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 The Impact of International Accreditation on The Quality of Health Services at King Fahd University Hospital, Saudi Arabia: A Mixed Methods Approach(2019) AL Shawan, Deema Saad; Franzini, Luisa; Health Services Administration; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)The Joint Commission International Accreditation (JCIA) is perceived worldwide as the symbol of exceptional quality of care. Despite the popularity of international accreditation, evidence of its effectiveness on improving health care quality is inconclusive. This dissertation research utilized a Convergent parallel mixed method framework to evaluate the impact of the JCIA process on quality and to identify the factors that influence the effectiveness of this process at King Fahd Hospital of the University in Khobar, Saudi Arabia. An interrupted time series analysis was conducted to assess the changes in a total of 12 quality outcomes pre and post accreditation. Furthermore, a qualitative approach was used to investigate the attitudes and perceptions of 31 health providers towards this process and the factors that influence its success. The quantitative results suggested that the JCIA had a positive impact on 9 out of 12 outcomes. The improved quality outcomes included: the average length of stay, the percentage of hand hygiene compliance, the rate of nosocomial infections, the percentage of radiology reporting outliers, the rate of pressure ulcers, the percentage of the correct identification of patients prior to medication administration, the percentage of critical lab reporting within 30 minutes, and the bed occupancy rate. The outcomes that did not improve were the rate of patients leaving the ER without being seen, the percentage of OR cancelations on the day of the or and the rate of patient falls. The qualitative analysis suggested that the JCIA was perceived positively by all participants. Some of the perceived advantages of international accreditation included the transformation of the organizational culture to a culture that promotes continuous quality improvement, standardization, and the reduced paperwork in some departments. The participants’ responses also indicated that there were many factors that influence the success of the process. Examples of the factors identified in the study include the increased workload and the providers’ resistance to participate in the JCIA process. In conclusion, international accreditation seemed to have a positive impact on quality outcomes and was received positively by providers. Nevertheless, the factors that hindered the JCIA process need to be addressed by the hospital’s leadership to ensure more efficient quality improvement efforts during future accreditation cycles.Item Sleep throughout the alcoholism recovery process: a mixed methods examination of individuals' experiences transitioning from an inpatient research facility providing rehabilitation treatment to the community(2015) Brooks, Alyssa Todaro; Beck, Kenneth; Public and Community Health; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)Despite research establishing the relationship between sleep disturbances and alcohol use, there is no clear understanding or model for what occurs once individuals who seek inpatient alcoholism treatment are discharged from rehabilitation facilities and attempt to integrate back into their homes and communities. This study used a mixed methods approach to assess individuals' perceptions of and experiences with sleep throughout the process of alcohol rehabilitation and to explore associations between sleep-related beliefs/behavior, sleep quality, and relapse. The Social Cognitive Theory (SCT), which posits that personal factors, the environment, and human behavior exert influence upon each other through reciprocal determinism, was used as the underlying theory for this study. Constructs from the SCT were measured directly in this study using both quantitative and qualitative approaches in a convergent parallel design to study the following aims: a) to assess perceptions of and experiences with sleep during alcohol rehabilitation, b) to describe sleep patterns, perceptions, and beliefs among individuals who are alcohol-dependent throughout the transition from a clinical research facility providing rehabilitation treatment back to the community, and c) to assess whether sleep-related beliefs and/or behavior are associated with sleep quality or alcohol relapse. Data were collected from a cohort of clinical research participants enrolled on an inpatient alcohol treatment protocol (n=32). Sleep was assessed quantitatively and qualitatively within one week of discharge from the inpatient facility and again four to six weeks post-discharge. Results indicated a prevalence of sleep disturbances throughout the process of rehabilitation. Self-efficacy for sleep was associated with better sleep quality at both time points. Thematic analyses of interview transcripts yielded overarching themes of sleep-related beliefs/behavior, sleep environments, stress related to transitions, and self-medication. This study demonstrates a prevalence of sleep disturbances among individuals undergoing alcohol treatment and relationships between SCT constructs and sleep quality. The period of transition from inpatient to outpatient represents a time of change, thus future behavioral sleep intervention efforts in this population may benefit from addressing underlying sleep-related beliefs and behaviors to improve sleep quality and encourage healthy and sober living.Item CONDOM USE IN OLDER AFRICAN AMERICANS: AN EXPLORATORY STUDY(2012) Ramos, Ina Ananda; Desmond, Sharon M; Public and Community Health; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)The purpose of this mixed methods exploratory study was to examine perceptions regarding condom use and sexual intercourse among African Americans 50 to 65 years of age, specifically attitudes, norms, self-efficacy and barriers regarding condom use behavior. There were three study phases: 1) a pilot study of the survey instrument (N=31), 2) an on-line survey (N=175), and 3) post survey explanatory interviews (N=10). The online survey contained items from the Sexual Risk Behavior Beliefs and Self-Efficacy Scales (SRBBS) (Basen-Enquist et al., 1999). Pilot study data indicated the online survey was understandable, acceptable, readable and appropriate for use by this sample of African Americans. Factor analyses of the survey items yielded similar constructs to the original SRBBS with seven of eight scales demonstrating internal consistency; Cronbach's alpha reliabilities ranged from .49 to 1.0. Logistic regression models found two independent variables increased the likelihood of condom use (condoms should be used even if people know each other well and friends feel condoms should be used even if pregnancy isn't possible) and two decreased the likelihood of condom use (friends feel you should use condoms even if people know each other well, and using condoms would be a hassle). A logistic regression model of significant independent variables found that provider speaking to patients about safer sex and male gender increased condom use, while being married and lower educational level decreased condom use behavior. Post-survey interviews, where participants (N = 10) were asked to elaborate on study findings, yielded six themes (the importance of trust and relationships, lack of knowledge, attitudes about condom use, sexual activity, health care providers, and friends opinions) that further explained statistical findings. Findings from this study have the potential to reduce the spread of HIV/STDs in this population through the use of educational programs that include empowerment and risk reduction components. Additionally, health care providers can potentially play a key role in these efforts and should be trained on how to communicate effectively with older adults around sexual health.