Browsing by Author "Tucker, Melanie Tara"

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    Application of the diffusion of innovations theory and the health belief model to describe EMR use among Alabama family medicine physicians: a rural and urban analysis
    (University of Alabama Libraries, 2009) Tucker, Melanie Tara; Higginbotham, John C.; University of Alabama Tuscaloosa
    The Alabama Black Belt region consists of twelve counties which are characterized by a high percentage of African Americans, acute poverty, rural decline, inadequate education programs, and significantly poor health outcomes. The Alabama Black Belt region suffers significantly with health disparities which, in part, may be attributed to low physician/patient ratio and physician isolation. These physicians tend to practice in private, solo establishments, which often lead to limited communication with other physicians and medical educators. Without continued communication and continuing medical education, rural physicians could lag behind their urban counterparts. In fact it has been shown that some physician practices lag as far as two decades behind their urban counterparts due to such things as limited access to new technologies. With the advent of the electronic medical record (EMR) this lag is likely to decrease exponentially for those in rural areas and could lead to an increase in quality of care for the rural communities. The purpose of this study was to evaluate the adoption and implementation of electronic medical records (EMR) by rural and urban Alabama Family Medicine physicians. The Diffusion of Innovations Theory and Health Belief Model were used to guide the study and develop the survey questions. EMR adoption was assessed in rural areas and compared to their urban counterparts while evaluating the individual characteristic (gender, race, age, and years of practice), organizational characteristics (practice size, patients seen per day, practice location) and individual perceptions regarding adoption (perceived threat, perceived barriers and self-efficacy). Thirty percent (30%) of the 1,205 Alabama Family Medicine physicians responded to the electronic or paper survey. Almost half (49.3%) of the physicians surveyed reported having EMR in their practice; however, 16.3% reported using it to its fullest capacity. Significant differences emerged with respect to EMR use among physicians based on age, years in practice, patients seen per day, practice size and with respect to elements of perceived threat, barriers to adoption and the self-efficacy. Throughout the analysis, differences emerged between Family Medicine physicians from urban Alabama settings and their counterparts from rural and Black Belt region practices.
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    Barriers to exercise/physical activity for adolescents in rural west Alabama
    (University of Alabama Libraries, 2016) Cox, Melissa; Richardson, Mark T.; University of Alabama Tuscaloosa
    Regular physical activity (PA) in childhood and adolescence improves strength and endurance, helps build healthy bones and muscles, helps control weight, reduces anxiety and stress, increases self-esteem, and may improve blood pressure and cholesterol levels. The American College of Sports Medicine (ACSM) shows PA trends among adolescents (defined as 13 – 18 yrs.) decrease such that the majority of adolescents are not participating in sufficient activity to meet recommended guidelines. Cardiovascular Disease (CVD) risk factors that are present in adolescence have a tendency to track into adulthood. Youth who are overweight tend to have a higher prevalence of CVD risk factors than their normal weight peers. Rural adolescents may not be engaging in PA as often as their urban counterparts due to barriers of their rural lifestyle. Many rural communities are characterized by vast distances, low socioeconomic status, transportation challenges, and low public funding levels for facilities, programs, and other public amenities. Rural residency, especially in the southern U.S. has been associated with low levels of PA. The rural population is very unique in that they have specific barriers to PA. These may be social, financial, transportation, personal (i.e. lack of time, resources, caregiver responsibilities) or environmental factors (i.e., transportation, inadequate programs, lack of facilities). The purpose of this study was to extend previous findings by surveying a large sample of rural Alabama adolescents regarding barriers to PA and surveying parents and school administrators in this regard as well. Also, this study evaluated the effect that age, race/ethnicity, gender, and SES have on barriers to PA. This study did indeed demonstrate several demographic differences concerning barriers to PA. Additionally, it demonstrated several differences between students, parents, and administrators regarding perceived barriers to PA. Finally, this study provided additional data concerning common barriers to PA reported in the literature. Gender and SES differences were found to be the two covariates that were barriers to exercise and PA in rural West Alabama adolescents.
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    Child life iPad distraction: a psychosocial tool for children receiving an injection
    (University of Alabama Libraries, 2015) Atencio, Stephanie; Burns-Nader, Sherwood; University of Alabama Tuscaloosa
    Distraction is a common and effective type of nonpharmacological intervention that offers support to children during medical procedures. Distraction helps children shift their attention away from a procedure to something more positive and engaging. Child life specialists are health care professionals who utilize distraction as a way to promote children's coping. Child life specialists are frequently using the iPad for interventions, including distraction, yet little research has examined the iPad as an effective distraction tool in pediatric health care. Also, few studies examine the psychosocial support that is provided by child life specialists during distraction. The purpose of this research was to assess the effectiveness of iPad distraction provided by a child life specialist on children receiving an injection at a pediatric clinic. Forty-one child participants, from 4- to 11-years-old, were randomly assigned to one of two groups: the standard iPad group and the child life iPad group. The standard iPad group received iPad distraction, but did not receive the component of child life. The child life iPad group received iPad distraction during an injection with psychosocial support from a child life specialist. Each child engaged with the iPad prior to the injection to provide familiarity and instruction on the specified iPad activity he or she would use. Children from 4- to 7-years-old engaged in "Talking Tom" and children 8- to 11-years-old played "Cut the Rope." Once the nurse entered the room to administer the injection, children in the child life iPad group were encouraged to continue playing the selected activity and were positively redirected to the iPad during the injection by the child life specialist. Children in the standard iPad group were not encouraged to continue engaging with the iPad, yet still had access to the iPad activity. The findings show that child life iPad distraction did not benefit those who received psychosocial support during the injection more than those who did not receive the psychosocial support. Gender and age differences were noted on children's pain and emotions during the injection with males and older children showing less pain and emotional behavior compared to females and younger children.
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    Differences in affect through medical play
    (University of Alabama Libraries, 2016) Davis, Fairfax; Burns-Nader, Sherwood; University of Alabama Tuscaloosa
    Child life specialists use play as a central mechanism to teach and communicate with their patients. Play allows children to learn, engage in their surroundings, and express themselves. A variety of types of play, including pretend and medical play, can be seen within the work of child life specialists. Few studies have examined medical play outside of the hospital, with no studies examining the affect displayed in medical play. The purpose of this research study is to examine the differences in affect expressed in children through non-medical themed pretend play and medical pretend play. Thirty-seven children, three to four years old, participated in the study. This study aimed to examine medical play outside of the hospital setting. Fantasy, positive expression, and additional pretend play qualities were analyzed to determine participants’ affect during medical play. Participants also engaged in pretend play without a medical theme as a mode of comparison. During non-medical themed pretend play, participants’ played the role of the pizza maker. During medical play, participants’ played the role of the doctor. The play sessions lasted a maximum of 10 minutes each, and they were recorded. Videos were then coded to examine the affect displayed in each play session. Children were asked to self report their feelings during the play sessions. The findings indicated that differences in affect do exist between non-medical themed pretend play and medical play. Children displayed more affect in the pizza play sessions than the medical play sessions. In addition, differences in affect were demonstrated between the quality of fantasy, comfort level, and frequency of play with children displaying more fantasy, comfort, and frequency of affect during play. Participants played longer with the pizza play items and reported more positive feelings after non-medical themed pretend play than medical pretend play. Children who are feeling unpleasant emotions have been found to display less affect and engage in less play. Considering this, the current study may suggest that medical play is associated with unpleasant thoughts decreasing the expression of affect and length of play. Adults providing medical play to children, such as child life specialists, should be sensitive to the cues provided during such play, including affect, and provide support to increase normalization and positive feelings during medical play.
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    Exploring risky sexual behaviors of southern African American men and their readiness for barbershop-based HIV prevention programs
    (University of Alabama Libraries, 2016) Gardner, Antonio; Paschal, Angelia M.; University of Alabama Tuscaloosa
    African Americans are disproportionately affected by HIV, and males make up most of the cases by gender. Innovative methods for addressing the gap in the HIV epidemic are needed. Barbershops have been identified as one locale to address health disparities among African American males. Few studies have used barbershops as sites to provide HIV prevention information. Though barbershops have been sites for a few urban-based HIV prevention programs for African American men, none have been inclusive of rural men and only one was conducted in the southern United States. The purpose of this study was to explore the risky sexual behaviors of African American men in Alabama, and assess their readiness for a barbershop-based HIV prevention program. The study was guided by the Theory of Planned Behavior. A paper-and-pencil survey was administered to adult African American males at three barbershops in Alabama. The results of this study suggested that over half the men in the study did not consistently use condoms in the preceding three months. About one-fourth of the men reported having multiple sexual partners, and over half of all sexually active men used drugs and/or alcohol during a sexual encounter in the last three months. Attitudes were a significant predictor of having multiple sexual partners. Overall, the men were moderately ready for a barbershop-based HIV prevention program. Neither engagement in risky sexual behaviors nor the antecedents to engagement in risky sexual behaviors were predictive of readiness for barbershop-based HIV prevention programs. The findings of the study provide valuable insight to stakeholders who are interested in reducing the spread of HIV among African American men. Improving attitudes toward condoms in the barbershop setting may lead to less frequent engagement in risky sexual behaviors, which could curb the HIV acquisition rate among African American males.
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    Investigating campus cycling environment of a large southeastern university from an ecological perspective
    (University of Alabama Libraries, 2015) Shields, Margaret Mary; Paschal, Angelia M.; University of Alabama Tuscaloosa
    Cycling is an effective method to address physical, psychological, and environmental health. As an alternative mode of transport, it can also be more economical compared to motor vehicles. Despite these benefits, cyclists run a moderately high risk of being injured on the road or in a vehicular accident. According to a survey completed by the National Highway Traffic Safety Administration, 88% of cyclists felt most threatened by motorists on the road and 37% perceived uneven walkways and roadways were a threat to personal safety. The purpose of this study was to examine college student perceptions of safety and factors contributing to campus cycling from an ecological perspective. Intrapersonal, interpersonal, and institutional factors associated with safety and campus cycling were assessed as well as how they interacted with each other. A survey was developed and administered to students on a large southeastern public university. The sample of 356 participants indicated that certain intrapersonal level factors were predictors of cycling, including bike specific issues (e.g., concerns about general bike maintenance) and personal appearance (e.g., looking "silly while wearing a helmet). Interpersonal cycling factors (e.g., concerns about interacting with motor vehicle drivers) were not statistically significant. However, institutional cycling factors, including institutional barriers (e.g., busy roads) and institutional facilitators (e.g., establishing more bike lanes and covered parking), were predictors of cycling. The study findings provide guidance to university stakeholders about what specific factors are prioritized and deemed more likely to facilitate cycling among students. Cycling has been found to be very beneficial, as it has been associated with reduced traffic, improved parking, and better ease of transport on campus. Therefore, these suggestions have implications for environmental and structural changes, policy development, and program planning.