Browsing by Author "ProescholdBell, Rae Jean"
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Item Open Access A Congregational Wellness Challenge: The Feasibility of a Holistic Church-Based Health Promotion Program in Durham, North Carolina(2016) Perry, Kathleen RebeccaBackground: Church-based health promotion programs have been shown to be effective in improving health outcomes, but rarely do they approach wellness from a holistic standpoint. This is a missed opportunity for fuller integration within congregations. This study sought to assess and evaluate the feasibility of a holistic multi-site church-based health promotion program, through engagement, acceptability, and preliminary behavior change outcomes. Methods: This study utilized a concurrent mixed-methods approach in order to evaluate the “Congregational Wellness Challenge” (CWC), a pilot initiative that encouraged behavior change in three areas of holistic wellness: body, spirit, and soul, over six weeks. Participants were asked to complete one activity from each of the three categories every day for forty days, and congregations were encouraged to support those participating in the challenge. This study utilized a pre-post one-group design. Participants were surveyed at baseline and at six weeks about their health behaviors and opinions of the programs, as well as recording their behaviors on activity logs. Seventeen semi-structured in-depth interviews were conducted eight weeks post-challenge. Results: The 39 participants in the study completed 64.2% of the activities during the challenge. There was a significant increase in several of the body health variables. The number of people reporting 30 minutes of physical activity about once a week, two or three times a week or every day, compared to (no times a week?) nearly doubled, from 43.5% to 82.6% (p=0.012). Vegetable and fruit intake also significantly increased, from 52.2% of people reporting eating at least 5 servings of vegetables and fruits daily to 100% of respondents (p=0.001). Frequency of reading for pleasure significantly increased, as did Scripture meditation, bible study, and singing to the Lord. Qualitative results indicated an overall acceptability of the program. Participants had a variety of motivations for joining, and gave valuable feedback on the importance of recording their activities. Conclusion: The CWC pilot initiative was feasible in a wide variety of churches, and future research should focus on the effectiveness of holistic wellness programs and improving implementation practices.
Item Open Access Conceptualization of Health Among United Methodist Church Clergy in Western Kenya(2012) Georggi, Nicole AAbstract
INTRODUCTION
Clergy are a dynamic group of the population: they point people to God, navigate social and spiritual waters, provide advice and guidance, and teach and visit parishioners. Research has shown that caregivers often neglect their health to tend to the health and well-being of others. Because of their unique role in society, the health and well-being of the clergy themselves is an important subject of research. While clergy health is a growing topic of interest in the Western world, very little is known. The few studies conducted on the health of clergy have found that in some areas, this group is less healthy than the general population due to their hectic schedules, lacking social support, and job-related stressors. With the exception of the United States, Canada, and Great Britain, almost nothing has been studied internationally regarding clergy health. In Africa, religion is known to play an important role in the daily life of its inhabitants; however, the overall well-being of clergy including mental, spiritual, and physical health remains under-studied. To date, nothing has been reported regarding the health of pastors in Kenya. This exploratory study sought to better understand how United Methodist Church (UMC) clergy in Western Kenya conceptualize health and how that relates to their health seeking behaviors.
METHODS
This study partnered with religion and public health researchers at Moi University in Eldoret, Kenya, and utilized qualitative methodology to gather information on the conceptualization of health among UMC clergy in Western Kenya. One hour in-depth oral interviews with seven clergy and two Associate District Superintendents and four focus group discussions were conducted with a total of 52 United Methodist Church clergy in Nyanza Province, Kenya in June and July 2012.
ANALYSIS
All transcripts were entered into QSR International's NVivo 10 qualitative data analysis software and coded. Two members of the research team coded an in-depth oral interview and focus group transcription to ensure replicability. A combination of Grounded Theory (GT) analysis and Interpretative Phenomenological Analysis (IPA) was used to interpret the data.
CONCLUSION
UMC clergy define health holistically as the complete well-being of a person in their mind, body, and spirit. Indigenous cultural traditions are still present within the UMC; pastors and parishioners will seek care from a magician rather than a medical doctor if they believe the disease stems from evil spirits. Religious beliefs relate to health seeking behavior in one of two ways: first, clergy believe God alone heals, and thereby view medical seeking behavior as unnecessary and second, clergy believe God alone heals, but view the doctor as a permitted conduit of healing. This knowledge learned from this exploratory study may help inform future interventions.
Item Open Access Educational Attainment and Personal Willingness to Undergo Safe Male Circumcision Among Young Men in Rural Uganda.(2011) Asiimwe, EdgarPrevious models have demonstrated that high uptake of male circumcision (MC) will be required if the procedure is to have a significant public health impact in sub-Saharan African countries (Nagelkerke et al., 2007). Therefore, research about the determinants of uptake of MC among different groups is warranted. The objective of this study was to examine the relationship between educational attainment and personal willingness to undergo safe male circumcision (SMC) in rural Uganda.
In this study, we surveyed 297 participants (aged 18-24) in three rural districts. Additionally, we conducted focus group discussions with between 8-12 participants in each of these districts.
We found that circumcision prevalence and characteristics of those who are circumcised were similar to findings shown elsewhere. Additionally, we found that personal willingness to undergo SMC was lower among respondents with higher educational attainment [OR (crude) = 0.28; p=0.002; CI: 0.12-0.62]. This odds ratio remained statistically significant when we adjusted for demographic confounders [OR = 0.20; p=0.001; CI: 0.08-0.52]. We did not observe any significant difference in willingness between those who had no educational attainment and those who had completed primary education only [OR= 0.90; p=0.89; CI: 0.22-3.68].
We conclude that young men with higher education are less willing to undergo SMC than their less educated peers. In addition, our qualitative results indicate that inadequate information about SMC, among those with higher education, might explain this difference in willingness to undergo the procedure.
Item Open Access Exploring Private Health Providers’ Perception of Challenges and Opportunities in Providing Quality Maternal and Neonatal Services in Uganda.(2017) Lubangakene, CaesarIn Uganda, neonatal and maternal mortality rates remain high despite modest improvements in the last decade. Public health officials often believe these mortality rates can be best improved by improving access and quality of care in public health facilities, but many Ugandans visit private providers due to ease of access to care and perceptions of better quality services. Few studies have examined provider perceptions of the delivery of quality maternal and neonatal care in private facilities in Uganda, especially in lower level private facilities. The objective of this study was to explore the administrative, contextual, and clinical challenges and opportunities in providing perceived quality obstetric and neonatal care services in private health facilities in Masaka and Jinja districts in Uganda. This descriptive qualitative study included 5 focus group discussions and 20 in-depth interviews with 27 staff from 7 private facilities that had all participated in trainings by Life-Net International, an organization that provides onsite medical and administrative training. The study participants were midwives, clinical officers, nurses, nursing assistants, a laboratory attendant and a cashier. Descriptive qualitative analysis was conducted using data-driven codes for the transcribed texts. Data were coded using NVivo software version 11 and coded segments were reviewed and themes developed, which were then categorized into domains. Our main finding is that 1) private lower level providers were not confident in their clinical skills capacity to provide quality neonatal and maternal care and 2) training is one piece of strengthening these systems and yet private lower level providers may have less access to training.
The factors reported to affect provision of quality maternal and neonatal care emerged in the following 6 domains: 1) health center supplies and equipment; 2) health center human resources; 3) health center record-keeping and data management; 4) facility connection to the health system; 5) in-clinic patient care at pre-natal, labor, birth and post-natal care; and 6) Life-Net training experiences. These factors are similar to those reported in the literature on public facilities, but private sector providers reported having less access to training opportunities. Further, clinical practice as reported was not consistent with government guidelines and World Health Organization standards for a low-level facility. To improve neonatal and maternal care in Uganda, both public and private facilities need to be robust. There is an urgent need to invest in private facilities, provide training programs and hear more from private lower level providers.
Item Open Access Facilitators and Barriers to Naloxone Kit Use Among Opioid-Dependent Patients Seeking Treatment at Medication Assisted Therapy Clinics in North Carolina, USA(2016) Khatiwoda, PrasanaNaloxone – an opioid antagonist that reverses the effects of opioids, including potential death from overdose – is increasingly being distributed in non-medical settings. We conducted a mixed methods study administering a survey to 100 treatment seekers and pursuing observant participation at four methadone/buprenorphine Medication Assisted Therapy (MAT) clinics in North Carolina, USA. Female participants were more likely to have gotten a kit and to carry it with them, whereas male participants were more likely to have witnessed an overdose and to have made use of naloxone. Men discussed the difficulties of carrying the naloxone kits, which are currently too large to fit in a pocket. Public health officials may be relieved to know that naloxone users intend to call emergency services.
Item Open Access The Relationship Between Child and Adolescent Sexual and Physical Abuse and Self-efficacy as an Adult Among HIV-positive Substance Users(2013) Rackliff, JenniferBackground: Over one million people have HIV infection in the United States (U.S.), where HIV has permeated all regions of the nation and all ethnic and racial groups. HIV transmission occurs through a number of mechanisms, many of which can be exacerbated by substance use. In 2008, nearly one in four of the HIV-positive population was in need of substance use treatment. The lives of HIV-positive substance users can be further complicated by histories of sexual and physical abuse which is related to worse overall health, health behaviors, and health outcomes.
Objective: This study explores the relationship between the age of initiation of abuse, the type of abuse, psychological symptoms that may result from abusive events, and the confidence in one's ability to communicate with a health care provider, get support from family and friends, and manage his or her mood.
Methods: In the current study, 206 HIV-positive patients were recruited from three infectious disease clinics. The participants screened positive for alcohol or substance use and, as part of a larger study, consented to twelve months of integrated HIV-substance use treatment. Using pre-intervention, baseline data, multiple regression analysis was used to examine the relationship between sexual and physical abuse during childhood and adolescence and current self-efficacy among HIV-positive substance users. Mediational analysis was used to test whether psychological symptoms mediated the relationship between abuse and self-efficacy.
Results: Because of the small sample size, individual categories of abuse were reported but interpretations of these results could not be justified. The primary focus of the discussion focused on individuals who experienced any abuse before the age of 19. Any abuse was not directly associated with one's confidence to communicate (p=0.78). In the relationship between any abuse, psychological symptoms, and communication self-efficacy, anxiety and depression trended towards significance (Banxiety=-0.03, p=0.06; Bdepression=-0.02, p=0.10), but was not a mediator of the relationship. Any abuse was not directly associated with one's confidence to seek support from others (p=0.35). When accounting for psychological symptoms, depression was associated with one's confidence to seek support (B=-0.06, p=0.01). Results were inconclusive for determining a mediation relationship. Any abuse trended toward significance of being negatively associated with one's confidence to manage one's mood (B=-0.34, p=0.11). In the relationship between any abuse, psychological symptoms, and mood management self-efficacy, anxiety and depression were associated with one's confidence to manage one's mood (Banxiety=-0.08, p=0.01; Bdepression=-0.06, p=0.01), but were not mediators of the relationship.
Conclusion: The findings suggest that one's confidence to apply positive health behaviors are tied to psychological symptoms and may be tied to histories of abuse. This study suggests that efforts to improve health behaviors should focus on one's self-efficacy in communicating with health care providers, seeking support from others, and managing one's mood. Additional efforts should be made to address symptoms of depression and anxiety and particularly the correlation that abuse may have in aggravating these symptoms.
Item Open Access The Relationship Between Stigma, Sexual Risk Behavior and HIV Testing Among Men Who Have Sex with Men (MSM) in Kolkata, India(2014) DiPrete, Bethany LinneaMen who have sex with men (MSM) are at high risk for HIV, because of engaging in risky sexual practices. In many countries, MSM remain a highly stigmatized and marginalized population, making them harder to reach for HIV prevention intervention. Until recently before the start of this study, homosexual practices in India were criminalized, which may be influential in establishing and upholding stigma towards the MSM community. The prevalence of HIV in MSM populations in India is higher than the Indian national prevalence rate. This study sought to examine the relationship between stigma and use of HIV preventive practices, HIV sexual risk practices, and HIV testing behaviors among MSM. Surveys were conducted with two samples of men in Kolkata, India. One sample was 43 MSM, drawn from an NGO in Kolkata. The other sample was 57 men who do not have sex with men, drawn from men in varying neighborhoods in Kolkata. Correlations, Fisher's exact tests, Wilcoxon rank sum tests, logistic regressions, and ordinary least squares regressions were used to compare the two samples and the relationships between the variables of interest among MSM. It was found that stigma surrounding homosexuality is present in Kolkata and that it is associated with increased sexual risk behavior among MSM. In addition, MSM reported accessing HIV testing more frequently than non-MSM, and greater stigma was in fact associated with increased testing behavior. MSM were also more knowledgeable about HIV and more sexually risky than non-MSM. These results suggest that there is a relationship between stigma, sexual risk behavior, and HIV testing that warrants further study.