Examples of Doctor of Health Science (DHSc) Dissertation Titles/Abstracts

Title: Caregivers’ Perspectives and Experiences with  Shared-site Intergenerational Day Programs  

Abstract

Background: The United States population is aging rapidly, with those aged 65 and older projected to comprise 25% of the population within the next thirty years. It is essential to prepare and consider ways to uphold the quality of life necessary for optimal aging. Shared-site intergenerational day programs (IGPs) focus on engaging young children (< 6 years of age) with older adults (> 60 years of age) to improve overall well-being and enrich quality of life. Despite studies endorsing the benefits for both age groups, there is a lack of research on caregivers' perceptions of older adults attending a shared-site IGP. Objective: This study explored the views and experiences of caregivers for older adult attendees of shared-site IGPs.

Method: A qualitative approach was employed to collect data through a 12-question open-ended survey distributed to various shared-site intergenerational day programs.

Results: Seven intergenerational programs throughout the United States, operating within a community-based or assisted living-linked program model, participated. The main themes that emerged from the data include positive perceptions, impacts on attendees' mental and social well-being, minimal perceived challenges, influences on caregivers, and financial factors.

Discussion: The benefits of shared-site IGPs included providing social engagement and meaningful role fulfillment that contributes to wellbeing, as well as aiding family caregivers’ respite, both of which were supported by this study. Challenges of IGP programs were also detailed. Further research is needed to explore IGPs as a means of care continuity as the population ages.

Title: Differences in Perceived Stress and Perceived Wellness Between Physical Therapy Students in Traditional and Accelerated Curriculums

Abstract

Background: Doctor of Physical Therapy (DPT) programs are known for their demanding curriculum, where students endure various academic challenges that can contribute to stress and impact their well-being. Few studies have compared SPT’s perceived stress and perceived wellness depending on the length of accelerated DPT curriculums.

Purpose: This study examined the differences in perceived stress and wellness between physical therapy students in accelerated and traditional three-year curriculums.

Method: A non-experimental, cross-sectional survey study was utilized to assess students' perceived stress and wellness in six DPT programs. Participants completed an online survey, including a demographics questionnaire, the Perceived Stress Scale-10 (PSS-10), and the Multidimensional Wellness Inventory (MDWI).

Results: There was a significant difference between groups in PSS-10 scores [t (187) = 2.17, p = .032]. A significant difference in MDWI scores was seen between groups for mental wellness (Z = -2.20, p = .028) and for spiritual wellness (Z = -2.29, p = .022). A statistically significant moderate, negative correlation was found between PSS-10 scores and mental, intellectual, and occupational wellness scores. Gender, mental wellness, and occupational wellness were included in the logistic regression model to predict moderate to high perceived stress. Discussion: Students in traditional programs may be at risk of higher perceived stress levels and lower mental and spiritual wellness levels. These findings may assist DPT educators to identify those at risk of higher perceived stress levels and implement wellness strategies to improve students' well-being.

Title: The Safety, Feasibility, and Outcomes of Group-Based Aquatic Exercise for Adolescents with Down Syndrome

Abstract

Physical activity (PA) levels in youth with Down syndrome (DS) are far below those of non-disabled peers. Aquatic exercise may appeal to youth with disabilities because the aquatic environment allows for increased ease of movement and mobility. However, research surrounding group-based aquatic interventions for adolescents with DS (ADS) is limited. The study purpose was to investigate the safety, feasibility, and outcomes of group-based aquatic exercise for ADS. Nine ADS, mean age of 14.29 years, were recruited from community DS organizations and schools. ADS participated in a twice-weekly, one-hour group-based aquatic exercise class incorporating aerobic activities and strength maneuvers for 8 weeks. Safety was assessed via heart rate monitoring and documentation of critical incidents. Feasibility was assessed through program adherence and parent perception of convenience. Outcome measures included the timed up-and-go test (TUG), hand-held dynamometry (HHD) grip strength, five-repetition sit-to-stand test (FRSTST), six-minute walk test (6MWT), pediatric quality of life inventory (PedsQL TM), and a parent satisfaction survey. Scores were compared pre- and post-intervention and at 4-week follow-up. No critical safety incidents were noted. Program adherence was excellent (> 80%). Statistically significant improvements in the 6MWT and Total Score for the PedsQL TM were found (p < .017). Clinically meaningful improvements exceeding the minimal detectable change were obtained for the 6MWT, TUG, FRSTST, and PedsQL TM. Parent satisfaction was high. Gains were retained for most measures at follow-up. Group-based aquatic exercise may provide a safe, feasible, effective, and enjoyable alternative for clinically meaningful PA in ADS.

Title: Oxygen Kinetics and Physiologic Responses: Comparing 2-Minute and 6-Minute Tests

Abstract

Cardiorespiratory fitness (CRF) is a critical biomarker of cardiovascular health and should be routinely assessed in clinical practice. Numerous field tests are available to evaluate CRF, with the Six-Minute Walk Test (6MWT) serving as a validated measure of aerobic endurance and functional capacity. However, its logistical demands can limit feasibility in certain settings. Shorter alternatives, such as the Two-Minute Step Test (2MST) and Two-Minute Walk Test (2MWT), offer more practical options but may capture different physiological constructs. This study compared physiologic responses across the 6MWT, 2MST, and 2MWT in older adults. Thirty-one healthy, community-dwelling older adults (mean age = 68.8 ± 5.3 years) completed all three tests. Repeated measures mixed models were used to assess physiological responses across the three test types, with all outcomes evaluated using adjusted least squares means. Variables included pre- to post-test in HR, SBP, and blood lactate concentration (BLC), and peak responses for RPE, %HRmax, VO₂, and ventilation (VE). Significant differences between test types were observed for RPE, HR, %HRmax, VO₂, and VE peaks (p < .001). Pairwise comparisons of adjusted means showed that the 6MWT elicited significantly higher responses than the 2MWT for RPE, HR, %HRmax, VO₂, and VE, and higher responses than the 2MST for VO₂ and VE. Bland-Altman analysis indicated a systematic difference in physiologic response, with consistently lower peak VO₂ and VE in the shorter tests. The two-minute tests produce different physiological responses than the 6MWT and are better characterized as measures of functional capacity in healthy older adults.

Title: Perceived Experiences of Infection Preventionists Working in Acute Care Hospitals During the COVID-19 Pandemic 

Abstract

Background: In hospitals, infection preventionists (IPs) are integral stakeholders, serving as vigilant guardians and implementing measures to ensure effective control and containment of infections; their significance has gained heightened awareness during the COVID-19 pandemic. The implications of the COVID-19 pandemic have led researchers to study the experiences of IPs to determine what support systems they need. Currently, there are limited studies that reflect the experiences of IPs from diverse backgrounds.

Purpose: This study aims to examine the experiences of IPs during the COVID-19 pandemic in acute care hospitals to inform health executives and stakeholders on how they can support infection prevention and control programs.

Method: The researcher utilized a qualitative basic interpretative approach to study the experiences of IPs in acute care hospitals during the pandemic and endemic stages of COVID-19. Participants engaged in semi-structured interviews exploring what it meant to work in an acute care hospital as an IP during that time.

Result: Five themes emerged from the data: work-life balance and personal well-being, external factors influencing infection prevention professionals during the pandemic, internal challenges and experiences of infection preventionists, infection preventionist’s relationships with other healthcare professionals, and prospects and perceptions of the infection prevention profession and IPC department. The study’s findings revealed answers to the research question describing the perceived experiences of IPs during the specified timeframe in acute care settings. Discussion: This study marks the first known systematic exploration of IPs' perceived experiences during the COVID-19 pandemic in acute care settings following the pandemic. Research findings underscore the impact of public health emergencies on IPs, both personally and professionally, and highlight opportunities for hospital stakeholders to develop and operationalize emergency preparedness plans to enhance departmental effectiveness and efficiency, as well as establish support systems for IPs.

Title: Quality of Life in Older Immigrant Adults on Hemodialysis

Abstract

Background: In 2021, over 34% of individuals with chronic kidney disease (CKD) were 65 years of age or older, compared to 13% of those aged 45-64, and 6% of those aged 18-44. Although extensive studies have examined the quality of life (QoL) of older adults on hemodialysis, little is known about older immigrant adults.

Purpose: This study explored how older immigrant adults perceived the influence of living with stage 5 CKD on their QoL and how they described the impact of CKD and hemodialysis on their cultural beliefs and practices.

Method: A basic qualitative interpretive study design was employed. Data collection was conducted using semi-structured interviews, and thematic analysis was used for data analysis.

Results: The QoL of older immigrant adults on hemodialysis was influenced by a complex interplay of factors, including family and social support, cultural and religious practices, balancing independence and dependence, health and illness perceptions, life adjustments to hemodialysis, emotional responses, and immigration adjustment.

Discussion: Several complex factors affected the QoL of older immigrant adults on hemodialysis, which could be improved through comprehensive, culturally competent care that integrated physical, emotional, and social support to improve patient outcomes. Critical gaps were identified in patient education, suggesting that structured programs could have helped patients better understand their treatment options and navigate the healthcare system. Additionally, spirituality and religious practices were crucial for maintaining hope and emotional resilience, underscoring the need for holistic care that respects cultural, religious, and spiritual beliefs.

Title: Faculty Teaching Experiences at a Community College with Non-traditional Allied Health Students

Abstract

Background: Non-traditional students face unique challenges that include balancing work, family, and academic needs. Community colleges offer a supportive environment for these students, with lower student-to-faculty ratios and lower tuition. Faculty at community colleges have valuable insights into managing challenges and addressing needs among non-traditional students. However, research on faculty perceptions of teaching allied health students in community colleges is limited.

Purpose: In this study, the researcher investigated the experiences of faculty teaching non-traditional, allied health students in community colleges to determine how they create a classroom environment that supports a diverse population.

Method: In this qualitative basic interpretive study, purposeful criterion sampling was used to recruit participants from community colleges in Indiana, Michigan, and Ohio to identify themes among teaching styles and classroom experiences and discover possible solutions to support faculty in teaching. Data was collected through semi-structured interviews. Data analysis was conducted using a thematic analysis. Results: Five major themes emerged from the data: community, positive experiences with non-traditional students, classroom experiences, emotional awareness, and ideas for support.

Discussion: The study findings indicate that learning styles for non-traditional students should focus on hands-on, active learning for the best results with these students. Additionally, non-traditional students benefit from emotional support structures to ensure retention. Further research is needed on faculty educational levels and understanding of teaching strategies, along with ways to better support non-traditional students; feelings of anxiety and self-doubt.

Title: Exploring the Association Between Physical Literacy and Physical Activity in Phase I Cardiac Rehabilitation Patients

Abstract

Background: Long-term adherence to physical activity (PA) programs remain problematic among United States (U.S.) adults, contributing to a global pandemic of physical inactivity (Liguori et al., 2022). An inverse relationship exists between regular PA and all-cause mortality, cardiovascular disease (CVD), and co-morbidities (Han & Won, 2022; Liguori et al., 2022; WHO, 2018). A growing topic among researchers is physical literacy (PL), a holistic framework that encompasses the ability, confidence, and motivation to engage in lifelong PA (Cornish et al., 2020; Holler et al., 2021).

Purpose: The purpose of this study is to examine the association between PL and PA levels of patients in Phase I Cardiac Rehabilitation (CR).

Method: A non-experimental, cross-sectional survey design was conducted. Adult Phase I CR patients were recruited through non-probability convenience sampling, and data were collected through an anonymous online, self-reported survey. Statistical Analyses involved descriptive statistics, bivariant correlation tests between PL scores and PA levels, and multiple regression to determine the impact that demographics and health characteristics have on the PL and PA relationship.

Results: A total of 74 participants were included in this study. Positive correlations were seen between total PL scores (r = .44, p < .001) and its subscales: Sense of Self (r = .39, p < .001), Self-Expression (r = .41, p < .001), and Knowledge and Understanding (r = .31, p = .006) with PA. Sense of Self (p = .003) and Self-Expression (p = .001) were significant predictors of PA, along with being employed (p < .001).

Discussion: These findings suggest that PL interventions may provide additional benefits in enhancing PA behavior among U.S. adults with CVD. Therefore, this study highlights the need for allied health professionals to address poor levels of PL and PA in cardiac patients, as these factors can significantly impact overall health and quality of life.

Title: African American Attitudes and Perceptions of the Impact of the Affordable Care Act 

Abstract

Background and Purpose: The Patient Protection and Affordable Care Act (ACA) was passed and signed into law by President Obama on March 23, 2010, to reduce the costs, improve the quality of healthcare, expand Medicaid, and implement innovative healthcare delivery. The purpose of this study was to explore how African Americans perceived the impact of the ACA on the African American community. Of specific focus was their perceptions of their access to affordable health insurance and care post-ACA implementation.

Method: The study was conducted using the interpretive (hermeneutic) phenomenological approach that examined the lived experience in the broader sociopolitical context. Ten participants identifying as African American or Black and over 18 years of age participated in semi-structured interviews.

Results: Data were collected between September 2023 and April 2024. Four themes emerged from the participants’ responses: 1) Limited Access to Health Insurance and Care Prior to ACA, 2) Improved Access to Health Insurance and Care Since ACA Implementation, 3) Innovative Healthcare Delivery, and 4) Opportunities for Improvement.

Discussion & Conclusion: The results of the study suggested that African American adults perceived that the ACA had a positive impact by increasing access to care and health insurance. While African Americans perceived the ACA to still have opportunities for improvement, they overall had positive perceptions and attitudes on the impact of the ACA on individuals the community at large.

Title: Carceral Determinants of Sexual Health Care: A Qualitative Inquiry

Abstract

Background: One in five Americans had a sexually transmitted infection (STI) in 2024. Incarcerated people are up to 20 times more likely to have an STI. Yet, there are no known qualitative studies examining correctional staff’s perceived facilitators and barriers to accessing and utilizing STI prevention, screening, diagnostic, and treatment services and resources for adult incarcerated males in the U.S.

Purpose: This study aimed to elucidate perceived facilitators and barriers among correctional staff on access to and uptake of sexual health care services and resources among adult males in carceral settings.

Method: The researcher recruited participants from the western, northwestern, midwestern, southern, eastern, and northern regions of the U.S. using online recruitment strategies. The purposive sampling consisted of nine male and four female adults with carceral employment experience within the past five years. Prescreening was used to determine eligibility. This basic interpretive qualitative study collected data through semi-structured interviews to better understand the participants' perceptions of access and uptake of STI healthcare services and resources for incarcerated adult males. A generalist approach allowed the researcher to construct the meaning of the phenomena, followed by a thematic analysis of the data.

Results: Correctional staff revealed contextual factors characterized as individual and institutional, acting as barriers and facilitators of STI, psychological, behavioral, and medical care services and resources for adult males in carceral settings.

Discussion: Multi-level interventions and prioritizing the equitable application of the CDC’s standards of care (CDC, 2022) are crucial for mitigating the adverse effects of incarceration on sexual health.

Title: Assessment of Musculoskeletal Interoceptive Experience in Muscle Length Testing of the Lower Limb

Abstract

Background: Interoception refers to the afferent signals originating from internal organs and body tissues as well as their interpretation by the central nervous system, which is critical to regulating posture and movement. Despite its importance, the utility of assessing interoceptive experience in musculoskeletal healthcare has not been previously investigated.

Purpose: This study aims to explore whether interoceptive experience during muscle length testing of the lower limbs can provide relevant information on functionality and impairment of musculoskeletal structures.

Method: Participants underwent three muscle length tests of both lower limbs. Interoceptive experiences during each test were classified as impaired or unimpaired across three sensory domains: location, distribution, and type. Data were gathered on participants’ musculoskeletal health history, pain levels, pain beliefs, self-reported functional ability, and physical activity levels. An exploratory bivariate correlation table was used to assess the associations between interoceptive experience impairment and the other covariates. Poisson Regression was then used to develop an adjusted prediction model for the sum interoceptive experience impairment value.

Results: The statistically significant associations with interoceptive experience impairment were with gender (r = .310, p = .019) and self-reported functional ability (r = -.285, p = .030). The prediction model demonstrated that for every point decrease in the LEFS score, IEI is expected to increase by 2.1%, and being male is associated with an IEI score that is 23.4% lower than that expected in females.

Discussion: The three-domain interoceptive experience impairment classification method is a viable operationalization of musculoskeletal interoceptive experience. Clinicians should consider asking their patients about their bodily experience during musculoskeletal assessments beyond pain alone.

Title: Mental Health Perceptions Among Community-Dwelling Older Women with Hand Osteoarthritis

Abstract

Background: Hand osteoarthritis (HOA), a progressive joint condition, disproportionately affects women aged 60 and above. Despite the significant long-term impact, the research on the mental health implications for women with HOA has been limited. Anxiety and depression are often linked with HOA, yet mental health correlates remain unrecognized, underexplored, or inadequately addressed.

Purpose: This study aimed to explore older women’s perspectives on their mental health experiences while living with HOA, emphasizing symptom identification, management, support systems, barriers, and coping strategies.

Method: A basic interpretive approach was employed, and semi-structured interviews were conducted to understand how women with HOA perceive mental health. The Michigan Hand Questionnaire (MHQ) was used to assess hand function. Nine participants were recruited using purposeful criterion sampling from three rehabilitation clinics. Electronically transcribed interviews were analyzed and coded, revealing themes that captured participants' experiences.

Results: Five key themes emerged: (1) Functional Challenges of HOA Influence Mental Health, (2) Mental Distress, (3) Coping Strategies Underpin Biopsychosocial Well-Being, (4) Overcoming Barriers Aided by a Sense of Self-Agency, and (5) Preserving Independence and Mental Well-Being.

Discussion: Physical and psychosocial factors interconnect to influence health outcomes. Findings revealed that acknowledging physical symptoms but discerning mental health symptoms in chronic pain conditions like HOA is challenging, underscoring the need for a holistic approach to care. The study also highlighted participants’ resilience, strength, and resourcefulness in maintaining independence and well-being despite HOA's limitations.

Title: Exploring the Feasibility of Utilizing the Borg Rate of Perceived Exertion Scale in Parkinson’s-Specific Community-Based Exercise Programs 

Abstract

Background: The ability to track exercise response in individuals with Parkinson’s Disease (PD) during community-based exercise is limited. Finding objective measures to track activity response offers the potential to prescribe activities during class better to maximize outcomes.

Purpose: This study investigated the feasibility, barriers, and facilitators of integrating the Borg Rate of Perceived Exertion (RPE) scale into PD-specific community-based exercise programs as an evaluative tool for exerciser response to activity.

Method: Coaches (n=10) and exercisers with PD (n=64) were recruited through non-probabilistic sampling from Rock Steady Boxing, PWR!, and Pedaling for PD programs. Participants received training on the scale before class and then participated in a class that integrated target RPE scores into relevant activities. Data was collected on class characteristics alongside frequency and method of scale implementation. Exercisers’ RPE responses were recorded throughout class. Post-class surveys evaluated participants’ experiences with the scale’s use.

Results: Baseline RPE knowledge was similar across all class types (p=0.498). There was no significant difference between class types in post-class survey scores (p=0.168), suggesting that the scale’s impact was consistent regardless of program setup. For exercisers, disease progression and cognitive status were the strongest correlates to the scale’s use (r=-0.663 and r=-0.748, respectively, p<0.001). For coaches, post-class survey responses were extremely favorable, with no barriers identified based on survey responses.

Discussion: The Borg RPE scale is a feasible method of evaluating response to activity during PD-specific community-based exercise programs. Disease and cognitive status are the most substantial considerations when integrating the scale into classes.

Title: Study of Attitudes, Beliefs, and Perceptions Toward Telehealth

Abstract

This study investigated the attitudes, beliefs, and perceptions of U.S. adults toward telehealth services and their influence on the willingness to utilize these services. Conducted online with a sample of 184 participants using a non-probability convenience sampling method, the research employed statistical analyses, including regression and correlation techniques. Findings reveal that 75% of participants reported prior telehealth usage, with a mean willingness to use telehealth score of 21.91 (SD = 4.99). Notably, demographic disparities emerged, as higher income and education levels correlated with a greater affinity for telehealth, while lower-income individuals expressed significant concerns regarding service quality, reflected in a mean score of 20.79 among those earning less than $50,000. Additionally, telehealth phobia was identified as a barrier to adoption, with a negative correlation (r = -0.290, p < 0.001) suggesting that increased familiarity can alleviate anxiety. The study underscores the importance of targeted educational initiatives to enhance perceptions of telehealth, particularly among underserved populations. These insights have critical implications for healthcare providers and policymakers aiming to sustain telehealth adoption beyond the pandemic, emphasizing the need for equitable access and supportive policies. Future research should focus on longitudinal studies to track changes in attitudes over time and explore the effectiveness of various telehealth modalities.

Title: Exploring the Exercise Experiences and Health Beliefs of Women Aged 85 and Older 

Abstract

Background: The fastest-growing age segment of the older population is individuals aged 85 and older. Research studies have shown that as the body ages, the risk of developing chronic conditions and decreased functionality and mobility increases. However, studies have also shown that exercise participation can decrease the risks and help maintain physical and mental health, functionality, and mobility among the oldest-aged adults. More health education programs are needed to keep older adults informed and educated about the continued importance of staying physically active, even in older age.

Purpose: This study employed qualitative research, utilizing interpretative phenomenology, to analyze the perceptions, experiences, and beliefs of women aged 85 and older who regularly participate in community exercise classes.

Method: Research information flyers were distributed at two exercise facilities to recruit potentially interested volunteers. Using qualitative purposive sampling, twelve women qualified for the research study. After receiving acceptance notifications, each female participant provided informed consent and participated in a 25- to 30-minute face-to-face, audiorecorded interview, during which the researcher used a semi-structured interview guide.

Results: Four themes were developed from recurring codes throughout the transcript data, which included health and energy, barriers to exercise, importance of healthy lifestyles, and functionality benefits.

Discussion: The Health Belief Model (HBM) did not significantly influence the four themes; however, the HBM framework was used to help describe the women’s health behaviors, beliefs, and exercise experiences that contribute to their continued exercise into older age, which the female participants attributed to helping them stay healthy and independent.

Title: Effect of Education on Parent Mental Health Service Access After Their Child’s Traumatic Brain Injury 

Abstract

Background: Parents’ unmet mental health needs after pediatric traumatic brain injury (TBI) have been reported in the literature. At one Midwest institution, most parents of children with TBI decline outpatient mental health services when offered by the social worker at discharge. They later report difficulty managing care and sometimes cannot complete the recommended follow-up.

Purpose: The first aim was to determine whether more parents accepted mental health services after a parent education protocol than when offered in usual care. The next aim was to determine whether TBI severity was correlated with parent acceptance of mental health services. The final aim was to determine whether parents’ perception of their preparedness for caregiving was correlated with their acceptance of mental health services.

Methods: A quasi-experimental study using a cross-sectional design explored whether implementing parent education on the association between parent well-being and child outcomes increased parent acceptance of mental health services. After mental health services were offered in usual care, parents received education on the association between their well-being and their child’s outcomes and completed the Preparedness for Caregiving Scale. Then mental health services were offered again.

Results: Thirteen parents of children with mild to severe TBI participated. Three parents accepted mental health services after they received education. This study was unable to determine whether more parents accepted mental health services after education on the association between parent wellbeing and child outcomes post-TBI. There was a significant, strong negative association between parents’ Preparedness for Caregiving Scale total scores and whether they accepted mental health services; however, there was no association between acceptance of mental health services and TBI severity.

Discussion: Parent acceptance of mental health services may be related to their perception of preparedness to care for their child post-TBI. Future research using qualitative methods may be useful to explore parent insight into supports and barriers to accepting mental health services after pediatric TBI. The most common barrier to study recruitment was the high number of children discharged to kinship or foster care, which has not yet been reported in pediatric TBI literature.