School of Public Health
Permanent URI for this communityhttp://hdl.handle.net/1903/1633
The collections in this community comprise faculty research works, as well as graduate theses and dissertations.
Note: Prior to July 1, 2007, the School of Public Health was named the College of Health & Human Performance.
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Item ‘Strategy-as-Practice’ by Personnel in Hospitals: A Scoping Review(2024-08-23) Jones, Brendan; Millwee, Elizabeth; Mulhall, Gabriela Irene; Ajayi, Damilola; Amon-Kotei, Nii Amon; Adeoti, Moboluwape; Din, Abdu Wakil Cyeef; Griffin, Lyndsey; Hashmi, Maryam Aslam; Schwartz, Brad E.; Fouladi, Negin; Tchangalova, Nedelina; Frazer, Kate; Kroll, Thilo; Donohoe, CarolynBACKGROUND Globally, hospitals face growing demands with increasing patient acuity compounded by workforce challenges, balancing finite resources, and responding to strategic developments. Strategizing in organizations is an active process of sensing, planning, implementing, and evaluating strategy. It is recognized that there is a disconnection between strategic planning and implementation; however, little is known about how organizational context influences the strategic process or how hospital personnel engage in strategic activities. STUDY AIMS This review aimed to map the extent and breadth of strategy-as-practice peer-reviewed literature relating to hospital personnel and establish how strategizing or ‘strategy-as-practice’ is described in hospital settings, how it is used, and what gaps exist. METHODS Four databases (Business Source Complete, CINAHL, PsycINFO through EBSCOhost, PubMed) were searched from January 1st, 2018, to June 27th, 2023. All study designs were included, and language was restricted to publications in English. Records were independently screened for eligibility, followed by full-text review. Reporting follows PRISMA-ScR guidelines. RESULTS 4,719 unique records were identified, and 45 full-text papers were included. Preliminary evidence from 17 countries is reported: 27.8% of studies (12/45) report evidence from the USA. All study designs are reported. Few studies (n=4) provided a specific definition of strategizing. 53.3% (24/45 studies) report multidisciplinary team perspectives, with only three studies including patients' perspectives. Flexible approaches are critical to adopting. IMPLICATIONS Current evidence shows that when hospital personnel strategize in practice, they use a combination of planning processes, varying quality improvement tools, and methodological approaches. CONCLUSION Understanding and operationalizing strategy in a hospital setting is critical to maintaining organizational adaptability and improving performance and quality of care. Future research should focus on robust studies with longitudinal follow-up to understand the sustainability of strategizing in hospital settings and how it continues to meet the growing demands for services and activities.Item Disparities in Toxic Chemical Exposures and Associated Neurodevelopmental Outcomes: A Scoping Review and Systematic Evidence Map of the Epidemiological Literature(2023-09-27) Payne-Sturges, Devon C.; Taiwo, Tanya Khemet; Ellickson, Kristie; Mullen, Haley; Tchangalova, Nedelina ; Anderko, Laura ; Chen, Aimin ; Swanson, MaureenBACKGROUND: Children are routinely exposed to chemicals known or suspected of harming brain development. Targeting Environmental Neuro-Development Risks (Project TENDR), an alliance of more than 50 leading scientists, health professionals, and advocates, is working to protect children from these toxic chemicals and pollutants, especially the disproportionate exposures experienced by children from families with low incomes and families of color. OBJECTIVE: This scoping review was initiated to map existing literature on disparities in neurodevelopmental outcomes for U.S. children from population groups who have been historically economically/socially marginalized and exposed to seven exemplar neurotoxicants: combustion-related air pollution (AP), lead (Pb), mercury (Hg), organophosphate pesticides (OPs), phthalates (Phth), polybrominated diphenyl ethers (PBDEs), and polychlorinated biphenyls (PCBs). METHODS: Systematic literature searches for the seven exemplar chemicals, informed by the Population, Exposure, Comparator, Outcome (PECO) framework, were conducted through 18 November 2022, using PubMed, CINAHL Plus (EBSCO), GreenFILE (EBSCO), and Web of Science sources. We examined these studies regarding authors’ conceptualization and operationalization of race, ethnicity, and other indicators of sociodemographic and socioeconomic disadvantage; whether studies presented data on exposure and outcome disparities and the patterns of those disparities; and the evidence of effect modification by or interaction with race and ethnicity. RESULTS: Two hundred twelve individual studies met the search criteria and were reviewed, resulting in 218 studies or investigations being included in this review. AP and Pb were the most commonly studied exposures. The most frequently identified neurodevelopmental outcomes were cognitive and behavioral/psychological. Approximately a third (74 studies) reported investigations of interactions or effect modification with 69% (51 of 74 studies) reporting the presence of interactions or effect modification. However, less than half of the studies presented data on disparities in the outcome or the exposure, and fewer conducted formal tests of heterogeneity. Ninety-two percent of the 165 articles that examined race and ethnicity did not provide an explanation of their constructs for these variables, creating an incomplete picture. DISCUSSION: As a whole, the studies we reviewed indicated a complex story about how racial and ethnic minority and low-income children may be disproportionately harmed by exposures to neurotoxicants, and this has implications for targeting interventions, policy change, and other necessary investments to eliminate these health disparities. We provide recommendations on improving environmental epidemiological studies on environmental health disparities. To achieve environmental justice and health equity, we recommend concomitant strategies to eradicate both neurotoxic chemical exposures and systems that perpetuate social inequities.Item Umbrella Review: COVID-19 Public Health Measures and Patient and Public Involvement in Health and Social Care Research(2023-08-10) Fouladi, Negin; Tchangalova, Nedelina; Ajayi, Damilola; Millwee, Elizabeth; Lovett, Corinne; Del Sordi, Alana; Liggett, Samantha; De Silva, Malki; Bonilla, Laura; Nkwonta, Angel; Ramnarine, Leah; Munoz, Allyssa; Frazer, Kate; Kroll, ThiloBackground: - Patient and public involvement (PPI) in health research refers to patients and other members of the public with relevant experience contributing to design, implementation, and dissemination of research. PPI entails research being carried out ‘with’ or ‘by’ members of the public, rather than ‘to’, ‘about’ or ‘for’ them. - Over the past decade, there has been an increased emphasis on the importance of PPI in health and social research as it provides alternative views and insights into the needs of healthcare users to improve the quality and relevance of research. - PPI enhances the efficiency, design, and quality of healthcare initiatives and facilitates decision-making regarding resource allocations and the usability of services by including information about the capabilities, needs, and priorities of local people. - The rapid response to the COVID-19 pandemic resulted in PPI being viewed as non-essential, leading to its minimal inclusion in research and, thereby, minimizing the contribution of patients, the public, and, particularly, minority groups in helping find solutions to the pandemic crisis. - Public health measures (PHM) aim to reduce the transmission, severity of illness, and death and are critical strategies to address pandemic outbreaks, therefore, PPI is crucial in building trust and acceptance in research, greater benefits for the community, new and improved services, valuable changes in practice/partnership leading to positive changes and outcomes.Item COVID-19 public health measures and patient and public involvement in health and social care research: An umbrella review(International Journal of Environmental Research and Public Health, 2023-03-10) Fouladi, Negin; Tchangalova, Nedelina; Ajayi, Damilola; Millwee, Elizabeth; Lovett, Corinne; Del Sordi, Alana; Liggett, Samantha; De Silva, Malki; Bonilla, Laura; Nkwonta, Angel; Ramnarine, Leah; Munoz, Allyssa; Frazer, Kate; Kroll, ThilloAn umbrella review of previously published systematic reviews was conducted to determine the nature and extent of the patient and public involvement (PPI) in COVID-19 health and social care research and identify how PPI has been used to develop public health measures (PHM). In recent years, there has been a growing emphasis on PPI in research as it offers alternative perspectives and insight into the needs of healthcare users to improve the quality and relevance of research. In January 2022, nine databases were searched from 2020–2022, and records were filtered to identify peer-reviewed articles published in English. From a total of 1437 unique records, 54 full-text articles were initially evaluated, and six articles met the inclusion criteria. The included studies suggest that PHM should be attuned to communities within a sociocultural context. Based on the evidence included, it is evident that PPI in COVID-19-related research is varied. The existing evidence includes written feedback, conversations with stakeholders, and working groups/task forces. An inconsistent evidence base exists in the application and use of PPI in PHM. Successful mitigation efforts must be community specific while making PPI an integral component of shared decision-making.Item Food insecurity among African Americans in the United States: A scoping review(2022-09-12) Dennard, Elizabeth; Kristjansson, Elizabeth; Tchangalova, Nedelina; Totton, Sarah; Winham, Donna; O’Connor, AnnetteIn 2019, the estimated prevalence of food insecurity for Black non-Hispanic households was higher than the national average due to health disparities exacerbated by forms of racial discrimination. During the COVID-19 pandemic, Black households have experienced higher rates of food insecurity when compared to other populations in the United States. The primary objectives of this review were to identify which risk factors have been investigated for an association with food insecurity, describe how food insecurity is measured across studies that have evaluated this outcome among African Americans, and determine which dimensions of food security (food accessibility, availability, and utilization) are captured by risk factors studied by authors. Food insecurity related studies were identified through a search of Google Scholar, PubMed, CINAHL Plus, MEDLINE®, PsycINFO, Health Source: Nursing/Academic Edition, and Web of Science™ (Clarivate), on May 20, 2021. Eligible studies were primary research studies, with a concurrent comparison group, published in English between 1995 and 2021. Ninety-eight relevant studies were included for data charting with 37 unique measurement tools, 115 risk factors, and 93 possible consequences of food insecurity identified. Few studies examined factors linked to racial discrimination, behaviour, or risk factors that mapped to the food availability dimension of food security. Infrequently studied factors, such as lifetime racial discrimination, socioeconomic status (SES), and income insecurity need further investigation while frequently studied factors such as age, education, race/ethnicity, and gender need to be summarized using a systematic review approach so that risk factor impact can be better assessed. Risk factors linked to racial discrimination and food insecurity need to be better understood in order to minimize health disparities among African American adults during the COVID-19 pandemic and beyond.Item Strategies to increase happiness and wellbeing among public health students, faculty and staff(2022-07-01) Carter-Pokras, Olivia; Tchangalova, Nedelina; Puett, RobinBACKGROUND: Public health schools equip students with skills to promote and protect health, however, little is known about what is provided to support physical, mental and social wellbeing in academic public health. AIMS: To identify programs, interventions, strategies, and tools in medical and academic settings that could be applicable to supporting mental health and wellbeing of public health professionals, students, staff and faculty. METHOD: In November 2019 (updated in January 2022), 13 databases were searched: PubMed, 10 EBSCO databases(e.g., Academic Search Ultimate, APA PsycINFO, CINAHL Plus, Education Source, ERIC, Health Source: Nursing/Academic Edition, MEDLINE, SocINDEX), ProQuest Dissertations & Theses Global, and Web of Science. Inclusion criteria were randomized controlled trials, group interventions to support mental health curriculum, online tools, strategies, techniques, and programs of mindfulness, anxiety, depression, stress/distress, or burnout. Studies were limited to English and from 1998 to January 3, 2022. Websites for U.S. Schools of Public Health were searched. RESULTS: Out of 19,527 articles, 6,752 duplicates were removed. Following abstract and title screening, full-text articles will be screened for eligibility. The main themes from included studies will be shared. Preliminary findings show examples of activities to support well-being of public health professional students, staff, and faculty (e.g., providing free access to meditation apps, funding a dedicated wellness coordinator within the School). CONCLUSIONS: The literature on strategies to increase happiness and wellbeing among public health students, faculty, and staff is scarce and efforts to support physical mental, and social wellbeing for this community should be evaluated, and findings shared.Item Psychosocial protective interventions for African American/Black female breast cancer survivors: A systematic integrative review.(2021-04-12) Gordon, Talya; Lee, Lena J.; Tchangalova, Nedelina; Brooks, Alyssa T.BACKGROUND: Despite the higher incidence rate of breast cancer among African American women compared to their White counterparts, this populations’ five-year survival rate has increased in recent years. The growing number of African American breast cancer survivors highlights the need for culturally appropriate psychosocial interventions to improve survivors’ quality of life and psychological wellbeing. OBJECTIVE: This systematic integrative review provides an overview of the current research-based psychosocial interventions for African American breast cancer survivors supplemented by an overview of the qualitative studies focusing on psychosocial wellbeing. METHODS: Utilizing the evidence-based PEO framework, a search of five databases was conducted for English-language articles published between 2013–2020: Pubmed, Academic Search Ultimate, CINAHL, PsycINFO, and Web of Science. Studies were excluded if there was a lack of primary data collection or if the population in the study was not identified as African American female breast cancer survivors. The seven interventions and twenty-one qualitative studies included in the final analysis underwent data extraction, critical appraisal using SRQR and STROBE checklists, and thematic analysis. RESULTS: Twenty-eight studies were identified in the search, including seven interventions and twenty-one qualitative studies. Analysis of the interventions revealed the importance of alleviating structural barriers and including peer support for African American breast cancer survivors. Analysis of the qualitative studies revealed five main themes: 1) spirituality and religion as a protective factor, 2) social support as a protective factor, 3) cultural perceptions of breast cancer, 4) negative impacts of treatment, and 5) healthcare system experience. CONCLUSUION: While study designs differed in the interventions, this review showed the critical need for culturally competent psychoeducational interventions for African American breast cancer survivors to improve this population’s psychological wellbeing. The qualitative research highlighted the importance of spirituality and social support as protective factors for African American breast cancer survivors’ psychological wellbeing. Further research using rigorous methodologies and transparent reporting practices is needed to further evaluate how to most effectively alleviate structural barriers that African American breast cancer survivors face.Item Psychosocial protective interventions for African American female breast cancer survivors: A systematic integrative review(Annals of Behavioral Medicine, vol. 55 (Suppl.1), pp. S384-384, 2021) Gordon, Talya; Brooks, Alyssa T.; Lee, Lena J.; Tchangalova, NedelinaBACKGROUND: Despite the higher incidence rate of breast cancer among African American women compared to their White counterparts, this populations’ five-year survival rate has increased in recent years. The growing number of African American breast cancer survivors highlights the need for culturally appropriate psychosocial interventions to improve survivors’ quality of life and psychological wellbeing. OBJECTIVE: This systematic integrative review provides an overview of the current research-based psychosocial interventions for African American breast cancer survivors supplemented by an overview of the qualitative studies focusing on psychosocial wellbeing. METHODS: Utilizing the evidence-based PEO framework, a search of five databases was conducted for English-language articles published between 2013–2020: Pubmed, Academic Search Ultimate, CINAHL, PsycINFO, and Web of Science. Studies were excluded if there was a lack of primary data collection or if the population in the study was not identified as African American female breast cancer survivors. The seven interventions and twenty-one qualitative studies included in the final analysis underwent data extraction, critical appraisal using SRQR and STROBE checklists, and thematic analysis. RESULTS: Twenty-eight studies were identified in the search, including seven interventions and twenty-one qualitative studies. Analysis of the interventions revealed the importance of alleviating structural barriers and including peer support for African American breast cancer survivors. Analysis of the qualitative studies revealed five main themes: 1) spirituality and religion as a protective factor, 2) social support as a protective factor, 3) cultural perceptions of breast cancer, 4) negative impacts of treatment, and 5) healthcare system experience. CONCLUSION: While study designs differed in the interventions, this review showed the critical need for culturally competent psychoeducational interventions for African American breast cancer survivors to improve this population’s psychological wellbeing. The qualitative research highlighted the importance of spirituality and social support as protective factors for African American breast cancer survivors’ psychological wellbeing. Further research using rigorous methodologies and transparent reporting practices is needed to further evaluate how to most effectively alleviate structural barriers that African American breast cancer survivors face.Item Psychosocial protective interventions associated with a better quality of life and psychological wellbeing for African American/Black female breast cancer survivors: An integrative review(Supportive Care in Cancer, 2021-08-21) Gordon, Talya; Lee, Lena J.; Tchangalova, Nedelina; Brooks, Alyssa T.PURPOSE This integrative review provides an overview of current psychosocial interventions and qualitative studies exploring African American Breast Cancer Survivors (AABCS)’ psychosocial wellbeing. METHODS We conducted a search of five databases: PubMed, Academic Search Ultimate, CINAHL, PsycINFO, and Web of Science. Peer-reviewed articles written in English and published from 2011 to May 26, 2021 were included. We critically appraised intervention studies and qualitative studies using established frameworks. RESULTS Of the 633 unique studies identified, seven interventions and twenty-one qualitative studies were included. Analysis of the interventions revealed the importance of alleviating structural barriers and facilitating peer support for AABCS. Analysis of the qualitative studies revealed seven themes: (1) spirituality/religion, (2) social support, (3) cultural perceptions of BC, (4) lack of representation, (5) negative impacts of treatment, (6) healthcare system experience, and (7) barriers to psychosocial care. CONCLUSIONS This review highlights the dearth of psychosocial interventions created specifically for AABCS. The qualitative literature in this review elucidates the unique psychosocial challenges that AABCS experience, providing rich data to inform the creation of future culturally competent interventions in this population. IMPLICATIONS FOR CANCER SURVIVORS This review found spirituality and social support to be protective factors for AABCS’ psychosocial wellbeing. Further research using rigorous methodologies is needed to further evaluate how to most effectively alleviate structural barriers that AABCS face in obtaining long-term support.Item Socially-assigned race and health: a scoping review with global implications for population health equity(Springer Nature, 2020-02-10) White, Kellee; Lawrence, Jourdyn A.; Tchangalova, Nedelina; Huang, Shuo J.; Cummings, Jason L.Self-identified race/ethnicity is largely used to identify, monitor, and examine racial/ethnic inequalities. A growing body of work underscores the need to consider multiple dimensions of race – the social construction of race as a function of appearance, societal interactions, institutional dynamics, stereotypes, and social norms. One such multidimensional measure is socially-assigned race, the perception of one’s race by others, that may serve as the basis for differential or unfair treatment and subsequently lead to deleterious health outcomes. We conducted a scoping review to systematically appraise the socially-assigned race and health literature. A systematic search of the PubMed, Web of Science, 28 EBSCO databases and 24 Proquest databases up to September 2019 was conducted and supplemented by a manual search of reference lists and grey literature. Quantitative and qualitative studies that examined socially-assigned race and health or health-related outcomes were considered for inclusion. Eighteen articles were included in the narrative synthesis. Self-rated health and mental health were among the most frequent outcomes studied. The majority of studies were conducted in the United States, with fewer studies conducted in New Zealand, Canada, and Latin America. While most studies demonstrate a positive association between social assignment as a disadvantaged racial or ethnic group and poorer health, some studies did not document an association. We describe key conceptual and methodological considerations that should be prioritized in future studies examining socially-assigned race and health. Socially-assigned race can provide additional insight into observed differential health outcomes among racial/ethnic groups in racialized societies based upon their lived experiences. Studies incorporating socially-assigned race warrants further investigation and may be leveraged to examine nuanced patterns of racial health advantage and disadvantage.