise. Pertinent Findings: Significant differences in the demographic data and motivation to walk was noted between the cohorts. Participants in 1995 were generally younger, significantly overweight or obese, and motivation to walk was often extrinsically driven based on physician recommendations. Mall walkers in the current study were older, more educated, had healthier BMIs, possessed multiple chronic diseases, and were more intrinsically motivated to exercise. Most participants in 2018 were also found to be meeting recommended physical activity guidelines by engaging in mu (open full item for complete abstract)

Committee: Evelyn Duffy DNP, AGPCNP-BC, FAANP (Committee Chair); Joachim Voss PhD, ACRN, FAAN (Committee Member); Hilaire Thompson PhD, ARNP, FAAN (Committee Member) Subjects: Aging; Gerontology; Nursing; Sports Medicine

Master of Arts (M.A.), University of Dayton, 2018, Communication

This study examined the potential for concepts within the Health Belief Model to predict Chinese college students' daily brushing, daily flossing, and annual dental check-up behavior. Additionally, dental-related information seeking and scanning were explored. The survey was completed by 150 Chinese college students and found that some components of HBM significantly predict brushing behavior, flossing behavior, and dental check-up behavior. Self- efficacy was the best predictor of brushing and dental check-up behavior, while barriers and dental-related knowledge were the best predictors of flossing behavior. Participants prefer to seeking from social media and with his or her dentist and scan information from social media and mass media. Information seeking and scanning only significantly predicted flossing behavior. Knowledge, seeking and scanning information from a dentist were the best predictor of dental check-up behavior. Future studies could examine more about self-efficacy and dental health behavior in the Chinese cultural context.

Committee: Angeline Sangalang (Advisor); Teri Thompson (Committee Member); James Robinson (Committee Member) Subjects: Communication; Dental Care

Master of Science, The Ohio State University, 2018, Allied Medicine

Prediabetes is a condition indicative of glycemic dysregulation in which individuals are at high risk for developing type 2 diabetes mellitus (T2DM). While intensive lifestyle interventions have been found to effectively reduce diabetes risk long term, diabetes rates continue to rise. Risk perception, a subjective judgement of one's vulnerability to a threat, has been identified as a factor that significantly impacts an individual's ability to initiate and maintain behavioral changes and may be an area of interest when developing prediabetes programming. This study used the Health Belief Model (HBM) to determine how individuals with prediabetes perceived their risk for developing T2DM and to identify specific factors influencing risk perception. Three focus groups were held at a community center in Columbus, Ohio with a total 13 African American participants (n=13). Data gathered from the qualitative interviews found that physical activity was a mediator of risk perception in this group. Knowledge of family history, diagnosis of prediabetes, and complications of diabetes in family members were important motivators in reducing risk or delaying the onset of T2DM in this group. Finally, a strong sense of personal control reduced the threat of T2DM and overall risk perception for developing the disease. While participants in this population had a high risk for T2DM due to age, race, and family history, we found that participants had strong levels of personal control, which they felt improved their ability to maintain these risk-reducing behaviors and prevent T2DM.

Committee: Ingrid Adams (Advisor); Kay Wolf (Committee Member); Marcia Nahikian-Nelms (Committee Member); Kristen Roberts (Committee Member) Subjects: Nutrition

PhD, University of Cincinnati, 2017, Education, Criminal Justice, and Human Services: Health Education

STUDY 1 - BACKGROUND: Occupational exposure to heat can result in illness, injury, and death among workers, particularly those in outdoor environments such as emergency oil spill cleanup responders. PURPOSE: This study assessed heat-related knowledge, perceptions, and barriers among oil spill cleanup responders. METHODS: A total of 65 oil spill cleanup responders completed an online survey which examined heat stress during cleanup activities. RESULTS: Of the respondents, most had 25 or more years' experience, worked for companies with 19 or fewer employees, were not classified as safety and health professionals, had a Bachelor's degree or higher, and worked in the northern/central regions of the U.S. While most were knowledgeable about heat stress, the items in which respondents were least knowledgeable were: identifying the difference between heat exhaustion and heat stroke, the appropriate use of salt tablets, the effects of air conditioning on acclimatization, and previous heat-related illness (HRI) as a risk factor. For heat stress knowledge, there was a significant difference between non-safety and health professionals (M = 5.70, SD = 1.081) and safety and health professionals (M = 6.62, SD = 1.024; t = -3.257, p = .002). Respondents reported that they tended to perceive that heat stress can be severe and that HRI's may affect workers. Regarding self-efficacy, most felt confident in contacting emergency medical services, recognizing symptoms, and knowing what to do if a coworker became ill. Discussion: The difference in heat stress knowledge between those with professional safety and health experience and those without experience is confirmatory. Oil spill cleanup responders are at high risk for HRI, injury, and death and those responsible for their training need to be knowledgeable about occupational heat stress. More research is needed to determine further information about knowledge, perceptions, self-efficacy, and barriers at the worker level. STUDY 2 (open full item for complete abstract)

Committee: Keith King Ph.D. (Committee Chair); Ashley Merianos Ph.D. (Committee Member); Rebecca Vidourek Ph.D. (Committee Member) Subjects: Health Education

Master of Science, The Ohio State University, 2017, Genetic Counseling

BACKGROUND: Breast cancer is the most common cancer diagnosis for women under 40 years of age. Since 1999, the National Comprehensive Cancer Network (NCCN) has recommended that anyone who is diagnosed with breast cancer under the age of 40 meet with a genetic counselor and be offered genetic testing. In our cohort of women with breast cancer diagnosed at or before age 40, 555 of 2,223 (24.9%) reported that they had not had genetic testing for Hereditary Breast and Ovarian Cancer syndrome (HBOC) at the time of enrollment. Our study aimed to assess whether geographic barriers had an effect on whether high-risk women underwent genetic testing. METHODS: We surveyed 1,673 women who were still living and had valid email addresses to assess geography as a barrier. Using the Health Belief Model, questions were designed to assess barriers believed to have an impact on women in rural areas getting genetic testing. We expected to observe that women from rural areas who had longer distances to travel for care, had a stronger relationship with their healthcare provider, and reported less of an understanding of cancer genetics were less likely to have undergone genetic testing for HBOC regardless of their high-risk status. RESULTS: We received 865 returned surveys giving a response rate of 51.6%. Of these, 825 were able to be analyzed. Nearly an equal proportion of women from both urban and rural areas reported having had genetic testing prior to the study. As expected, our study showed that women from rural areas did have a longer travel time required in order to receive care. Unexpectedly, our study showed that women from urban areas were more likely to have a stronger relationship with their physician and results were mixed in regards to which group of women had more of an understanding of cancer genetics. CONCLUSION: We did not receive enough responses from women in rural areas to make our data statistically significant and therefore did not have statistical power. T (open full item for complete abstract)

Committee: Robert Pilarski MS, LGC, MSW (Advisor); Kate Shane MS, LGC (Committee Member); Paul Goodfellow PhD (Committee Member) Subjects: Genetics

Master of Science, University of Toledo, 2016, Spatially Integrated Social Science

Goal: To determine the factors affecting patients' perceived benefits of 1) adherence packaging, 2) medication therapy management (MTM), 3) delivery, 4) automatic refill, and 5) refill synchronization. Additionally, to determine the patients perceived benefits that predict their interest in participating in a pharmacy service. Methods: This cross-sectional exploratory study used convenience sampling to survey participants over a seven-week period. Survey questions were designed through elicitation interviews. Validity (factor analysis) and reliability (Cronbach's alpha) were assessed. Linear regression and logistic regression were conducted. Results: A total of 304 surveys were collected. The majority of the participants were not aware of refill synchronization (68.4%), MTM (58.2%), and adherence packaging (77.3%). Age (p=0.018) and the number of medications (p=0.028) a participant contributed the most to how patients perceived the benefit of services. Participants who perceived adherence packaging (B=3.098), MTM (B=2.286), delivery (B=5.148), automatic refill (B=12.047), and refill synch (B=1.598) will help them feel more in control of taking their medication were more likely to participate in the service. Conclusion: In an effort to increase patient participation in pharmacy services, pharmacies need to assess patients' perceptions and cater their services to address the patients' beliefs.

Committee: Sharrel Pinto PhD (Advisor); Amit Patel PhD (Committee Member); Sadik Khuder PhD (Committee Member) Subjects: Pharmacy Sciences

DNP, Otterbein University, 2016, Nursing

Rural residents at all income levels are significantly less likely than urban residents to participate in cancer screenings. Furthermore, rural women face common significant barriers to mammography, including: knowledge deficit, lack of primary care provider, no health insurance, fear, decreased access, transportation issues and financial constraints. The purpose of this project is to investigate factors influencing participation in screening mammography among rural women in Adams and Highland counties. Both of these Southern Ohio counties have lower than average rates of screening mammography. For this project, a non-experimental, cross-sectional design was utilized. Data was collected using a survey, based on the revised Champions Health Belief Model Scale. One hundred women voluntarily signed consent and participated in the survey, ninety of the women met the inclusion criteria. Quantitative data analysis was performed, as well as qualitative inquiry on the open-ended questions. A two proportions test found with statistical significance that women who have a primary care provider are more likely to participate in screening mammography than women without a primary care provider. It was also found that the majority of rural women surveyed, unless there is a positive family history of breast cancer, do not view themselves as susceptible to breast cancer. The qualitative data provided valuable insight regarding the attitude of rural women towards participation in screening mammography. “Time constraints” was the most common reason given for not having a mammogram in the past 12 months. A “reminder card” is what the participants believed made it easy for them to get a mammogram regularly. Consistent with the literature, the findings reiterate the importance of the role of the primary care provider in health promotion among rural women.

Committee: Patricia Keane Dr. (Advisor) Subjects: Nursing; Public Health

Doctor of Philosophy (PhD), Ohio University, 2015, Communication Studies (Communication)

Advance care planning (i.e., the process by which individuals identify life- sustaining treatment preferences; ACP) is frequently targeted to older adult and terminally ill populations. This is a shortcoming because young adults are also at risk for sudden illness and traumatic injury, and making advance care plans prior to becoming ill may make decision-making easier for both individuals and their families. As such, this dissertation views ACP as life-long process that should begin when individuals are young adults. Because ACP is often perceived as a difficult conversation and individuals are reluctant to engage in it, it is important to understand the individual and relational factors that affect young adults' intent to have ACP conversations. This dissertation advances health communication research by developing the difficult conversation model (DCM) that bridges components of the theory of planned behavior, the health belief model, and the disclosure decision-making model. The following dissertation reports three studies that build upon one another to finally assess the proposed DCM model. The first step in building and evaluating this model was formative research. Formative research allowed for both the exploration of anticipated individual motivating factors as well as the discovery of unanticipated individual and relational factors. Results of the focus groups showed that relational factors do play a part in individuals' intent to communicate about ACP. In Study 1, I applied the findings of the focus groups by testing several of the individual and relational factors for the model. Study 2 was an extension of Study 1, in which I added the remaining individual and relational factors, and the DCM was developed and assessed. The results of Study 2 indicated that barriers, severity, anticipated response, attitude, perceived behavioral control, and cues to action affect young adults' intent to have ACP conversations. Several interesting mediations were also rev (open full item for complete abstract)

Committee: Amy Chadwick Dr. (Advisor); Charee Thompson Dr. (Committee Co-Chair) Subjects: Communication

MPH, University of Cincinnati, 2015, Education, Criminal Justice, and Human Services: Public Health - Health Education/Health Promotion

The purpose of this study is to determine if the health belief model predicts childhood obesity prevention behaviors among upper elementary school children in a sample drawn from the Chennai region of southern India. The study reports data about three behaviors: less than two hours of screen time, drinking 6 to 8 cups of water instead of sweetened beverages, and eating five or more cups of fruits and vegetables. The health belief model has offered a practical framework for designing primary prevention interventions to reduce other health problems and continues to do so in the West. This study was designed to examine the extent to which selected health belief model constructs could predict the chosen behaviors among upper elementary school children in India. Data were collected using a 47-item valid and reliable scale administered to the sample population. Regression analyses were run to test for variance in behaviors attributable to each of the independent variables. The final regression model revealed that the health belief model predictors were weak in the current context of study, probably due to cultural differences in India compared to the USA where this model originated. Recommendations have been offered to evolve interventions aimed at predicting obesity associated behaviors in children.

Committee: Bradley Wilson Ph.D. (Committee Chair); Brittany L. Rosen Ph.D. (Committee Member); Manoj Sharma M.B.B.S. Ph.D. (Committee Member); Jun Ying Ph.D. (Committee Member) Subjects: Public Health

DNP, Walsh University, 2015, Nursing

Breast cancer is a serious problem worldwide, with more than 200,000 new diagnoses and over 50,000 deaths each year as a result of the disease (Centers for Disease Control [CDC], 2013). In the United States, it ranks second only to lung cancer as the leading cause of death due to cancer for women (CDC, 2013). Studies show a number of risk factors for breast cancer that are not in our control, however, multiple studies have shown a positive correlation with higher BMI's and the incidence of breast cancer in the postmenopausal woman (World Cancer Research Fund, 2010). Few studies have been done to determine if there is a relationship of BMI to breast cancer rates in the premenopausal woman (Cheraghi, Poorolajal, Hashem, Esmailasab, & Irani, 2012). The prevalence of breast cancer in the United States provides an opportunity for investigating if a relationship exists between obesity and premenopausal breast cancer. The knowledge gained from this research could be valuable for healthcare providers in the disease prevention education for patients. The purpose of this study is to determine if there is a relationship between obesity, defined as a BMI greater than 29, and breast cancer in premenopausal women. This retrospective study was conducted at a regional healthcare center specializing in cancer research in Southwestern Ohio. Criteria for inclusion was being a woman between the ages of 18-49 with a diagnosis of breast cancer in the past 6 years. Results of the study showed an association between elevated BMI and the incidence of breast cancer in the premenopausal woman. Limitations included a small geographical area, lack of racial and economic diversity related to the location of the facility, and was limited to the data collected by the facility.

Committee: Sharon Oetker-Black PhD, RN, JD (Committee Chair) Subjects: Health; Health Care; Health Education; Nursing

PHD, Kent State University, 2015, College of Education, Health and Human Services / School of Health Sciences

The purpose of this study was to investigate intimate partner violence (IPV) in nine Appalachian Ohio counties by applying the constructs of the Health Belief Model as the theoretical underpinning. A multi-scale instrument was developed to explore participant attitudes toward IPV as a public and personal health concern. Participant ranking of physical, sexual, and expressive aggression, coercive control, and stalking IPV behaviors based on perceived severity was examined. Demographics included age, household income, educational attainment, environment (rural, suburban, urban), Appalachian self-identity, and self-reported lifetime IPV experience. These variables were used to determine if a relationship existed between the variables and attitudes toward IPV behaviors. Cues to action were considered to determine what influences would encourage a woman to seek help if IPV were experienced. Findings from this study shed light on the diversity in the region, and demonstrated how risk factors played a substantial part in IPV experience, attitudes and behaviors. Results showed how IPV experience (or no experience) may alter perceptions of susceptibility, severity, and barriers to help seeking. Results also presented consistency with seminal findings regarding IPV experience in Appalachia, the effect of labeling one's self as Appalachian, and the importance of family and friends in addressing IPV issues. Areas of contradiction were highlighted, specifically in regards to rural environments affecting perceptions, and the importance of health care professionals. The HBM was proven to be an effective theory for evaluating IPV-related health behaviors and perceptions.

Committee: Dianne Kerr Ph.D. (Committee Co-Chair); Donna Bernert Ph.D. (Committee Co-Chair); Schimmel Kimberly Ph.D. (Committee Member) Subjects: Health Education