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Social determinants of health have become a global concern over the past several years. Efforts to reduce negative health outcomes related to social determinants of health are of high priority. Awareness of this issue by providers, especially pediatric providers, must be considered to help combat this major concern. A researcher seeks through an integrative review to determine provider perspective on social determinants of health, impact of social determinants of health on outcomes, and ways of integrating social determinants into prescriptive practice. The integrative review will inform stakeholders about the importance of pediatric provider assessment of social determinants of health and the impact on health outcomes. By using nursing science and research as a foundation, this review will serve as a call to action for the healthcare community.

"As women take on the new role of motherhood, changes in their environment and social dynamics can significantly influence their physical activity levels. These changes can result in postpartum stress and make it challenging for new mothers to initiate and maintain physical activity during this period. The purpose of this study was to identify why some women are more, or less, active by determining what factors could be promoting or inhibiting PA levels during the first year following childbirth. Participants (n = 214; Mage = 31.53 years, SD = 3.996) completed a web-based survey assessing physical activity (PA) levels prior to pregnancy and after birth, psychosocial constructs from behavioral theories to understand PA barriers and enablers, and environmental factors that may be promoting or preventing PA. Paired samples t-test indicated significant decreases in self-reported MVPA from pre-pregnancy (M = 38.24, SD = 27.98) to postpartum (M = 24.72, SD = 23.18), with a quarter of the sample (25%) currently reporting no moderate-to-vigorous PA. Though there were no significant relations or differences identified in current MVPA based on demographic or environmental factors, most of the psychosocial variables examined in this study demonstrated positive and significant correlations with MVPA. Results of a hierarchical regression analysis suggested prior MVPA and self-efficacy to engage in physical activity were the strongest predictors of current MVPA, explaining 47.7% of the variance in this sample of postpartum women. Based on open-ended responses, women reported the key factors related to decreased PA during the transition from pre- pregnancy to the postpartum period were barriers such as time or motivation, sleep/fatigue/no energy, and caregiver responsibilities. On the other hand, women reported they were able to be more active if they had accountability/social support, experienced positive mental and physical health factors, and increased motivation and time. Continued research should focus on developing women’s self-efficacy for promoting and maintaining higher levels of PA during the prenatal and postpartum period."--Abstract from author supplied metadata.

"Physical activity is an important determinant of health throughout the lifespan. Meeting physical activity guidelines has been shown to help improve individuals' health outcomes as well as prevent or slow the progression of more than 20 chronic health conditions. Previous studies have shown that a large number of Arab Americans do not meet the national physical activity guidelines, and little is known about determinants of physical activity in this population. Guided by the Social Ecological Model (SEM) of McLeroy, Bibeau, Steckler, and Glanz (1988), the broad purpose of this cross-sectional descriptive correlational study was to explore the determinants of physical activity in Arab Americans. Specifically, the purpose of the study was to describe the physical activity and investigate the relationships between intrapersonal factors and interpersonal factors and physical activity and to examine to what extent do these factors influence physical activity in Arab Americans. A total of 140 Arab Americans were recruited and provided data for the study. Age, gender, marital status, country of origin, length of the United States (U.S.), birthplace, current residence, number of family members, religious affiliation, level of education, income, employment status and type of job, body mass index, and health status were reported. Interestingly, a majority of the participants (58.6%) reported a high level of physical activity. Spearman's rho correlation was used to assess the associations between physical activity and sample characteristics, intrapersonal factors, and interpersonal factors. Findings revealed statistically significant associations between physical activity level and health status, religiosity, and physical activity self-efficacy. Three simultaneous multiple linear regression models with gamma regression with a log-link function were used to assess to what extent did sample characteristics, intrapersonal, and interpersonal factors influence physical activity level. Multiple regression models revealed that employment and health status were the only significant factors influencing physical activity level when accounting for other sample characteristics, intrapersonal, and interpersonal factors."--Abstract from author supplied metadata.

"People in the Appalachian Mountains have an increased prevalence in poverty, low educational attainment, and low employment opportunities that are associated with poor health outcomes. Also, the Appalachian Mountain people suffer stigmas that have been propagated since the late 1890s. However, much of the research has been an etic focus and the emic focus is limited. A qualitative study of emic care explored the ways people in the Appalachian Mountains of Western North Carolina assured wellbeing. Leininger's Culture of Care model was used to guide the study and discover emic ways of wellbeing. The sample included 21 persons between the ages of 25 and 70 years old, persons who had lived in Western North Carolina (WNC) for 15 years of more and who had generational roots to Appalachia. Individual interviews were conducted in homes, at workplaces and in community settings after consent was obtained. Audiotapes were transcribed verbatim and analyzed through multiple levels to ensure trustworthiness, credibility and validity of findings. Emic themes were identified and included Communal Caring Relationships, Spirituality, Place Matters, Grandmothers Caring, and Etic Care. Specific actions and situations within each theme were reported. For example, the Place Matters theme included participants relating their ingestion of healthy diet of fresh fruits and vegetables from the garden or locally grown (the land). Enjoying the outdoors was related to physical, emotional, and spiritual wellbeing. Spirituality was found to be a major component in a sense of wellbeing, and was described by participants as going to church, not going to church and the old ways. The use of wild crafted herbs and home remedies occurred by the participants in this study. Leininger's theory and model were useful in guiding the study, as were Spradley's ethnographic interview guidelines. The well-being discussed by participants provides the emic sense of wellbeing in the Appalachian culture. However, the model was not fully supported in terms of participants' discussion of challenges or barriers to wellbeing. Rather, the researcher was able to classify participant responses within the areas of physical, spiritual, and mental well-being. Perhaps this is another indication of how etic perspectives focus much of the perceived Appalachian and non-emic health. The findings provide an understanding of well-being and health that can guide future."--Abstract from author supplied metadata

Author's abstract: This study sought to examine associations of the high incidences of orthopedic and/or musculoskeletal injuries sustained among Reserve Officer Training Corps (ROTC). The aim of this study was to determine if a relationship exists between functional movement and health behavior as well as evaluate the effectiveness of the Functional Movement Screening (FMS) program. The study generated a study population of (n=47) cadets yielding a 35% participation rate from the ROTC Program. Participants completed a baseline health behavior assessment with specific items designed to measure ten health behaviors. The study population also completed a pre and post program Functional Movement Screening (FMS). Indicated participants were prescribed an individualized corrective exercise program to correct dysfunctional movement noted during baseline FMS. Researchers applied the Anderson Healthcare Utilization Model (HCUM), constructs of the Socio Ecological Model (SEM) and constructs from the Health Belief Model (HBM) public health theory methodology to help explain from a multifaceted perspective the potential barriers and facilitators to musculoskeletal/orthopedic injury and health behavior. This conceptual framework and study outcomes will also be utilized to examine a potential relationship between dysfunctional movement and health behavior outcomes. Study outcomes found a relationship between functional movement and stress as a health behavior. Additionally, a paired samples t-test for functional movement screening yielded a statistically significant relationship (P-value: 0.05) between baseline and posttests. Data outcomes would be utilized to formulate recommendations for future university health and wellness interventions.

This research proposes a design solution that integrates gamification and behavioural change theories into a mobile fitness application to promote and maintain physical activity for young adults. This research proposes that the usability of mobile apps on behavioural modification can be improved by integrating psychological interventional methods into the product design. The design output, Messagerunner, will provoke critical reflection about the future design of mobile fitness applications. During the design process, I identified and collected related theories to analyse existing precedents, and then extracted design methods and criteria. Various methodologies including literature analysis, contextual inquiry, and iterative prototyping support the design solution. Messagerunner seeks to balance the tedious exercise routine with the enjoyment from gamification. It uses widely accepted theories and methods on behavioural intervention to promote physical activity. This research was started by analysing the benefits and cost of behavioural intervention counselling and mobile persuasive technologies. Mobile applications have the benefits of being low cost and easy to access, compared to counselling. However, the existing applications have limits compared to professional intervention. Design solutions that combine intervention methods with persuasive technologies could lead to a better management for sedentary lifestyles. Messagerunner adopts activity promotion methods drawn from a range of theories. These includes the transtheoretical model (TTM), the theory of planned behaviour (TPB), and flow theory. The design of the app is inspired by three precedents: Pokémon Go, Habitica, and Run An Empire. To test the method, the design process includes contextual inquiry, prototyping, and user testing. The design outcomes apply to users worldwide and reflect on the design of current commercial fitness apps. The outputs produce a concept and UI design for the final iteration of

Sexually transmitted infections (STIs) are a global public health problem. Sequelae for infected individuals can be serious and STIs impose a substantial financial burden on healthcare systems. Duration of infection is one factor influencing transmission rates, and is modifiable through secondary prevention methods, namely 'test and treat'. For this approach to be effective, at-risk individuals must choose to present for testing. New Zealand provides a useful case-study to investigate healthcare-seeking behaviour for STI testing, as incidence rates of common STIs are especially high. The aims of this thesis were to quantify healthcare-seeking behaviour for STI symptoms and assess the risk of transmission in this period, to identify the barriers to STI testing, to understand the personal drivers for getting an STI test, to examine how STI knowledge is associated with testing behaviour, and finally, to collate and critically evaluate the published evidence regarding the incidence of a lesser known sequela of STI, reactive arthritis. This thesis took a mixed method approach, employing both qualitative and quantitative methods to address the research aims. The results showed that delays in healthcare-seeking for STI symptoms were common among patients attending an inner-city Sexual Health Clinic (SHC). Almost half of people with symptoms waited longer than seven days to seek healthcare, although there were no identified predictors of delayed healthcare-seeking. Around a third of people with symptoms continued to have sex after they first thought they may need to seek healthcare. Among these individuals, infrequent condom use was reported more by those who had sex with existing sexual partners than by those who had sex with new partners. Having sex while symptomatic was statistically significantly associated with delaying seeking healthcare for more than seven days (odds ratio (OR) = 3.25, 95% CI 1.225 - 8.623, p = 0.018) ...

"The purposes of this study were to: (a) describe the prodromal and acute symptoms of myocardial infarction (MI) in women and the relationship to delays in seeking treatment, (b) comprehensively examine other factors associated with delays, and (c) explore novel concepts in relation to delay, such as temporal orientation, time duration estimation, and impulsivity. The theory of unpleasant symptoms served as the framework for this investigation. A cross-sectional, correlational, non-experimental research design was used. Fifty-six women (85% White, 11% Black, and 5% Native American) were recruited that had been discharged with an MI from a hospital in the southeastern United States. The women were interviewed either in person or by telephone using the McSweeney Acute and Prodromal Myocardial Infarction Symptom Survey (MAPMISS), a demographic data tool, the Time Orientation Scale, and the Barrett Impulsivity Scale 11 (BIS-11). The mean age was 70.2 (SD+11), with a range from37-92. The majority of the sample were currently unmarried (70%), unemployed (79%), and experiencing their first MI (79%). The median delay was 60 minutes, but delays ranged from 10 -20,160 minutes. Age was negatively correlated with symptom scores, with older women reporting lower scores. There was no correlation between symptom scores and delay. Similarly, there was no correlation between the symptom scores and impulsivity. There was no difference in the symptom scores between women who were present oriented and those who were future oriented. The patient's reported delay in seeking treatment was positively correlated with the duration recorded in the medical record, except for those women who perceived their symptoms life-threating. Thus, perceived threat affected time duration estimation retrospectively. Women who perceived their symptoms as life-threatening delayed longer than those who did not and also underestimated their delays when compared with the delays recorded in the medical record. Age was the only predictor of all symptom score (prodromal, acute and total). None of the regression models were statistically significant for symptom scores predicting delay in this study. Age, race, first-degree relative with MI, modifiable risk factors, temporal orientation, or impulsivity were also not predictors of delay. Future research should investigate factors related to delay in men and women in rural and urban settings."--Abstract from author supplied metadata.