Behavioral & Community Health Theses and Dissertations
Permanent URI for this collectionhttp://hdl.handle.net/1903/2802
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Item DEVELOPMENT OF A CORE OUTCOME SET FOR STUDIES INVESTIGATING SAFETY, EFFICACY, AND IMPLEMENTATION OF COVID-19 VACCINES: A COLLABORATION WITH AFRICAN AMERICAN/BLACK COMMUNITIES IN BALTIMORE CITY, MARYLAND(2022) Datar, Reva; Howard, Donna; Public and Community Health; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)Background: Since it was declared a global pandemic in March 2020, Coronavirus Disease 2019 (COVID-19) has claimed over one million lives in the United States. Since COVID-19 vaccine rollout efforts began in Baltimore City, Maryland in December 2020, approximately 63.4% of all residents have been fully vaccinated (i.e., received their first and second doses in a two-dose series or received a single-dose vaccine). Despite efforts to implement equitable vaccine distribution in Baltimore City, prominent disparities in COVID-19 vaccine uptake persist, with poorer, predominantly Black neighborhoods frequently reporting lower levels of vaccine uptake than affluent, predominantly White neighborhoods. Guided by key principles of community-based participatory research, this dissertation explores community experiences with COVID-19 vaccines and develops a core outcome set (COS), inclusive of community-important outcomes, for use in studies evaluating the safety, efficacy, and implementation of COVID-19 vaccines. Methods: In March 2022, semi-structured interviews were held with vaccinated and unvaccinated Black residents of a community in Baltimore City reporting 40% vaccination uptake. Data were analyzed using inductive thematic analysis with subsequent subgroup analyses and thematic network analyses. To assess the extent to which outcomes measured in COVID-19 vaccine studies published between December 2019 and March 2022 aligned with factors of vaccine hesitancy, a systematic literature review (SLR) was conducted. Results from the qualitative analyses and the SLR informed the development of a candidate list of outcomes used in the first round of a Delphi study held in June 2020. After two rounds of Delphi survey distribution, a face-to-face consensus meeting was held with community members and community health workers to prioritize outcomes of interest to all relevant stakeholders and finalize the COS.Results: Thematic analysis yielded four emergent themes relating to COVID-19 vaccine uptake decision making: (I) Safety and efficacy of vaccines, (II) Perceived importance of COVID-19 vaccines in relation to pre-existing community needs, divided into two subthemes, a) Environmental injustice and (b) Personal health concerns, (III) Access to trustworthy, understandable information, and (IV) Physical access to vaccines. Participants acknowledged that physical access to COVID-19 vaccines was not a major barrier to uptake, however finding trustworthy and understandable information about the safety and efficacy of the vaccines were common areas of concern. Of all primary outcomes (N=20) identified in the 56 articles included in the SLR, 85% (n=17) corresponded with factors of vaccine hesitancy. The final COS included 19 outcomes across four “domains:” “Is the vaccine safe?”; “Does the vaccine work in my body?”; “Does the vaccine work in the community?”; and “Outcomes identified during consensus meeting.” Conclusion: The findings from this dissertation suggest that although community-important outcomes related to safety and efficacy of vaccines are often addressed in clinical studies, outcomes measuring institutional trust, economic and health impacts, community acceptance of the vaccines, and trustworthiness of vaccine information are underutilized in studies of vaccine implementation. As these social factors function as barriers to vaccine uptake, particularly among underserved communities, they should be regarded as indicators of equitable access to COVID-19 vaccines. The findings from this dissertation provide a framework with which public health researchers can begin to rethink measures of equity in vaccine rollout efforts.Item MENTAL HEALTH IN UNIVERSITY STUDENTS IN BANGLADESH: AN EXAMINATION OF CURRENT PRACTICES, SERVICE USE, AND AN EXPLORATION OF THE ACCEPTABILITY OF MHEALTH FOR MENTAL HEALTH AND MINDFULNESS(2021) Sifat, Munjireen Sara; Green, Kerry M; Public and Community Health; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)The prevalence of mental health problems, such as depression and suicide, is high in Bangladesh. The incidence of mental health problems in Bangladesh is highest in young adulthood and often occurs in university students. Mobile health apps are effective in Bangladesh for chronic health problems, though there is no current literature on the use of mHealth for mental health promotion in Bangladesh, nor in the university student population in Bangladesh. The study utilizes a multi-method design informed by Self-Determination Theory and the Technology Acceptance Model to explore motivational factors for mental health practices, such as coping techniques, and use of professional services, such as therapy. The quantitative component includes regression analysis of an online survey delivered to students currently enrolled in universities in Bangladesh to determine current attitudes and practices of mental health services (n=350) and the possibility of using mHealth for mental health (n=311). The qualitative component involves thematic analysis of semi-structured interviews with randomly selected students (n=12) who complete the quantitative portion of the study, regarding their opinion of mHealth for mental health app content. Results show that subjective perception of needing mental health support was the strongest predictor of clinical service utilization. Additionally, the perception of viewing mental health positively was associated with actual use of clinical services, but the association became insignificant after adjusting for the perceived need. One's social influences predicted perceived need for mental health support; and knowledge about mental health predicted positive views of clinical mental health care. Intent to use general mHealth is driven by social influence, ease of use, and perceived utility. According to this study, mobile health services are acceptable to this population and can be helpful for students with barriers to accessing traditional mental health services. The qualitative interviews revealed that students felt that guided mindfulness exercises relieved stress, and the potential of having easy access to such exercises on an app on their phone overcame barriers they had previously encountered. These findings suggest that an app with mindfulness exercises may be worth developing and testing in Bangladesh in order to promote student mental health.Item A DESCRIPTIVE STUDY OF PROGRAM IMPLEMENTATION AMONG A GROUP OF HIGH ACHIEVING COALITIONS IN THE DRUG-FREE COMMUNITIES SUPPORT PROGRAM(2015) Perper, Emily; Beck, Kenneth H; Public and Community Health; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)Substance abuse is a pervasive public health problem that affects all people and communities, regardless of socioeconomic status, race and ethnicity. Substance abuse can particularly devastate youth, as it correlates with many negative health outcomes including damage to the developing brain, dependence, delinquency, decreased academic potential, DUIs, and death. A potential solution to address these problems is the development and implementation of community coalitions. At the federal level, The Office of National Drug Control Policy's (ONDCP) Drug-Free Communities (DFC) Support Program does this through distributing competitive grants to eligible community coalitions that organize to prevent youth substance abuse. This descriptive study examines the degree of agreement between activities of 12 high achieving DFC coalitions to determine best practices. The analysis of the similarities and differences between the program implementation activities determined that 6 activities were universally present among high achieving coalitions, 10 activities has high agreement, and 33 activities to have low agreement among the coalitions. This paper aims to increase the knowledge about high achieving DFCs to help inform policies and practices for communities to reduce youth substance use.Item The Development of a Non-Physical Dating Violence Risk Assessment Instrument for Urban Black Young Adult Men(2013) Gilchrist, Brian Winston; Sawyer, Robin G; Public and Community Health; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)Young urban African American men may be disproportionately affected by dating violence victimization. To date, there are no known reliable and valid measurement instruments that have been developed to assess the risk of dating violence victimization among this population. Furthermore, there is very little research that has been conducted assessing factors related to dating violence victimization specifically among young urban men. The current study developed a valid and reliable non-physical dating violence victimization risk assessment instrument for urban African American males ages 18-25 years old. Focus groups, survey pre-testing, and expert panel review was used to develop an initial set of items included in the new instrument. The survey administration phase of the study used a non-experimental cross-sectional design to collect primary data from participants for psychometric analysis. A new instrument with a total of 9 new scales (83 items) was developed as a result of this study. Results from the study support evidence of psychometrically sound and reliable measures that can be used in the target population.