health behavior thesis

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Health Promotion, Education, and Behavior Theses and Dissertations

Theses/dissertations from 2023 2023.

Exploration of the Association Between Obesogenic Environments and Childhood Overweight/Obesity Rates In Rural Counties in the United States , Kara Lea Ferguson Davis

Social Network Attributes Associated With Conversations About Smoking And Cessation And Differences By Socioeconomic Status , Victoria Catherine Lambert

Babe (Body Appreciation and Better Eating), Just Add a Dash of Self-Compassion: A Randomized Controlled Pilot Study for Black/African American Teenage Girls , Nkechi Bianca Okpara

No More Loosies: A Mixed-Methods Study on the Implementation and Enforcement of the Loose Cigarette and Bidi Sale Ban in India , Mayank Sakhuja

Theses/Dissertations from 2022 2022

Food Insecurity Resilience of Refugee Families in the United States: A Qualitative Study , Maryam Suliman Alhabas

Homestead Vegetable and Poultry Production and Related Practices: An Assessment in Nepal , Shiva Bhandari

Living With Ulcerative Colitis: Exploring Dietary Inflammatory Intake, Physical Activity, and Methods to Manage the Burden of Illness , Kelli E. DuBois

Exploration of the Role of Neighborhood Residential Segregation by Race and Ethnicity in Obesity Risk Among School-Aged , Melissa L. Fair

Perspectives About Food Safety in Diverse Low- And Middle-Income Countries , Sejla Isanovic

Nutrition Facts Label Use Among U.S. Adolescents , Jennifer Beth Mandelbaum

HIV-Related Stigma, Sexual and Gender Minority-Related Stigma, and Health Outcomes Among MSM Living With HIV: Measurement, Impact, and Intersectionality , Tianyue Mi

Greenspace Across the United States: Exploring Equity and Associations With Physical Activity, Obesity, and Health-Related Quality of Life , Ellen W. Stowe

Theses/Dissertations from 2021 2021

Pre-Exposure Prophylaxis (PrEP) Knowledge, Willingness to Use & Uptake Among Black Heterosexual Men , Akeen Lowell Hamilton

A Contextual Evaluation of the Fresh Fruit and Vegetable Program in South Carolina and Related Child Health Behaviors , Kathryn Irene Hoy

Food Choice Decision-Making Among School-Going Adolescents Amidst the Nutrition Transition in Urban Accra, Ghana , Krystal Krsna Rampalli

Neighborhood Socioeconomic Status, Green Space, and Walkability and Risk for Falls and Fracture Among Postmenopausal Women: The Women’s Health Initiative , Marilyn Elizabeth Wende

Evaluation of a Clinic-Based Peer Navigation Program (PNP) For African Americans Living With HIV In South Carolina , Kimberly Butler Willis

Applying Health Stigma Framework to Examine the Mechanisms Of HIV-Related Stigma on Clinical Outcomes , Chengbo Zeng

Theses/Dissertations from 2020 2020

Determinants of Nutrition Agenda Setting in the Context of the Double Burden of Malnutrition in Tamil Nadu, India , Shilpa Vimalananda Constantinides

Understanding the Role of Political Commitment and Coherence Across Sectors and Across National and Sub-National Levels in Enabling Improvements in Nutrition in Rwanda , Elyse Iruhiriye

Rethinking the Customer Experience: An Empirical Comparison of Airbnb and Hotels , Jing Li

Does Marriage, Employment and Having Children Matter? A Secondary Analysis on Physical Activity Levels, Leisure Time Physical Activity, and Social Roles Among Women in the United States , Tramaine Paul McMullen

Influences on Parents’ Food Shopping for Children’s Consumption in South Carolina , Nazratun Nayeem Monalisa

Social Networks, the Local Food Environment, and Maternal Food Choice for Children Ages 1 to 5 Years Old in Rural Mexico , Ligia Ivette Reyes

Studying the “Snip”: A Multi-Methods Exploration of Vasectomy in the Southern United States , Ashley Lauren White

Examining the Organizational Capacity of Public Libraries That Offer Obesity Prevention Programs , Olivia Whitt

Theses/Dissertations from 2019 2019

Women’s Socio-Economic Empowerment and Uptake of HIV Testing in Ethiopia , Dawit Alemu

Role of Resources for Care in Improving Care Behaviors, Children’s Nutritional Status and Early Childhood Development in Low- and Middle-Income Countries , Sulochana Basnet

Social Networks, Social Support, and Contextual Factors That Affect Blood Glucose Control Among Individuals with Type 2 Diabetes Mellitus in Urban Ghana , Marian O. Botchway

Examining the Relationships Between Stress, Depressive Symptoms, and the Neighborhood Food Environment on Diet Quality Among Racially-Diverse Pregnant Women in South Carolina , Alycia K. Boutté

Experience of Persistent Pain Among Military Service Members Participating in an Interdisciplinary Intensive Outpatient Program , Barbara Katarzyna Bujak

The Plant-Based and Soul-Full Study (PASS): Examining How Owners of Local Vegan Soul Food Restaurants Promote the Consumption of Vegan Foods in the African American Community , Anthony Crimarco

Applying the Health Action Process Approach (HAPA) in Program Evaluation of a Theory-Based Parental HIV Disclosure Intervention Among Parents Living With HIV (PLH) in China , Wendi Da

Sociocultural Factors Influencing Cervical Cancer Prevention and Control Behaviors in Cusco, Peru , Venice Elizabeth Haynes

Evaluating Impacts of a Multilevel Resilience-Based Psychosocial Intervention on Mental Health of Children Affected by Parental HIV in China , Yanping Jiang

Expanding Immediate Postpartum Contraceptive Options: South Carolina’s Medicaid Policy , Amy Mattison-Faye

Parenting and Child Self-Regulation as Mechanisms for the Relationship of Household Food Insecurity with Child Dietary Behavior , Hoa Thi Mai Nguyen

Helping South Carolina’s Children Thrive: Promoting Protective Factors to Prevent the Long-Term Impact of Adverse Childhood Experiences Through the Development of Evidence-Based Public Health Policies , Aditi Srivastav

Pre-Exposure Prophylaxis (PrEP) for HIV Prevention: A Mixed-Methods Study of Sexual Risks and Knowledge, Perceptions, and Willingness of PrEP Use Among African American Women in the South , Jamie Troutman

Theses/Dissertations from 2018 2018

Healthy Motivations for Moms-To-Be (Healthy MoM2B) Study: A Mobile Health Intervention Targeting Gestational Weight Gain among U.S. Women , Alicia Anne Dahl

The Impact of False Positive Mammography Results on Breast Cancer Screening Intention Among Black Women , Deeonna E. Farr

Examining Faith-Based Communities As Leverage Points For The Prevention Of Childhood And Adolescent Obesity , Caroline Glagola Dunn

Body Mass Index Trajectories And The Relationship Between Stressful Life Changes And Nutrition-Related Health Outcomes Among United States Army Soldiers , Julianna Marie Jayne

Understanding The Mechanisms Linking Gendered Intrahousehold Bargaining Power And Child Nutrition In Rural Nepal , Shibani Kulkarni

Interpersonal Communication About Cigarette Warning Labels Among U.S. Smokers: Differences Between Latinos And Whites , Victoria Catherine Lambert

The Effects Of The Affordable Care Act On The Receipt Of Colonoscopies Among Insured Elderly , Min Jee Lee

Racism, Black College Students’ Mental Health, And The Efficacy Of Diversity And Inclusion Initiatives: A Case Study. , Kaleea R. Lewis

Intervention For Women In Costa Rica Who Are Discouraged And Have Food Insecurity And Excess Body Weight , Tatiana Martínez-Jaikel

The Effect Of Neighborhood Characteristics And Acculturation On Vegetable Intake Among U.S. Hispanics , Anna Victoria Mesa

A Qualitative Exploration Of Experiences And Motivations For Diabetes Self-Management In African American Men Between The Ages Of 40-85 With Type 2 Diabetes , Anthony Q. Walker

Theses/Dissertations from 2017 2017

Effectiveness of Pictorial Health Warning Labels for Indonesia's Cigarette Packages , Dien Anshari

“An Uphill Battle”: Psychosocial Health and Self-Care among Advocates who work Against Gender-Based Violence in South Carolina , Ebru Cayir

Exploring Spatial Patterning and the Impact of Obesogenic built Environments for Youth Obesity , S. Morgan Hughey

Involvement Of Men In Responsible Parenthood In Croatia, India, And Mexico: Major Factors, Correlates, And National Policy , Salima Kasymova

Multilevel and Multisectoral Processes of Implementing Nutritionsensitive Ideology and Programming in Ethiopia’s Development Landscape , Andrea Marie Warren

Theses/Dissertations from 2016 2016

Breastfeeding Among Working Mothers in Saudi Arabia , Maryam Suliman Alhabas

Social Capital And Social Networks: The Importance Of Social Ties For Health Among Residents Of Disadvantaged Communities , Stephanie Child

Implementation Processes And Impacts Of School Store Policies In South Korea , Seul Ki Choi

Conversations About Sexuality On A Public University Campus: Exploring Perspectives From Campus Ministry Leaders And Students , Charis Rebecca Davidson

Sleep Disruption and Cancer Incidence in a Southeastern Veteran Population , Alexandria F. Delage

Non-Steroidal Anti-Inflammatory Drug Effects On Core Temperature, Hydration, Gastrointestinal Distress, And Performance In Exercising Humans , Dawn Marie Emerson

Sustainability Of Food And Nutrition Security Policies During Presidential Transitions: Integrating Socio-Political And Nutritional Sciences , Jessica Liana Escobar-Alegría

A Qualitative Study Of How Communities Think About And Act Upon Hunger In The Presence Of A Food Banking System , Eliza Miriam Fishbein

Examining Crowdsourced Social Media Platforms And Their Association With College Students' Alcohol Consumption, Perceived Risk, And Behaviors , Danielle Gentile

Quality Over Quantity: Positive Interactions During Family Meals In Food-Insecure Households Compensate For The Negative Impacts Of Household Chaos On Child Emotional Well-Being, But Not Diet Quality , Tiara Nicόl Rosemond

Enhancing Parent-Child Communication and Promoting Physical Activity and Healthy Eating Through Mobile Technology: A Randomized Trial , Danielle E. Schoffman

Examining Infant Health Outcomes Impacted By South Carolina's Regionalized System of Perinatal Care , Michael Grady Smith

Understanding Conceptualizations and Structural Environment for Improving Pre-Pregnancy Planning for Adolescent Girls and Young Women in Harare, Zimbabwe , Chiwoneso Beverley Tinago

Bayesian Semiparametric Quantile Regression for Clustered Data , Xin Tong

The Roots Of Perspective In The American Context: News Media Discourse And Stakeholder Perspectives About The Supplemental Nutrition Assistance Program , Nicholas Younginer

Theses/Dissertations from 2015 2015

Telling a Different Narrative: Exploring the Values and Challenges of Performing Enslaved Community Members’ Stories at U.S. Southern Plantation Museums , Stefanie Kate Benjamin

Post-Fall Decision Making Among Older Women Living in Continuing Care Retirement Communities: A Mixed Methods Study , Caroline D. Bergeron

eCPAT: Development and Testing of Mobile Technology to Engage Youth in Active Living Policy, Systems, and Environmental Health Promotion Efforts , Gina M. Besenyi

Building Capacity for Advocacy for Local Food Systems Change: An Ethnographic Study Documenting the Process of Change in South Carolina Communities , Casey Denise Childers

Refinement and Pilot Testing Social Networks for Encouraging Healthy Behaviors: The Social Pounds Off Digitally (Social POD) Study , Sarah B. Hales

A Qualitative Study of the Massage Therapy Foundation's Best Practices Symposium: Clarifying Definitions and Creating a Framework for Practice , Ann Blair Kennedy

Support for Comprehensive Sexuality Education and Adolescent Access to Condoms and Contraceptions in South Carolina , Sarah H. Kershner

By Word of Mouth: A Qualitative Approach to Understanding the Integration of Preventive Dental Health in Primary Care Settings , Joni D. Nelson

Ethnic Discrimination: Measurement And Associations With Smoking-Related Outcomes Among Arab Male Current And Former Smokers In Israel , Amira Osman

Addressing Disparity: one Unique School’s Efforts to Provide Holistic Education in a low-income, Black Community , Allison Anne Parsons

The Influence of Self-Reported Degree of Masculinity/Femininity on Condom Use Among Black Men Who Have Sex with Men in the Deep South , Elizabeth D. Peeler

Framing Risk, Responsibility, and Resolution: A Mixed-Methods Study Exploring Traditional and Social Media Coverage of the 2014 Elk River Chemical Spill , Tracey Thomas

Statewide Scale-up of Group Prenatal Care in South Carolina , Kristin M. Van De Griend

Theses/Dissertations from 2014 2014

The Emergence of U.S. Hospital-Based Doula Programs , Violet Dawn Beets

The Association between the Social Context of Mealtime, Children's Diet, Caregiver's Experiences with Discrimination and Household Food Insecurity , Michael Patrick Burke

The Comparative Effectiveness of Group Prenatal Care on Women's Psychosocial Health , Emily Heberlein

The Development, Implementation, and Testing of an Interactive Sexual Health Web-Based Application Intervention to Reduce Sexual Risk Behaviors Among College Students , Dawnyéa Dominique Jackson

A Community-Driven Approach to the Development of a Digital Decision Aid to Facilitate Informed Decision Making for Prostate Cancer Screening among African-American Men in Communities of Faith , Otis LaShaun Owens

Elucidating Perceived and Actual Cancer Risk in Disadvantaged Neighborhoods Differentially Impacted by Environmental Hazards to Inform Future Public Health Interventions , LaShanta J. Rice

Food Insecurity and Physical Activity among U.S. populations , Quyen G. To

Theses/Dissertations from 2013 2013

Understanding Online and offline Sex Seeking Behavior Among Young Men Who Have Sex With Men: Implications For HIV/AIDS Interventions , Winston Eromosele Abara

Smokers' Neurological Responses to Imagery From Cigarette Package Warning Labels , Johann Fridrik Fridriksson

Exploring African American and White 18-19 Year Old Males' Communication Experiences With Their Parents and Partners About Sex and Contraception , Charlotte Toole Galloway

Investigating Developmental Patterns of Symptom and Impairment Change Among Youth With ADHD, Subthreshold ADHDand Youth Without ADHD , Lorie Love Geryk

Understanding the Early Stages of Development of A Global Health Partnership , Wendy Raquel Gonzalez Navarrete

Promoting Early Childhood Development Through Community Health Worker Interventions: Implementation and Measurement Issues In Rural Pakistan , Zaeem Haq

Evaluation of Mass Media Campaigns to Change Smokers' Knowledge, Attitudes, and Behaviors In China and Taiwan , Li-Ling Huang

Race, Ethnicity, and Differential Perceptions of Sexual Victimization (Assault) , Kaleea Regina Lewis

Postnatal Depression In Mexico: Healthcare Provider Conceptualizations and Policies In the Public Health Sector , Jean Marie Sims Place

Examining the Relationships Between Religiosity, Spirituality, Internalized Homonegativity, and Sexual Risk Behaviors Among African-American Men Who Have Sex With Men: The Sexual Health In Faith Traditions (SHIFT) Study , Stacy Whichard Smallwood

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Health, Behavior and Society, PhD

Bloomberg school of public health, overview of phd program.

The PhD in Social and Behavioral Sciences program is designed for students seeking training for careers in social and behavioral sciences, health education, and health communication, most often in academic or research settings. The curriculum emphasizes the application of social and behavioral science perspectives to contemporary health problems. The training in this program focuses on the theoretical perspectives and methods of the social and behavioral sciences that enable scholars to understand and influence the social contexts and behaviors relevant to health.

The PhD degree represents outstanding scholarly achievement and the accomplishment of independent research. The University’s Doctor of Philosophy Board oversees the granting of all PhD degrees.

The following two areas are examples of significant work in the PhD program:

Social and Psychological Influences on Health

This area focuses on social and psychological factors and processes in the etiology and prevalence of disease, in healthcare-seeking behavior, adaptation and coping, and disease prevention. Students are exposed to current research on contextual factors and their relation to health knowledge, attitudes and beliefs; social and psychological factors in disease etiology; risk reduction; and cultural influences in public health, including cross-cultural studies.

This sociological and psychological conceptualization of health and illness, theories of stress and coping, and the special problems in the design and measurement of social and psychological variables are emphasized in the training of the PhD student. The interactive and independent roles of psychosocial factors for disease, with a focus on the social context in which illness is defined and treated, are emphasized. Major social structural divisions such as gender, socioeconomic status, and ethnicity are influential in health outcomes. The basic structure and function of health care systems of societies are also considered in their social-political context.

Health Education and Health Communication

Research and practice in this area focus on how principles from educational, behavioral, social, psychological, and communication theory influence health practices and behaviors conducive to optimal health in individuals, groups, and communities. Students are exposed to current research on health education and communication, with a particular focus on ecological models of health, evaluating multi-faceted intervention programs, and patient-provider communication.

Health education and communication programs are laboratories for the study of effective intervention strategies. Students in this area focus on needs assessment, planning, implementation, and evaluation of comprehensive health promotion programs with an eye toward improving both theory and practice. Specific intervention strategies of interest may include individual behavior change strategies based on learning theory and theories of psychosocial dynamics; use of mass media communication; interpersonal communication; mobilization of social and community support; and advocacy. Program implementation issues such as administrative and staff development and support are also considered. Interventions studied include those directed at patients, health care professionals, administrators, legislators, the general public, or combinations of the above.

Program Requirements

Course location and modality is found on the BSPH website .

Our doctoral curriculum is designed to help students master a set of program competencies through corresponding required and recommended courses. Courses listed as required must be taken by all doctoral students. Students should meet with their advisers prior to registering for courses each term to discuss the selection and sequence of HBS-recommended courses, as well as courses offered by other departments and divisions appropriate for their individual areas of interest.

Students are expected to take methods courses relevant to the field of their dissertation research. Students who wish to take advanced biostatistics courses ( PH.140.651 Methods in Biostatistics I - PH.140.654 Methods in Biostatistics IV ) in place of the basic requirements are encouraged to do so, provided they have the necessary background. To register for the advanced series, a working knowledge of calculus and linear algebra is required.

At the end of the first year of coursework, first-year doctoral students take the qualifying exam. This exam tests whether the student has mastered the basic knowledge of the field (as exemplified by the competencies) and whether the student is ready to specialize in a specific area of study.

Students take the Departmental and School-wide Preliminary Oral Examinations in sequence by the end of their third year in the PhD program. In these exams, the goal is for faculty members to examine the student’s readiness to conduct independent research. Upon passing, students pursue a research topic under the guidance of an academic adviser and faculty committee. The student’s written dissertation is presented in a formal public seminar and then defended at a closed oral examination. Most students complete the PhD within four to five years, and the School requires that students complete it within seven years.

Course Requirements - School

The School requires that at least 18 credit units must be satisfactorily completed in formal courses outside the student's primary department. Among these 18 credit units, no fewer than three courses (totaling at least 9 credits) must be satisfactorily completed in two or more departments of the Bloomberg School of Public Health. The remaining outside credit units may be earned in any department or division of the University. This requirement is usually satisfied with the biostatistics and epidemiology courses required by the department and taken in Year 1 of the PhD program.

Students who have completed a master’s program at the Bloomberg School of Public Health may apply 12 credits from that program toward this School requirement of taking at least 18 credit units outside the department. Contact the Doctoral Program Coordinator for further information.

Council on Education in Public Health (CEPH) Requirements

All students matriculating into a graduate program in an accredited school of public health (such as BSPH) are required to take courses that expose them to content that covers 12 ‘introductory learning objectives’ before graduation. For PhD students in HBS, some of these exposures will come through regular program courses, and others will come through ½ credit “Cells to Society” (C2S) online modules developed by the school. The C2S modules will be offered at least twice a year and will be taken in the first 4 weeks of the term in which they are held.  Some courses fulfill more than one learning objective.  These courses need to be successfully completed prior to graduation, and it may be advisable to take some of them in years 2 and 3.   HBS PhD students will fulfill the CEPH requirements by taking the following courses:

• Explain public health history, philosophy and values:  552.601.81 Foundational Principles of Public Health 
• Identify the core functions of public health and the 10 essential services of public health:  552.601.81 Foundational Principles of Public Health
• 3a. Explain the role of quantitative methods and sciences in describing and assessing a population’s health: 140.62 1 Statistical Methods in Public Health 3b. Explain the role of qualitative methods and sciences in describing and assessing a population’s health:  410.710 Concepts in Qualitative Methods (or another qualitative course of at least 3 credits)
• Discuss the science of primary, secondary and tertiary prevention in population health, including health promotion, screening, etc.: 340.721 Epidemiological Inferences in Public Health
• List major causes and trends of morbidity and mortality in the US or other community relevant to the school or program: 340.721 Epidemiological Inferences in Public Health
• Explain the critical importance of evidence in advancing public health knowledge: 340.721 Epidemiological Inferences in Public Health  
• Explain effects of environmental factors on a population’s health:  552.607.81 Essentials of Environmental Health
• Explain biological and genetic factors that affect a population’s health. Choose 1 of the following :  552.608.81 Biologic, Genetic, and Infectious Bases of Human Disease ,  380.604.01 Life Course Perspectives on Health ,  550.631.81 Biological Basis of Public Health
• Explain behavioral and psychological factors that affect a population’s health:  410.650 Persuasive Communication
• Explain the social, political and economic determinants of health and how they contribute to population health and health inequities:  410.860 Graduate Seminar in Social and Behavioral Sciences
• Explain how globalization affects global burdens of disease:  552.611.81 Globalization and Health: A Framework for Analysis
• Explain an ecological perspective on the connections among human health, animal health and ecosystem health (e.g. One Health):  552.612.81 Essentials of One Health

Curriculum - Social and Behavioral Sciences

Note: Minimum of 16 credits (including special studies and thesis research) is required each term throughout the first 4 years of the PhD program. After Year 4, most students will elect to go part-time and register for 3 credits per term.

Students must take the free, non-credit mini-course “Introduction to Online Learning (IOL) .” Students are now required to take IOL before beginning their first term. 

Students are required to discuss course selections with their advisors prior to registration. Students who would like to waive an HBS requirement and/or substitute another course must complete and submit the "Petition for Course Waiver or Substitution" which can be found in My Portfolio in CoursePlus.

Students who have taken prior similar coursework should discuss this with their advisors to ensure that they have covered the course content and have met the learning objectives of this course in prior training. Students who would like to waive an HBS requirment and/or substitute another course must complete and submit the "Petition for Course Waiver or Substitution" which can be found in My Portfolio in CoursePlus. The course should be taken in 1st term by students who plan to take the course.

Students not taking PH.410.600 FUNDAMENTALS OF HEALTH, BEHAVIOR AND SOCIETY in 1st term are required to select at least one 1st term HBS course in addition to PH.410.860 GRADUATE SEMINAR IN SOCIAL AND BEHAVIORAL SCIENCES and PH.410.863 DOCTORAL SEMINAR IN SOCIAL AND BEHAVIORAL RESEARCH AND PRACTICE  (often this will be Sociological Perspectives/410.612). 

Students who have taken prior similar coursework should discuss this with their advisors to ensure that they have covered the course content and have met the learning objectives of this course in prior training. Students who would like to waive an HBS requirment and/or substitute another course must complete and submit the "Petition for Course Waiver or Substitution" which can be found in My Portfolio in CoursePlus

Recommended HBS Courses

Students should discuss the selection and sequence of recommended and other courses relevant to their research interests with their advisers. Students will select some recommended courses in their first year; other courses may be taken in their second and later years of the program. Note:  methodological training requirements in the next section.

The Department offers a flexible PhD curriculum. Students are strongly encouraged to balance breadth and depth, theory, and methodology in pursuing training in the Department. The Department has a broad focus, incorporating health education/health communication as well as social and psychological influences on health.

Students are required to take at least 12 credits of the following HBS courses before they sit for their departmental oral exams. For students with a prior master's in HBS or a BSPH MPH with an SBS concentration, 10 of these credits can be transferred.

HBS courses recommended for doctoral students and offered by term (list does not include required courses noted above):

School of Public Health course listings for courses in HBS and other departments.

Students also have the opportunity to take courses in other divisions of the University. Contact Records and Registration regarding interdivisional course registration procedures.

Additional Requirements in Methodological Training

In addition to the specific required courses listed above, students are required to complete, prior to their preliminary oral examination , at least one HBS course in each of four areas of methodological training in the social and behavioral sciences: quantitative methods (QN), qualitative methods (QL), evaluation methodologies (EV), and methods applications specific to the social and behavioral sciences (SBS).  HBS courses are easily identified by the 410-course number prefix.  These courses should be taken for a letter grade and not on a Pass/Fail basis. From the menu of courses listed below, students should carefully choose methods training by considering both their previous training and future research goals. Departmental faculty should be consulted as needed.

One HBS course in each of the four areas is considered the minimum; students are encouraged to build their methodological expertise in all areas relevant to their proposed thesis activities and scientific areas of interest. It is valuable for students to seek both breadth and depth in methods training. Therefore, we strongly recommend that students also elect an area of methodological focus and take multiple courses (3 or more) in this area .  Not all courses in an area of methodological focus need to be in HBS. Whatever one’s area of methodological focus, we recommend that all students take at least two courses in the Qualitative area (with at least one being in HBS).

Students who would like to propose taking a methods course not currently listed in lieu of the listed courses may, with their adviser’s consent, request such a substitution in writing using the "Petition for Course Waiver or Substitution" form in My Portfolio. 

Note: Qualitative Reasoning in Public Health (550.604) cannot count towards fulfilling the qualitative requirements for HBS PhD students

HBS faculty instructor

Course/Credit Load

The Department strongly encourages doctoral students to register for fewer than 19 credits (including special studies and thesis research) in any one academic term. While a credit registration of more than 18 credits is possible through the registration system, departmental faculty think that the additional course burden prohibits doctoral students from dedicating the appropriate time needed for the educational activities being undertaken. Any decision to register for more than 18 credits should be carefully considered and discussed with the student’s adviser prior to registering. Doctoral students should register for a minimum of 16 credits each term; the maximum number of credits per term is 22.

Satisfactory Academic Progress

Doctoral students in the Department of Health, Behavior, and Society are expected to maintain satisfactory academic standards for the duration of the degree program. In the Department, satisfactory academic progress is defined as follows:

• A minimum grade point average (GPA) of 3.00. Any doctoral student who does not obtain the minimum 3.00 GPA by the end of the third term during the first year will not be permitted to sit for the written qualifying exams. In this situation, an appropriate course of action will be determined by the Department Chair. If students fall below a 3.0 GPA, they have up to 2 terms to regain at least a 3.0 GPA.
• All courses required for the program must be taken for a letter grade. All HBS departmental courses must be taken for a letter grade except with prior consent of the adviser. The pass/fail option may only be used for elective courses and only with the consent of the student’s adviser.
• No grades below a “B” in core courses. Any required course (or course taken to fulfill a methodological requirement) for which a grade of C or below is received) must either be retaken, or an alternative mechanism for material mastery must be agreed upon between the PhD program director, the adviser and the student. This should be successfully completed before taking the schoolwide oral exam. 
• All grades will be calculated into the student’s GPA.
• All doctoral students will have their transcripts evaluated at the end of their first year. This evaluation will be completed in conjunction with the qualifying exam review process.

Independent Developmental Plans (IDP)

It is now university policy that each Ph.D. student and Post Doctoral Fellow will develop an individual development plan (IDP) in conjunction with their adviser. This is in line with the 2014 NIH notice that strongly encourages the development of an institutional policy on Individual Development Plans for all graduate students and postdoctoral scholars who are supported by NIH funds. Beginning in 2017-2018, all matriculating PhD students must complete an IDP, review it with their adviser and submit a signed IDP form for departmental records on an annual basis. The completed and signed IDP must be submitted via the "Independent Development Plan" touchpoint in My Portfolio in CoursePlus by January 15th of each year. 

The IDP is a mechanism for self-reflection as well as a communication and planning tool for the student and their faculty mentor/s. The IDP can be useful to make sure that the student's and the adviser’s expectations are clearly outlined and in agreement so that there are no big surprises, particularly at the end of the student’s training.

The goal of the IDP and the annual review process is to support the student in their success in the program and in attaining readiness for their intended future career. To this end, the IDP creates a structure for the student to:

• assess current skills, interests, and strengths;
• make a plan for developing skills to meet academic and professional goals; and
• communicate and collaborate with supervisors, advisers, and mentors about evolving goals and related skills.

The onus to engage in the IDP process is on the student, with the support and input of the adviser. Although the IDP is kept on file in the department, it is primarily a document for use by the student. Through the IDP process, it is possible that the student may decide to identify various additional mentors to whom they can go for expertise and advice.

Once an IDP is written, it is expected that it will be revisited and revised by the student and their adviser (and when appropriate, the dissertation committee) on an annual basis and that this review will be integrated into an annual review process for each student. It is expected that the department will keep a record of this document and of the process by which it was developed and revised.

There are three aspects of the HBS IDP that will be completed on an annual basis, and uploaded to the “ Ind epe nd e n t D e velop me nt Plan” touchpoint in My Portfolio in CoursePlus by January 15th of each year.  The IDP summary and the signature form will both be kept in the student’s departmental file.

• Self-assessment and goal setting , primarily accomplished by the student through the completion of an assessment tool provided by the department. 
• The student should set up a meeting with their adviser specifically to review the IDP. The IDP should be forwarded to the adviser in advance of this meeting so that the adviser has time to review before the meeting. The student and the adviser should discuss the IDP and possibly revise (e.g. add goals or members of the mentorship team). 
• Both student and adviser should sign the signature form. Once completed, the student must submit the signed form using the  “ Ind epe nd e n t   D e velop me nt   Plan” touchpoint in  My  Portfolio  in CoursePlus. 
• Annual Departmental and program feedback to the student . Written feedback will be provided from the department/program, that evaluates student progress in the program to date and the student's graduation trajectory, and progress toward stated career goals. Departmental feedback should be integrated into the IDP process. After Year 1, students will receive written departmental feedback before the beginning of the first term of each year .  The goals outlined in the IDP will be reviewed in preparation of this feedback. Other elements of the IDP will not factor into departmental feedback.

Ideas for Items/Topics to Consider in Creation/Review of the IDP

• Career goal for PhD program (long-term goals)
• Coursework plans/goals for Year 1 (other than required courses)
• Coursework plans/goals before embarking on dissertation
• Skills assessment (areas of strength and needs for additional training)
• Goals for establishment of professional identity and network
• Goals for research opportunities in coming year/entire PhD program
• Goals for teaching opportunities
• Goals for practice opportunities
• Funding targets/opportunities
• Preparation for qualifying exams

Year 2/3 (before departmental and schoolwide preliminary exams)

• Achievements/goals met over the past year
• Challenges faced over the past year
• Remaining coursework plans/goals (other than required courses)
• Goals related to identification of dissertation topic/focus
• Progress on identification of broader mentorship team/committee
• Progress on preparation of dissertation proposal

Years 3+ (after preliminary exams)

• Dissertation goals for the coming year
• Planned timeline for program completion and remaining activities and milestones
• Non-dissertation (research/teaching/practice) goals for remainder of program
• Identification of possible career opportunities

Departmental Qualifying Examination

As stated in the School’s Policy and Procedure Memorandum for doctoral degree programs, the examination should constitute a comprehensive inquiry into the student's grasp of the subject matter underlying their discipline. It should explore the student's understanding of scientific principles and methods as well as their substantive knowledge of the major field and related areas. 

Doctoral students become eligible for the departmental qualifying examination upon successful completion of the first-year required courses while maintaining the minimum GPA required. 

The exam is offered in June and is under the purview of the HBS Exam Committee.  Specific details on the nature of the exam and policies related to grading will be distributed well in advance of the exam.

Research Hours

The School requires all doctoral students to engage in research in addition to the research conducted as part of their dissertation, so that they will gain exposure to and experience in different research skills, and approaches. While HBS encourages students to work within the Department, students are free to pursue opportunities of interest throughout the School, University, or off-campus. Research hours can be fulfilled by engaging in either paid or unpaid research tasks.

The research hours can involve participation in any of the following aspects of research, including but not limited to:

• elements of research design (literature review and development of the conceptual framework of a study);
• community development and liaison activities;
• community needs assessment and its related social, epidemiological, behavioral, or political diagnosis;
• development and piloting of health interventions or materials;
• data collection;
• data analysis and interpretation;
• policy analysis;
• literature reviews;
• manuscript preparation;
• grant preparation and any other form of research approved by the adviser.

Students must discuss their plan for fulfilling the research hours requirement with their academic adviser and have the plan approved by their academic adviser prior to engaging in the research tasks. Students are expected to engage in at least two different research tasks, which may be related to a single study or two separate studies. These tasks should reflect different elements of the research design as outlined above. The student must identify a primary mentor to work with for each of the tasks, and this mentor must agree to serve in this capacity by signing the research hours form in advance. Up to 50% of the required hours can be accomplished through off-campus work, as long as the work has been approved by the student’s academic adviser. A student’s academic adviser can serve as a primary mentor for one but not both of the research tasks. A minimum of 300 hours for total work on research tasks is required, with at least 100 hours on each task.

The research hours should be completed between matriculation and the Departmental preliminary oral exam. Completion of this requirement will be monitored by the Department through submission of the Research Hours Form to the HBS Doctoral Program Coordinator. 

Departmental Preliminary Oral Examination

Students must successfully pass the Departmental preliminary oral examination before taking or scheduling the School-wide preliminary oral exam. The format of the exam is similar to the School-wide preliminary oral exam and is intended to determine if the student is academically prepared to pass the School-wide preliminary oral exam and to carry out independent dissertation research. Students must have successfully completed the departmental qualifying exam before taking the departmental or schoolwide oral exam.

The examination requires the student to prepare a dissertation protocol that will be examined by the committee members before the exam takes place. This protocol should be between 7,000 and 9,000 words (rough guide) and no more than 10,000 words. The proposal should provide the committee with the student's rationale for the proposed study and the research questions to be examined and the approach and methods the student proposes to use.

The departmental preliminary orals committee consists of four faculty members and an alternate. The student's adviser is included in the four committee members. All committee members should have primary appointments in the Department of Health, Behavior, and Society. (An exception is made when the student’s adviser has a primary appointment in another department and a joint appointment in HBS.) The senior faculty member from the department who is not the student's adviser will serve as chair of the committee. The exam is closed, with only the committee members and the student in attendance.

The student will coordinate the date of the exam with the exam committee members and will distribute a copy of the research proposal to all committee members at least three weeks before the exam is scheduled to be held . The student is required to complete the Departmental Oral Form, available from the HBS Doctoral Program Coordinator. The information required on this form includes the names of the committee members, the title of the research protocol, and the date, time, and location of the exam. Committee members will receive formal written notification of the exam date and time by memo.

Immediately following the examination, the committee evaluates the success or failure of the student. One of the following results must be reported to the HBS Doctoral Program Coordinator by the Committee Chair. The two main criteria to determine the outcome of this exam are:

• The student is academically prepared to pass the School-wide oral examination.
• The student is academically prepared to carry out their dissertation research. Note: The exam is an evaluation of the student’s general academic preparation and is not limited to an assessment of the student’s proposal or the details of the proposed study.

Based on the above criteria, students can then receive:

• Unconditional Pass: If the members each vote “unconditional pass” on the first ballot, this result is reported with no further discussion. If one or more members vote “conditional pass” or “fail,” then the committee should discuss the specific concerns of those members as discussed below.
• Conditional Pass: The committee may decide that further evidence of qualifications is necessary and impose a specific condition that the candidate must fulfill within a given period of time. Those who feel the need for a condition or failure must convince others or vice versa. The committee should make a concerted effort to reach a consensus. In the case of a conditional pass, the committee will remain appointed until the condition is removed. Terms of the condition and its removal must be reported in writing to the HBS Academic Office. Students will not be permitted to sit for the School-wide preliminary oral until the conditions have been removed. It is recommended that conditions are met within six months unless otherwise recommended by the examination committee.
• Reexamination by the same Committee
• Reexamination by a new committee.

HBS Guidelines for the Dissertation Proposal

Research Plan:  The student must provide a narrative project description that contains a detailed discussion of the following specific points.

• An introduction that describes the public health problem and brief overview of the sample, aims/research questions, and public health significance.    
• A literature review that describes the supporting literature and a synthesis of the themes, gaps, and weaknesses in the literature related to the social and behavioral aspects of the proposed project.  
• A conceptual framework and theoretical foundations discussion. 
• The methodology section will discuss sampling, recruitment, data collection procedures, measures, analysis, and steps that will be taken to protect human subjects as appropriate.
• The strengths and limitations of the proposed project.
• Timeline for completion of the proposed study.
• Other pertinent information deemed appropriate by the student and their adviser such as facilities and resources, timeline, etc. 

School-wide Preliminary Oral Examination

The School-wide preliminary oral examination takes place after the student has successfully completed the departmental qualifying examination and the departmental preliminary oral examination and completed PH.550.600 LIVING SCIENCE ETHICS - RESPONSIBLE CONDUCT OF RESEARCH (it is only offered in 1st term) . You will not be approved to complete the school-wide exam if you have not taken this course. The purpose of this examination, as stated in the School’s Policy and Procedure Memorandum (PPM), is to determine whether the student has both the ability and knowledge to undertake significant research in their general area of interest. Specifically, the examiners will be concerned with the student's:

• capacity of logical thinking;
• breadth of knowledge in relevant areas;
• ability to develop and conduct research leading to a completed dissertation.

Discussion of a specific research proposal, if available, may serve as a vehicle for determining the student's general knowledge and research capacity. However, this examination is not intended to be a defense of a specific research proposal.

It is a School requirement that the School-wide preliminary oral exam be taken by the end of the student's third year in residence and before significant engagement in their own research.  Note: The school has placed a time limit   of three years between matriculation into a degree program and successful completion of the preliminary oral   exam.  Students are encouraged to keep this time limit in mind when planning their academic schedule.

All requests for extensions beyond the stated time periods to take and pass the School-wide Preliminary Oral Examination or to complete the doctoral degree requirements must be approved by the Committee on Academic Standards. School policy regarding extension requests can be accessed here . Contact the HBS Doctoral Program Coordinator for the most up-to-date information on extension policies.

The School-wide preliminary oral examination must be scheduled at least one month in advance by submission of a preliminary oral examination form to the HBS Doctoral Program Coordinator. Instructions on  scheduling the examination and information on committee composition are available on the Records and Registration website : 

After successful completion of School-wide preliminary oral exam, students register for 16 credits of PH.410.820 THESIS RESEARCH IN HEALTH BEHAVIOR AND SOCIETY each term (or a combination of Thesis Research and other courses totaling at least 16 credits) until completion of all degree requirements.

Dissertation Advisory Committee

The progress of each doctoral student is followed regularly, at least once a year, by a committee consisting of the dissertation adviser and two to four other faculty members. Other committee members can come from either inside and/or outside the student’s department. The student and their adviser, with the consent of the Department chair, decide on the composition of this committee. The objective of the Dissertation Advisory Committee is to provide continuity in the evaluation of the student’s progress during the dissertation phase of the student’s training. Students should form their advisory committees and obtain IRB approval soon after passing their preliminary oral exams and well before the Office of Graduate Education and Research deadline.

Each month, the Office of Graduate Education and Research will generate a report of the students who passed their Preliminary Oral Exam within the past three months. (Students receiving a conditional pass must meet the conditions before this contact is initiated.) An e-mail and “Dissertation Research Documentation Form” will be sent to the student and copied to the student’s Dissertation A (as identified on the Preliminary Oral Exam Committee) and the HBS Doctoral Program Coordinator. The form is to be completed and returned within three months of contact (or six months past preliminary oral exam date) to the Office of Graduate Education and Research for tracking and inclusion in the student’s academic file. A copy is kept by the HBS Doctoral Program Coordinator. 

As noted in the “Milestones” table of this handbook, students should schedule meetings with their advisers at least once per term to review their dissertation progress. Students are required to meet at least once per year with their Dissertation Advisory Committee and provide this committee with a written progress report and a copy of the “HBS Doctoral Dissertation Progress Evaluation Form” (available from the HBS Doctoral Program Coordinator) to be completed by the student’s adviser, attached to the progress report, and submitted to the HBS Doctoral Program Coordinator for the student’s file. The first progress report and evaluation form should be completed by one year from the date the "Dissertation Research Documentation Form” was submitted.

Completion of this requirement each year will be monitored by the student’s adviser and the HBS Doctoral Program Coordinator.

Dissertation Guidelines

All doctoral students must complete an original investigation presented in the form of a dissertation. The dissertation must be based on original research, worthy of publication, and acceptable to the Department of Health, Behavior, and Society and to a committee of dissertation readers. During the student’s application process, various research ideas may have been discussed with faculty members. However, each student’s dissertation proposal must be developed, reviewed, and found acceptable to departmental faculty while the candidate has been enrolled as a doctoral student .

The traditional doctoral dissertation consists of a statement of the problem and specific aims; a literature review; data and research methods; analyses and results; and a discussion of findings and their implications. The form these take will reflect the specific academic discipline or orientation guiding the student's research. Doctoral students also have the option of a manuscript-oriented dissertation as an alternative to the traditional dissertation. See the “Dissertation Policy for HBS Doctoral Students” at the end of this section for more information on manuscript formats.

Students should discuss the advantages and disadvantages of each option with their adviser before deciding on a dissertation strategy.

Completion of a satisfactory investigation of the principal subject and its presentation in the form of a dissertation, approved by a committee of the faculty, is the next step toward the doctoral degree. The material contained in the dissertation should be worthy of publication in a scientific journal in the field involved. To establish this committee, the student and adviser recommend four faculty members to serve as dissertation readers. These faculty members, one of whom is the dissertation adviser, should hold an appointment as Assistant Professor or higher and represent at least three departments of the University and at least two departments of the School of Public Health. One member must hold the rank of Associate Professor or Full Professor and not hold a joint appointment in the student’s department. This individual will serve as the Chair of the Final Oral Examination Committee. One adjunct or one scientist faculty member may serve on the Committee but not both. All faculty members must serve as Dissertation Readers representing the department of their primary faculty appointment.

The committee of readers may be increased to five members provided the conditions stated above are satisfied for four readers. If a fifth member was approved to serve as a Dissertation Reader, that individual does not have voting privileges on the Final Examination Committee.

Oral Defense of Dissertation

The oral defense of the dissertation by the candidate before a committee of the faculty is the final step for the doctoral degree candidate. Instruction and forms for the appointment of dissertation readers and scheduling the final oral exam can be accessed here .

Records and Registration require that the “Appointment of Dissertation Readers & Final Oral Examination Committee” form be submitted at least one month in advance of the proposed date.

The completed form must be submitted to the HBS Doctoral Program Coordinator for review. The HBS Doctoral Program Coordinator will obtain the Department Chair's signature and forward the form to Records and Registration. Committee members should be given at least 30 days to properly read the dissertation before the defense, and the “Dissertation/Dissertation Approval Form,” signed by the adviser, should be included with the dissertation copies. The adviser should consult with committee members at least two weeks prior to the exam date to ensure that the student is ready to proceed with the exam.

Students must be continuously registered up to and including their term of completion. A doctoral student is not considered complete at the time they pass their final defense. Note that students must be registered in the term of their final oral exam. Doctoral students who schedule their exams after the end of 4th term must register for the summer term. They then have until the end of the add/drop period of the following term to complete all requirements. Students are considered complete:

• when copies of their acceptance letters from the Examining Committee Chair and Dissertation Adviser are on file in the Office of Records & Registration;
• the dissertation is submitted electronically to The Milton S. Eisenhower Library; and
• a pdf copy of the dissertation and a dissertation form submitted to the HBS Doctoral Program Coordinator once approved by the library.

Students should be sure to check both graduation and registration deadlines with the HBS Doctoral Program Coordinator well in advance.

Public Seminar

As a culminating experience, all doctoral students are required by the School to present a formal, public seminar. A room that holds no less than 25 people should be reserved for the public seminar. A three-hour period should be allowed for the final oral examination, consisting of the public seminar and session with the examination committee. It will begin with an approximately 45-minute public seminar followed by 15 minutes of Q&A with the audience. This will be immediately followed by the closed portion of the examination, which is closed to all except the doctoral candidate and the examination committee. Records and Registration posts the seminar announcement to the School's events calendar.

Dissertation Policy for HBS Doctoral Students

Students in HBS have the choice of completing a “traditional” doctoral dissertation or a manuscript-oriented dissertation. Ideally, this decision should be made by the time the student undergoes the departmental preliminary oral examination. There are advantages and disadvantages to each option which should be carefully discussed with the student’s adviser.

Each of these options is described briefly below.

The traditional doctoral dissertation generally consists of an abstract, five chapters, references, and any appendices. The outline of chapters below is merely a guide. The page numbers are rough estimates, and the form of the chapters will vary, reflecting the academic discipline or orientation of the student’s research.

Abstract: The abstract is a short overall summary of the work. It lays out the purpose(s) and aims of the study, the methods, and the key results and implications. The abstract generally is 2-3 double-spaced pages.

Chapter 1: Introduction: Statement of the Problem and Specific Aims. This chapter, which tends to be relatively short (5-6 double-spaced pages), provides an introduction to the dissertation. It describes briefly why this work was undertaken, what background conditions or data suggested it was an important problem, and what, then, this project was intended to accomplish.

Chapter 2: Literature Review. The literature review summarizes existing literature that informed the dissertation research. It is generally organized topically. The literature review tends to be a fairly detailed review, particularly for those topics most directly related to the content and methods of the dissertation. The literature review tends to be 30-60 pages in length.

Chapter 3: Methods. The content of the methods chapter varies tremendously with the methodological approach taken by the student for the dissertation research. With traditional empirical studies, it will generally include the specific aims, research questions, and/or hypothesis; a description of the source of study data, a description of the study instrument and its development, if relevant; a description of secondary data obtained, if relevant; analytic methods, including data cleaning, creation of a data set, creation of variables and/or qualitative codes, types of analyses done, and human subjects issues. The methods chapter ranges from 20-40 pages.

Chapter 4: Results. The results chapter reports the main findings of the dissertation. It is often organized by research question or specific aim or hypothesis but need not necessarily follow this format. The results chapter ranges from 25-50 pages.

Chapter 5: Discussion of Results and Policy Implications. The discussion chapter both summarizes key findings and discusses findings in light of existing literature and in light of their policy implications. Also included generally is a description of the study’s limitations and implications for future research. The Discussion chapter is generally 25-50 pages.

References: A listing of all citations used for the dissertation must be provided. The Department allows any standard format for references.

Appendices: Appendices can be used for many purposes. They can include study instruments, if relevant; they can include additional tables not included in the main body of the dissertation; also to be included must be a copy of the student’s CV. The traditional dissertation should be able to “stand alone” without appendices; however, such results should never be put in appendices that are key to the study’s main findings.

All components of the traditional dissertation will be judged by the committee to be one of the following: Acceptable, Acceptable with Revisions, or Unacceptable. Students, with guidance from their adviser, will rework their dissertation until all components are judged acceptable.

The manuscript dissertation consists of the following:

• A total of three (or more) papers, linked to the student’s dissertation topic. One of these papers may be the literature review, provided it is a comprehensive critical review, suitable for publication. ​If one of the three papers is not a literature review, the dissertation must still contain a chapter that critically surveys the literature.
• A chapter that integrates and discusses the findings reported in the manuscripts. It should include a discussion of the conclusions of the research, and it should make recommendations for further studies.
• An appendix outlining in detail the study methods and any accompanying data tables necessary to fully understand the data.

A manuscript-oriented dissertation must also meet the following criteria:

• The doctoral student must be the first author on the three manuscripts used to satisfy this requirement.
• No manuscript will be accepted as part of the dissertation if it was submitted for publication before the student passes the School-wide preliminary oral exam.

As is true for the traditional doctoral dissertation, all components of the manuscript-oriented dissertation will be judged to be one of the following: Acceptable, Acceptable with Revisions, or Unacceptable. Students, with guidance from their adviser, will rework their dissertation until all components are judged acceptable.

Role of Faculty Adviser in Relation to the Dissertation:

The adviser's role is to facilitate successful completion of the doctoral dissertation. The type of assistance provided should be tailored to the individual student's needs. Both the traditional dissertation and the manuscript-oriented dissertation must reflect work that is the student’s independent and original work. The adviser, then, can and should provide ongoing and critical feedback, but the research must be that of the student.

Maintaining this balance may be particularly challenging for manuscript-oriented theses. Even if the adviser (or another committee member) will be a co-author on a manuscript, the manuscripts must be viewed first and foremost as fulfilling the student's needs in the dissertation process, with publication as a secondary goal. Advisers or other committee members who are co-authors may not undertake the first draft of any portions of the manuscripts nor substantial re-writes. Whether an adviser will be a co-author on any manuscript should be decided early in the dissertation process.

Link to Thesis guidelines and deadlines

Link to School PPM on PhD Degree

Career Development Resources for PhD Students

The BSPH Career Services Office provides a variety of assistance including individual career coaching, a university-wide  job and employer database , career development  workshops and events , a list of  career resources , and an annual  career fair . More information is available here .

The Professional Development and Career Office (PDCO) provides professional development training and career services to support PhD students and Postdoctoral Scholars in designing their life. The PDCO supports academic careers by providing grant writing workshops, teaching opportunities at local undergraduate institutions, and an annual academic job search series. It also supports career exploration outside the academy by hosting alumni career panels, organizing an alumni mentorship program, running leadership workshops, and by offering paid internships in science policy, consulting, business development, etc. PDCO staff can also meet with PhD students or post-doctoral fellows one on one to meet their specific career goals.  The PDCO services are outlined  here . They also send monthly emails that list events for PhDs happening across the university (sent through the doctoral student listserv). 

Milestones for the PhD Program

Timetable for Completion of Degree Requirements

Please direct questions regarding the timetable for completion of degree requirements to the Office of Records & Registration ( [email protected] ).

For a full list of program policies, please visit the PhD in Social and Behavioral Sciences page where students can find our handbook.

Our curriculum is designed to help students master the following competencies:

• Design a research study using qualitative or quantitative methods to answer social science questions relevant to public health at a doctoral level
• Demonstrate that the theoretical perspective one begins with influences the scientific questions analyzed
• Critically discuss theoretical concepts and orientations in the social and behavioral sciences
• Integrate understanding of concepts related to multiple levels of determinants of health and inequality
• Demonstrate skills for oral presentation and defense of their research in both academic and professional settings
• Design public health interventions based on theoretical foundations to address health determinants outlined by the socioecological model
• Apply core methodological concepts and analytical approaches for social and behavioral sciences in public health 

According to the requirements of the Council on Education for Public Health (CEPH), all BSPH degree students must be grounded in foundational public health knowledge. Please view the list of specific CEPH requirements by degree type .

• Research article
• Open access
• Published: 27 March 2020

A population-based study on healthcare-seeking behaviour of persons with symptoms of respiratory and gastrointestinal-related infections in Hong Kong

• Qiqi Zhang 1 ,
• Shuo Feng 1 ,
• Irene O. L. Wong 1 ,
• Dennis K. M. Ip 1 ,
• Benjamin J. Cowling 1 &
• Eric H. Y. Lau 1  

BMC Public Health volume  20 , Article number:  402 ( 2020 ) Cite this article

24k Accesses

27 Citations

Metrics details

Studies on healthcare-seeking behaviour usually adopted a patient care perspective, or restricted to specific disease conditions. However, pre-diagnosis symptoms may be more relevant to healthcare-seeking behaviour from a patient perspective. We described healthcare-seeking behaviours by specific symptoms related to respiratory and gastrointestinal-related infections.

We conducted a longitudinal population-based telephone survey in Hong Kong. We collected data on healthcare-seeking behaviour specific to symptoms of respiratory and gastrointestinal-related infections and also associated demographic factors. We performed descriptive analyses and estimated the proportion of participants who sought medical consultation, types of services utilized and duration from symptom onset to healthcare seeking, by different age groups. Post-stratification was used to compensate non-response and multiple imputation to handle missing and right-censored data.

We recruited 2564 participants who reported a total of 4370 illness episodes and 7914 symptoms. Fatigue was the most frequently reported symptom, followed by headache and runny nose, with 30-day incidence rate of 9.1, 7.7, and 7.7% respectively. 78% of the participants who had fever sought medical consultation, followed by those with rash (60%) and shortness of breath (58%). Older adults (aged ≥55y) who had symptoms including fever, sore throat, and headache had a significantly higher consultation rate comparing to the other age groups. The 30-day incidence rates of influenza-like illness (ILI) and acute respiratory illness (ARI) were 0.8 and 7.2% respectively, and the consultation rates among these participants were 91 and 64%. Private general practitioner clinics was the main service utilized by participants for most of the symptoms considered, especially those related to acute illness such as fever, diarrhoea and vomiting. Chinese medicine clinics were mostly likely to be visited by participants with low back pain, myalgia and fatigue. Among participants who have sought medical services, most were within 3 days of symptom onset.

Conclusions

Healthcare-seeking behaviour were different by symptoms and age. Characterization of these patterns provides crucial parameters for estimating the full burden of common infectious diseases from facility-based surveillance system, for planning and allocation of healthcare resources.

Peer Review reports

Healthcare-seeking behaviour is defined as “any activity undertaken by individuals who perceived themselves to have a health problem or to be ill for purpose of finding an appropriate remedy” [ 1 ]. Healthcare-seeking behaviour includes the timing and types of healthcare service utilization and may affect population health outcomes [ 2 ]. Delayed medical attention has been shown to associate with an increased risk of unfavourable outcomes [ 3 ]. For patients with infectious diseases, delay in seeking care may also result in increased transmission risk in the community. Understanding the pattern of healthcare-seeking behaviour could help public health practitioners and policy makers to improve the healthcare system and health promotion strategies.

From a patients’ perspective, healthcare-seeking behaviour tends to be responsive to discomfort or symptoms, rather than to specific diagnosed diseases which were unknown to them before medical consultation. However, many studies examined healthcare-seeking behaviour either focused on a patient care perspective, or restricted to a specific disease related to a few limited symptoms [ 4 , 5 , 6 ]. In this study, we focused on healthcare-seeking behaviour specific to symptoms and syndromes, which may more realistically reflect personal responses to sickness in the general population. Such data is still limited in the literature.

A previous study in Denmark showed that for patients with any symptoms, on average < 40% of the patients actually sought healthcare service, though the proportion varied substantially by symptoms [ 7 ]. Here we reported the findings in Hong Kong which also has a well-developed healthcare system composed of both public and private sectors but with very different share in the outpatients and inpatients services: 70% of outpatient services were delivered by private sectors, whereas 90–95% of inpatient services were provided by public sectors [ 8 ]. Also, Hong Kong has its unique mixed culture, which provides and promotes both western and Chinese medicine in the healthcare system. Western medicine has been widely accepted and is the dominant medical system for a long time, but the Hong Kong Government has also actively promoted the development of Chinese medicine.

The objective of this study is to describe the characteristics of healthcare-seeking behaviour due to different symptoms and syndromes related to respiratory and gastrointestinal-related diseases, such as the proportions of patients seeking medical consultation, types of healthcare service utilized, and time from symptom onset to consultation. Data describing healthcare-seeking behaviour could characterize the utilization of the healthcare services, and facilitate risk communication during outbreaks, planning of health care resources, and interpretation of practitioner-based surveillance system.

Study design and study population

A longitudinal survey consisting of 4 rounds of telephone interviews was carried out from February 2014 to May 2015. We selected different times of the year to capture the variation in different infectious disease activity and also to avoid over-representation of a specific timing (e.g. winter) (Fig.  1 ). We avoided long holidays (e.g. Chinese New Year, Easter) which may alter typical healthcare-seeking behaviour.

Timing of the surveys (shaded bars) and influenza-like illness consultation rates (lines) in the community from private general practitioners (GP) and public general outpatient clinics (GOPC) influenza surveillance

The study population was the general population including children and adults in Hong Kong, a subtropical city of 7.5 million people with an ageing population of which more than 95% speak Cantonese [ 9 ]. We adopted a two-stage sampling where participants were recruited by trained interviewers through telephone calls to landlines generated by random-digit dialling. The sample size was calculated based on a previous household telephone survey, with an average of 3.5 symptoms per illness episode and a follow-up rate of about 60%,, assuming a conservative prevalence of 50% [ 10 , 11 ]. Allowing for an error margin of 3% and assuming a 95% confidence level, 3000 participants would provide enough sample size to obtain accurate estimates for the top 10 symptoms. From each household, one household member aged 16 years or above was invited to participate in the study. The person who answered the phone was first recruited. To increase the sample size of the young population, we also recruited caregivers of children aged below 16 years as a booster samplevia telephone and online survey in parallel of the main survey. Up to two follow-up calls were made at different times of the day for unanswered calls. We only recruited Cantonese-speaking participants to our study. Verbal or online informed consent was obtained from participants or from parents prior to the survey. In our longitudinal study, we followed up all participants recruited in the first round and did not recruit new participants.

Data collection

We asked the respondents about any symptoms in 30 days preceding the interview, and the corresponding healthcare-seeking behaviour. To minimize recall and reporting bias, we provided a list of 30 symptoms related to respiratory and gastrointestinal-related infections in Hong Kong [ 12 ], each of which was read out during the interview. The questionnaire was developed for this study, adopted or modified from previous questionnaires in similar studies [ 8 , 10 ] (see Additional file  1 ). The questionnaire consisted of six main sections, including questions on [ 1 ] self-reported symptoms of the most recent illness episode [ 2 ]; healthcare-seeking behaviour (including specific symptoms leading to healthcare-seeking, types of healthcare service utilized and time from symptom onset to medical consultation) [ 3 ]; risk perception of the symptoms [ 4 ]; behavioural change and change of contact pattern due to the symptoms [ 5 ]; social-economic and host determinant of healthcare-seeking behaviour (e.g. social economic status, medical insurance, and perceived benefit of consultation) [ 6 ]; demographic information (including age, sex, education, place of living) of the participants and caregiver (if the participants are aged below 16 years). Types of healthcare service considered in our questionnaire included private general practitioner clinics (GP), general out-patient clinics (GOPC) from the public sector, Chinese medicine practitioner clinics (CMP), and Accident and Emergency Department (A&E). For the main outcome healthcare-seeking behaviour, we specifically asked the participants which symptoms directly triggered their healthcare-seeking behaviour. Besides studying healthcare-seeking behaviour by specific symptoms, we also grouped symptoms into influenza-like illness (ILI) and acute respiratory illness (ARI). ILI was defined as fever (≥37.8 °C) plus cough or sore throat; ARI was defined as any two of the symptoms including fever (≥37.8 °C), chills, headache, myalgia, cough, runny nose, and sore throat. We collected information on time from symptom onset to healthcare-seeking for each symptom that the participants have reported. We interviewed all participants irrespective of whether they had illness in the 30 days preceding the first interview, hence avoided selection of participants who were sick in the first round of interview.

Statistical analysis

We described the healthcare-seeking behaviour triggered by specific symptoms and by ILI and ARI in all participants and by three age groups: children (0–15 years), adults (16–54 years), and the elderly (≥55 years). We defined a symptom as a trigger if the subject specifically stated that s/he sought medical consultation due to this symptom. We calculated proportion of participants seeking medical consultation by each symptom, by using the number of responses reporting medical consultation due to the symptom as numerator, and the number of episodes of each symptom as denominator. We calculated proportions of healthcare service type utilized and the distribution of the timing by each symptom, using the number of responses reporting medical consultation by each symptom as denominator. To avoid over-representation of healthcare-seeking behaviour triggered by the same symptoms for the same participants, we only included the first episode of a certain symptom for analysis. Also, healthcare-seeking behaviour was right-censored when symptom onset was close to the interview. We assumed that healthcare-seeking behaviour were fully observed for participants who had symptom onset more than 6 days before the interview, or those who have recovered at the time of interview. Participants who reported time from symptom(s) onset to medical consultation more than 30 days were regarded as missing data. Censored healthcare-seeking behaviours were imputed based on the fully observed data, with consideration of different days elapsed since symptom onset. Subjects who attended A&E were excluded when characterizing the duration from symptom onset to medical consultation.

Missing data were handled using multiple imputation with 100 sets of imputed datasets. We applied Rubin’s rules to obtain the overall estimates and 95% confidence intervals [ 13 ]. To achieve population representativeness, we applied post-stratification adjustment by age and sex according to local census data in 2014. Healthcare-seeking behaviours are described by medical consultation rate triggered by the symptom, healthcare service utilized by participants, and time from symptom onset to medical consultation. We used likelihood ratio test to assess potential age differences on healthcare-seeking behaviour using median p -values resulting from multiple imputation [ 14 ]. For better presentation, we combined symptoms which are related (e.g. eye problems) or having fewer than 20 reported illness episodes. All analyses were conducted in R version 3.3.3 (R Foundation for Statistical Computing, Vienna, Austria). A p -value of less than 0.05 was considered to be statistically significant.

Incidence of illness and proportion of healthcare seeking

We recruited 3253 participants in the first round of survey, regardless of whether illness was reported 30 days preceding the interview, and received a total of 8727 responses throughout 4 rounds of telephone survey from February 2014 to May 2015. The response rate of the main sample was 29.0% in the first round, with follow-up rates of 73.6, 57.3 and 41.4% in rounds 2 to 4 respectively. The booster samples were recruited by referrals, with follow-up rates of 56.4, 42.0 and 22.0% from rounds 2 to 4 respectively. Among the 8727 responses, a total of 4370 illness episodes were reported from 2564 participants (Table  1 ), resulting in 7914 reported symptoms. The onset of 763 reported illness episodes were within 7 days of the telephone interview and for those participants who have not reported seeking medical consultations, their healthcare-seeking behaviours were considered right-censored and were handled using multiple imputation. After excluding the recurring symptoms, a total of 7120 reported symptoms from 4015 illness episodes were included for analysis (Tables  2 & 3 ). Symptoms related to chronic conditions usually had a larger number of repeated episodes, such as fatigue (201 recurring symptoms) and headache (118 recurring symptoms).

To achieve population representativeness, we applied post-stratification adjustment for age and sex. Young male adults were over-represented, with post-stratification weights ranging from 0.3 to 1.1, while the older population was under represented in our study, with post-stratification weights of 18.0 and 4.6 in female and male participants respectively (Table 1 ).

Fatigue was the most frequently reported symptom (30-day incidence = 9.1%), followed by headache (7.7%) and runny nose (7.7%) (Table  2 ). Fever was the strongest driver to seeking medical consultation: 77.8% of the participants having fever had sought for medical consultation, followed by rash (59.8%) and shortness of breath (58.2%) (Table 2 ). Symptoms related to acute illness were associated with higher medical consultation rates than those related chronic illness, such as nausea, low back pain, myalgia, and fatigue.

Over a 30-day period, almost half of the adults (aged between 16 and 54 years) reported having any symptoms (46.5%), though they are least likely to seek healthcare service when comparing to other age groups (Table  3 ). For children, runny nose had the highest 30-day incidence rate of 11.9%, followed by cough with incidence rate of 9.5%. For adults and the elderly, fatigue (10.0 and 7.9%, respectively) and headache (8.6 and 7.9%, respectively) were most common.

When compared across age groups, incidence rates of fever, rash, vomiting, cough, runny nose, ILI and ARI were highest in children and lowest in the elderly. Incidence rate of loss of appetite was highest in children but lowest in the 16–54 years age group (Table 3 ). For symptoms including headache, dizziness, chills, abdominal pain, low back pain, myalgia, and fatigue, subjects aged 16–54 years had the highest incidence rates and children had the lowest incidence rates.

Older adults who had symptoms including fever, sore throat, and headache had significantly higher consultation rates comparing to other age groups (Table 3 ). Children were most likely to utilize medical services, while younger adults were least likely to seek medical consultation, except when they developed rash.

Types of healthcare service utilized

Regardless of specific symptoms, western medicine, i.e. GP and GOPC, was the most preferred healthcare provider, accounting for 80.9% of consultations. Private GP was the main service utilized by participants with most of the symptoms considered, especially those related to acute illness (Fig.  2 ). CMP was more likely to be utilized for patients with low back pain, myalgia and fatigue, and least utilized by participants with acute symptoms. 50.7% of the participants who utilized medical care due to low back pain visited CMP only. GOPC, as a public service, was only preferred by participants with eye-related symptoms, of which 53.7% visited public doctors. Considering general medical practitioners only, our study found that patients favoured GP (70.5%) over GOPC (9.9%), and relatively few participants utilized both private and public medical services (0.5%). Participants with myalgia (11.6%), shortness of breath (8.8%), and fever (7.0%) have sought both western and CMP services. 16.7% of the participants with any symptoms visited CMP, and 12.9% visiting CMP only. Most of the participants with ILI and ARI visited general medical practitioners, with proportions of 89.4 and 86.3%, respectively (Fig. 2 ).

Type of healthcare services by symptoms in different age groups, among those who sought care. Healthcare services included private general practitioners (GP), public general outpatient clinics (GOPC), Chinese medicine practitioner clinics (CMP), and Accident and Emergency Department (A&E)

Common to each age group, participants mostly consulted western medicine for acute symptoms and CMP for chronic symptoms. Children seemed more likely to consult CMP for several specific symptoms, while the other age groups consulted CMP for broader range of symptoms. Young adults were most likely to seek both western medical service and CMP, compared with other age groups. A&E visits were mostly utilized by the older population, mainly triggered by fever (12.9%), chills (14.9%), ILI (9.6%) and ARI (6.3%).

Duration between symptom onset and medical consultation

Figure  3 shows the duration between symptom onset and medical consultation in the three specific age groups and overall. Most of the participants sought medical consultation within 2 days of symptom onset regardless of symptoms. Among participants with fever, diarrhoea, vomiting, chills, abdominal pain, nausea, and ILI, more than half of the participants sought medical consultation within 12 h due to these symptoms. Among those participants who had sought medical attention due to symptoms related to acute illness and discomfort, these consultations usually took place immediately or within 12 h of symptom onsets, while it usually took longer for patients with symptoms related to chronic illness. Compared to other age groups, older participants tend to delay seeking consultation slightly. In particular, most of the older participants reported with fever either sought medical services immediately, or delay it to 2 days after symptom onset.

Duration from symptom onset to medical consultation for each triggering symptom, by age groups and all participants, among those who sought care. The symptoms were ordered descendingly based on proportion of seeking healthcare service

We studied healthcare-seeking behaviour specific to symptoms, which allows interpretation and application of the results in the patient perspective for Hong Kong Chinese population. Our study found that nearly half of the participants reported infectious diseases-related symptoms over a 30-day period, and 41.4% of whom have sought medical consultation (Table 2 ). Consultation rate varied across symptoms, ranging from 14% due to fatigue, to 78% due to fever, and was usually higher among those with acute/infectious symptoms and lower among those with mild/chronic symptoms (Table 2 ). The consultation rates were highest in the children and lowest in young adults, suggesting that the working population is least likely to seek medical attention when having infectious disease-related symptoms.

An overall consultation rate of about 40% (Table 2 ) for symptomatic patients of respiratory and gastrointestinal-related infections suggested that the majority of patients were not captured by the healthcare system, forming the submerged part of the disease iceberg. Understanding the proportions of medically unattended patients may help policy makers for developing health campaigns targeting these individuals or estimating the full burden of disease.

In Hong Kong, the private sector is the major provider of primary care, delivering about 70% of outpatient consultations [ 8 ], and CMP is used as the main alternative and complementary healthcare service in Hong Kong. In our study, we also found that western medicine is the preferred healthcare provider, contributing more than 80% of the consultations (Fig. 2 ). 16.7% of consultations visited CMP (Fig. 2 ). A local study showed that 85% of people who have sought medical consultation had consulted western medicine, while 10% had consulted CMP [ 8 ]. Another study found that 8.8% of respondents who reported symptoms during the 30 days before survey had visited a CMP for the discomfort [ 15 ]. In comparison, our finding shows that the preference for CMP may have increased slightly in the last decade with the promotion of Chinese Medicine by the Hong Kong Government. Many patients utilized both systems in parallel, taking western medicine to relieve symptoms and Chinese medicine to restore balance and health. In our study, 3.8% of participants had sought both western and Chinese medicine consultation for the same illness episode (Fig. 2 ). This could be interpreted as integrative medicine, or was in fact doctor shopping.

Participants had different preference on the type of health service according to their symptoms. Participants with acute symptoms favoured western medicine, whereas participants with gradually developing symptoms prefer to visit CMP. This preference could be explained by the common perception that western medicine is ‘powerful and quick’ comparing to CMP [ 16 ]. Chan et al. found that older, poorer people who have chronic conditions were more sceptical of western physicians [ 17 ]. In our study, we also found that older people having chronic symptoms such as low back pain, myalgia, and fatigue have 10–20% higher utilization of CMP than those of younger age. Considering western medicine only, our study found that patients favoured GP over GOPC regardless of their symptoms, consistent with a study showing that 76% of patients utilized primary care service provided by GPs [ 4 ].

Meng et al. [ 18 ] investigated the difference in healthcare-seeking behaviour of patients with ILI (defined as “at least two of the signs or symptoms [fever ≥37.8 ̊C, cough, sore throat, headache, or myalgia]”, more similar to the definition of ARI in our study) between summer and winter influenza epidemics. Meng et al. [ 18 ] found that 25.0 and 38.6% of respondents reported ILI in summer and winter peak, respectively. Among those with ILI, 42.3 and 48.5% had sought medical care for each peak, respectively. In our study 64.0% of those with ARI sought medical care (Table 2 ), probably because our surveys were carried out closer to the influenza peak period. In a US study, 40 and 56% of the adults and children respectively who had ILI sought healthcare service during the 2009 H1N1 pandemic [ 19 ], compared to 92 and 84% in our study (Table 2 ). Patients in Hong Kong were much more likely to seek medical attention when presenting with influenza-associated symptoms.

In our study, 91.7 and 75.4% of the children with ILI and ARI respectively sought medical consultation (Table 2 ). In Israel, 81.5% of the children under 13 year-old consulted a physician when they had flu-like symptoms [ 20 ]. Both studies showed that children with flu-related symptoms would have a high consultation rate. Age difference in the consultation rate was statistically significant only for ARI ( p -value < 0.001) but not ILI ( p -value = 0.106), with adults having ARI noticeably less likely to seek medical consultation (Table 3 ). Comparing with ARI, ILI is more specific to influenza infection, and led to high consultation rates irrespective of age (Table 3 ). The high consultation rates due to ILI may result in school or work absence, which probably reduced influenza transmission risk in schools or workplace. In Hong Kong, medical certificate is required for taking sick leave according to the Employment Ordinance. Though this may not be strictly enforced for short sick leave of 1 or 2 days, the need of medical certificate for the working population cannot explain the lower healthcare-seeking behaviour among adults.

Previous studies showed that some influenza patients did not visit doctors. The proportions vary across countries, for example 55% of ILI patients in the US [ 21 ], and 38% of cases of self-defined influenza in France [ 22 ]. From our study, the proportions were lower in Hong Kong (10 and 35% for patients with ILI and ARI respectively, Table 2 ). Most of the influenza surveillance systems are established in the clinical settings, which limits its ability to fully capture the burden of ILI/ARI for patients who have mild symptoms or do not seek any medical consultation. Our findings may help to estimate the proportion not being captured in the surveillance system.

Few studies examined the duration between symptom onset to medical consultation for common infectious diseases, in particular with respective to specific symptoms. In our study, more than 60% of participants had sought medical care within 2 days from symptom onset (Fig.  3 ). A US study showed that among adults with seasonal influenza, 35 and 47% sought medical care within 2 days and within 3–7 days of illness onset respectively [ 21 ], compared to our results for adults with ILI (65 and 35% respectively, combining age groups 16–54 years and ≥ 55 years in Fig. 3 ). The relatively short duration from illness to medical attention in Hong Kong may be attributed to easy access of medical service in a compact city. Delayed access to healthcare might be associated with longer hospital stays and poorer health outcomes [ 23 ]. Shorter duration between symptom onset and medical consultation may allow patient to have more timely diagnosis and better health outcomes.

There are a few limitations in our study. First, our data had a relatively low response rate and might suffer from under-representation of the older population. We addressed this issue by applying post-stratification weighting methods. Second, some other factors that may affect symptom-specific healthcare-seeking behaviour such as self-medication, and vaccination status were not explored in this descriptive study. Third, there may be recall bias for reporting the illness in the past 30 days. We specifically asked the participants to report the latest illness episode, and provided a list of symptoms to minimize under-reporting. However, very mild and unattended symptoms could still be missed from the survey, especially for symptoms reported by parents of younger children. Fourth, there is seasonal variation in disease activities, the associated symptoms and potentially healthcare-seeking behaviour trigged by these symptoms.

Healthcare-seeking behaviour varied substantially by infectious-disease associated symptoms and age for the Hong Kong population. People with acute symptoms were more likely to see western medicine, and people with symptoms related to chronic conditions favoured Chinese medicine. Characterization of these patterns provides crucial parameters for estimating the full burden of common infectious diseases from facility-based surveillance system, for planning and allocation of healthcare resources.

Availability of data and materials

The datasets generated and/or analysed during the current study are not publicly available but are available upon request to the corresponding author.

Abbreviations

Accident and emergency department

Acute respiratory illness

Confidence interval

Chinese medicine practitioner clinics

General out-patient clinics

General practitioner clinics

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Acknowledgments

We thank the interviewers from Hong Kong Quality Assurance Agency (HKQAA) for conducting telephone and online interviews.

This study was supported by Health and Medical Research Fund from the Government of the Hong Kong Special Administrative Region (grant no. 13121262) and Theme-based Research Scheme of the Hong Kong University Grants Committee (grant no. T11–705/14-N). The funding body has no role in the design of the study and collection, analysis, and interpretation of data and in writing the manuscript.

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SF, IOLW, DKMI, BJC and EHYL designed study. QZ analysed data and drafted manuscript. QZ, IOLW, BJC, and EHYL have contributed to interpretation of the results. All authors participated in reviewing and revising of the manuscript, and approved the final manuscript as submitted.

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Verbal or online informed consent was obtained prior to the survey, from all participants and parents/caregivers of the participants aged below 16 years. Ethics approval has been obtained from the Institutional Review Board (IRB) of the University of Hong Kong/Hospital Authority Hong Kong West Cluster (UW 13–420). The verbal/online consent was approved by the IRB for practical reason due to the nature of the survey and considering only minimal personal information were collected.

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B. J. Cowling has received research funding from Sanofi for a study of influenza vaccine effectiveness in China, and honoraria from Sanofi and Roche. Other authors declare that they have no conflict of interest

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Healthcare-seeking Behavior Survey.

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Zhang, Q., Feng, S., Wong, I.O.L. et al. A population-based study on healthcare-seeking behaviour of persons with symptoms of respiratory and gastrointestinal-related infections in Hong Kong. BMC Public Health 20 , 402 (2020). https://doi.org/10.1186/s12889-020-08555-2

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Health knowledge and care seeking behaviour in resource-limited settings amidst the COVID-19 pandemic: A qualitative study in Ghana

Roles Conceptualization, Data curation, Formal analysis, Funding acquisition, Investigation, Methodology, Project administration, Resources, Software, Visualization, Writing – original draft, Writing – review & editing

* E-mail: [email protected]

Affiliation Department of Epidemiology and Biostatistics, School of Public Health, University of Health and Allied Sciences, Hohoe, Ghana

Roles Funding acquisition, Methodology, Resources, Supervision, Writing – review & editing

Affiliation Department of Population and Behavioural Sciences, School of Public Health, University of Health and Allied Sciences, Hohoe, Ghana

Roles Conceptualization, Funding acquisition, Methodology, Resources, Supervision, Writing – original draft, Writing – review & editing

Affiliations Department of Population and Health, University of Cape Coast, Cape Coast, Ghana, College of Public Health, Medical and Veterinary Services, James Cook University, Townsville, Australia

Roles Conceptualization, Data curation, Funding acquisition, Investigation, Methodology, Project administration, Resources, Supervision, Writing – original draft, Writing – review & editing

Affiliation International Institute of Rural Health, College of Social Science, University of Lincoln, Lincoln, United Kingdom

• Farrukh Ishaque Saah, 
• Hubert Amu, 
• Abdul-Aziz Seidu, 
• Luchuo Engelbert Bain

• Published: May 5, 2021
• https://doi.org/10.1371/journal.pone.0250940
• Peer Review
• Reader Comments

The emergence of a pandemic presents challenges and opportunities for healthcare, health promotion interventions, and overall improvement in healthcare seeking behaviour. This study explored the impact of COVID-19 on health knowledge, lifestyle, and healthcare seeking behaviour among residents of a resource-limited setting in Ghana.

This qualitative study adopted an exploratory design to collect data from 20 adult residents in the Cape Coast Metropolis using face-to-face in-depth interviews. Data collected were analysed thematically and statements from participants presented verbatim to illustrate the themes realised.

Health knowledge has improved due to COVID–19 in terms of access to health information and increased understanding of health issues. There were reductions in risky health-related lifestyles (alcohol intake, sharing of personal items, and consumption of junk foods) while improvements were observed in healthy lifestyles such as regular physical exercise and increased consumption of fruits and vegetables. COVID–19 also positively impacted health seeking behaviour through increased health consciousness and regular check-ups. However, reduced healthcare utilization was prevalent.

The COVID–19 pandemic has presented a positive cue to action and helped improved health knowledge, lifestyle, and care seeking behaviour although existing health system constrains and low economic status reduced healthcare utilization. To improve health systems, health-related lifestyles and healthcare seeking behaviour as well as overall health outcomes even after the pandemic wades off, COVID–19 associated conscious and unconscious reforms should be systematically harnessed.

Citation: Saah FI, Amu H, Seidu A-A, Bain LE (2021) Health knowledge and care seeking behaviour in resource-limited settings amidst the COVID-19 pandemic: A qualitative study in Ghana. PLoS ONE 16(5): e0250940. https://doi.org/10.1371/journal.pone.0250940

Editor: Kingston Rajiah, International Medical University, MALAYSIA

Received: February 22, 2021; Accepted: April 18, 2021; Published: May 5, 2021

Copyright: © 2021 Saah et al. This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Data Availability: All relevant data are within the paper.

Funding: The author(s) received no specific funding for this work.

Competing interests: The authors have declared that no competing interests exist.

SARS-CoV-2, also called COVID–19, emerged as a new strain of Coronaviruses after a cluster of patients were identified with pneumonia suspected to be novel coronavirus pneumonia in December 2019 in Wuhan, China [ 1 , 2 ]. On March 11, 2020, the World Health Organization (WHO) declared COVID-19 as a global pandemic [ 3 ]. As of February, 7, 2021, 106.7 million confirmed cases and over 2.3 million deaths were recorded cumulatively worldwide since the start of the pandemic [ 4 ]. In Ghana, 70,046 confirmed cases and 449 confirmed deaths were recorded [ 4 ].

The increasing burden of COVID-19 has resulted in various international and national level decisions and protocols, shaped largely by initial responses by high-income countries aimed at ending the pandemic [ 5 ]. These protocols include physical/social distancing, wearing of face masks, frequent hand washing with soap, stay-at-home/work-at-home, closure of schools, international travel bans, and economic lockdown of non-essential businesses together with isolation of infected persons and quarantining of exposed individuals [ 5 – 7 ]. With the recent vaccine breakthrough, vaccination is expected to soon become a bigger tool to the fight against COVID-19 [ 8 , 9 ].

The emergence of COVID-19 has deepened the strain on health systems across the globe more especially the already overburdened health systems of resource-limited countries with 90% of countries in five WHO regions experiencing disruptions to their health services [ 10 ]. The greatest difficulties are reported by low- and middle-income countries [ 10 ]. In fact, poor health system capacity in such countries makes them highly vulnerable to COVID-19 [ 11 ]. Many people in sub-Saharan Africa (SSA) for instance, often lack ready access to clean water for regular hand washing, have poor sanitation, limited to no internet connection for home work and schooling, and little or no savings to support loss of income [ 12 ]. Again, in SSA including Ghana, many of the healthcare and public health systems are compromised by inadequate equipment for the care of COVID–19 patients like intensive care unit (ICU) beds, bedside oxygen supply, pulse oximeters, ventilators, and personal protective equipment [ 5 ].

Healthcare seeking behaviour (HSB) of a population serves as one major determinant of the health status of a country and thus, its socio-economic development [ 13 ]. HSB encompasses a people’s inaction, procrastination or action undertaken following recognition by themselves of departing from good health or having a particular health problem to finding appropriate remedy to restore health [ 14 ]. There is predominantly poor healthcare seeking behaviour among populations in SSA countries like many other low-and middle-income countries [ 15 ]. Poor health seeking behaviour is likely to be deepened with the COVID–19 pandemic because delay in seeking care has been identified to contribute to increased morbidity, mortality and worse health outcomes among patients [ 13 , 16 ].

Although the COVID-19 pandemic has placed many challenges on health systems worldwide, it has also presented opportunities to re-direct resources to many health promotion interventions and activities where lacking. For instance, the Ghana Health Service (GHS) has intensified public health education across the country using various media. However, the impact of the pandemic and its accompanying national prevention protocols and health education activities have on the health knowledge, behaviours and care seeking behaviour of the population has not been investigated. We thus, explored the effect of the COVID-19 pandemic and health education intervention on the healthcare seeking behaviour of residents in a peri-urban community in Ghana.

Conceptual framework

We adapted Andersen’s Healthcare Utilization Model (HUM) propounded in 1968 [ 17 ]. The conceptualization of healthcare utilization by this model acts on the assumption that a person’s use of health service is influenced by three key factors, namely, predisposing factors, enabling factors, and the need for care factors [ 17 , 18 ], incorporating both contextual and individual level predictors [ 19 ]. There are three main tenets of the theory. These are predisposing, enabling, and need factors ( Fig 1 ). The tenets adequately explain the various factors influencing health seeking behaviour amidst the COVID-19 pandemic.

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Source: Adapted from Andersen and Davidson [ 21 ].

https://doi.org/10.1371/journal.pone.0250940.g001

The predisposing factors refer to individual level predictors comprising sociodemographic characteristics such as sex, age [ 20 ], religion, education, ethnicity, attitude towards health, and social relations, health beliefs [ 18 , 19 ] and contextual factors like social and demographic composition of communities, organisational and collective values, political perspectives and cultural norms. Health knowledge is covered in this tenet as a factor to healthcare behaviours as it shapes beliefs, attitudes, and overall understanding of implications of a specific health behaviour.

According to Andersen and Davidson [ 20 ], enabling factors are organisational and financial factors considered to directly affect access to healthcare as well as access to health knowledge and subsequent use of health service [ 20 , 21 ]. In the context of this study, enabling factors at the individual level include wealth and income at the individual’s disposal to cover the cost of assuming positive health-related lifestyles such as good nutrition, physical exercising, wearing face mask and good hand hygiene [ 19 ]. They also include travel time to the health facility, the means of transportation, and waiting time for healthcare [ 21 ]. In addition, health education and outreach programmes and health policies are factors during this COVID-19 pandemic relevant to individual health behaviour and subsequent healthcare seeking attitude [ 20 , 21 ].

Furthermore, the need factors refer to individual and contextual level perceptions of the seriousness of a disease or health condition [ 21 , 22 ]. At the individual level, the model distinguishes between perceived need for health services (how people perceive and experience their own health status (self-rated health), functional state and illness symptoms) and evaluated need (objective measurements of patients’ health status and professional assessments, and need for medical care) [ 20 , 21 ]. Again, contextually, individuals make a differentiation between population health indices such as current COVID-19 infection rate, death rates and overall incidence and prevalence nationally and locally [ 21 ]. More so, overall measurements of community health, including epidemiological indicators of COVID-19 morbidity and mortality [ 22 ] influence healthcare seeking behaviour.

Despite the few flaws of this model such as disregard for sociocultural dimensions and interactions and omission of social construction of need [ 23 ], as well as inadequacy in forestalling service use as predisposing factors might be exogenous and enabling resources are necessary [ 24 ], it was considered relevant to this study. This is because its tenets are in line with the study and has the strength of indicating both the micro (individual) and the macro (community) level factors that influence healthcare seeking behaviour. It thus, fits well with the study’s objective of assessing impact of the COVID-19 pandemic on the health knowledge and behaviours and subsequent care seeking behaviours of individuals.

Materials and methods

Study design.

This was an exploratory study adopting qualitative approach. The design allowed for exploring care seeking behaviour by gathering in-depth information through interviews [ 25 ]. The design was chosen because it helped to gain in-depth insight on care seeking behaviour amidst COVID-19 with little to no earlier studies to rely upon to predict an outcome for later investigations [ 26 , 27 ]. It is also flexible and helps address all types of research questions such as the what, why, and how of a phenomenon [ 25 , 26 ]. The study also used the interpretivist philosophy due to this philosophy’s ability to explain how people create and maintain their own social worlds and understanding through personal interpretations of their worlds [ 28 ]. The Consolidated Criteria for Reporting Qualitative Research (COREQ) guideline was followed in reporting this study [ 29 ].

Study setting

The study was carried out in the Cape Coast Metropolis of Ghana. The metropolis is one of the 23 administrative districts in the Central Region and its capital, Cape Coast is also the regional capital. The metropolis lies between longitude 1°15ˈW and latitude 5°06ˈN with boundaries to the South by the Gulf of Guinea, to the East by Abura Asebu Kwamankese District, to the West by Komenda Edina Eguafo Abrem Municipality, and the North by Twifu Heman Lower Denkyira District. It has a population of 169,894 (7.7% of the region’s total population) with 48.7% being males according to the 2010 population and housing census [ 30 ]. Also, 90% of the population aged 11 years or older are literate with 67.2% capable of writing and reading English and other Ghanaian languages. Again, 69.5% of the population aged 12 years and above use mobile phones with 32% having access to internet service [ 30 ]. The metropolis also has a regional/teaching hospital, and a district hospital among other health facilities including clinics, health centres, and Community Health and Planning Services (CHPS) compounds.

Study population and sampling

Adult residents in the Cape Coast Metropolis were the study population and were selected using a purposive sampling approach. Only residents aged 18 years and above who had lived in the metropolis for at least six months within the period of COVID-19 pandemic in Ghana were included in the study. The six months inclusion criterion was to ensure that the study included only persons who experienced COVID-19 within the period from April to September 2020 when effects of the COVID-19 pandemic were heavily felt within the Cape Coast Metropolis as COVID-19 case count increased abruptly making the Central Region the third highest region in terms of case prevalence in the country.

The purposive sampling approach allowed us to select only participants who have experienced living in a district with significant COVID-19 cases. Recruitment of participants was done progressively until no new issues were emerging from additional interviewees. Data saturation was achieved after interviewing 20 participants (10 males and 10 females).

Data collection instruments and procedures

Data were collected face-to-face using an in-depth interview guide. The instrument was self-developed and sectioned into four. While section A collected socio-demographic information of the participants, section B, C, and D, focused on the impact of COVID-19 pandemic on health knowledge, health behaviours, and care seeking behaviours, respectively. The key questions contained in the guide included effects of COVID-19 pandemic on: access to health information, understanding and knowledge of selected health issues, risky health behaviours, adoption of preventive health behaviours like healthy diet and physical exercise, health consciousness, access and use of healthcare services. The questions were generated from literature review and the conceptual framework.

The interviews were conducted at the participants’ convenience with support from two trained research assistants who were experienced qualitative researchers with a minimum of bachelor’s degree and fluent Fante speakers. Two of the authors who are qualitative research experts, HA and FIS also conducted some of the interviews. The interviews were conducted in Fante, dialect of a major Akan language group predominant in the Cape Coast Metropolis for participants who could not speak or understand English while some were conducted in English. Consequently, the instrument was translated into the Fante language during the two-day training of the research assistants to ensure consistency in translating from English to Fante during interviews. Each interview was between 30–45 minutes and was tape recorded with the consent of the participants. Also, field notes were taken in order to corroborate the transcriptions from the recorded audios.

Ethical issues

The study obtained approval from the Cape Coast Metropolitan Health Directorate. Prior to inclusion in the study, written informed consent was obtained from the study participants after the study purpose and procedures were explained to them. In effort to protect the study participants and interviewers, the COVID-19 prevention measures of wearing face mask, physically/socially distancing, and using hand sanitizers were ensured. Anonymity was ensured by using pseudonyms combing letters and numbers to identify each participant instead of their personal identifying details. Also, the study data has been stored and password-protected on the personal computer of the corresponding author without access to any third parties to ensure confidentiality.

Data analyses

All the audio recordings were transcribed and those in Fante and Twi (local dialects of the Akan language) were translated and transcribed into English. While listening to the tapes and using the field notes taken, the transcripts were read and edited to resolve any omissions and mistakes in the original transcripts. Thematic analysis was carried out using NVivo version 10 by first re-reading the transcripts to help familiarize with the data [ 31 ]. Initial codes were produced by two of the authors (FIS and HA) from list of ideas found to be interesting and relevant in the data which were later organized into meaningful groups [ 32 ]. The generated codes were sorted out and merged to form potential themes [ 31 ] based on the research objectives, namely; impact of COVID-19 pandemic on health knowledge, health behaviours and care seeking behaviour; and on literature review and emergent themes. The initial themes were reviewed and refined into final themes taking into consideration internal homogeneity (ensuring everything in a theme is similar) and external heterogeneity (ensuring different contents in different themes) [ 33 ]. The themes were defined and named and detailed analysis conducted and written based on how they fit into the broader story of the data. The final step involved full write-up of the report ensuring merit and validity of the analysis using extracts from the data which capture the essence of each theme being demonstrated [ 31 ].

Table 1 presents the themes and sub-themes of the results. Two sub-themes were identified for the impact of COVID-19 on health knowledge whiles there were three sub-themes for the impact of COVID-19 on health-related lifestyles and two for healthcare seeking behaviour.

https://doi.org/10.1371/journal.pone.0250940.t001

Impact of COVID-19 pandemic on health knowledge

The study explored impact of COVID-19 pandemic on health knowledge among participants which found two main positive impacts namely; increased access to health information and improved health knowledge related to chronic diseases, nutrition, hygiene, and risky health behaviours. Regarding increased access to health information, the participants explained that due to the pandemic, many health education activities were ongoing on various media platforms including television and radio stations, community information centres and social media. Mass media, that is, radio and television stations and community information centres, are major platforms used in health education and promotion [ 34 , 35 ] due to their availability to majority of Ghana’s population (69% of women and 80% of men are exposed to radio alone) [ 36 ]. This education aimed at not just educating the public on the pandemic but other health issues that were pertinent to transmission of the infection and risk of complications associated with the COVID-19 disease. Also, these education sessions allowed their consumers to participate through text messages and phone calls. For instance, a 36-year-old man said, “ Oh , due to Covid many education activities are ongoing on both tv and radio . … and it is helping with getting information like this . ” Another participant, 28-year-old woman noted, “Now , most of them (television and radio stations) have health education sessions trying to educate the public on the Covid and how to protect ourselves . Even other health issues like hypertension are discussed . ”

Also, a 42-year man stated;

For those of us who don’t know much about internet , we now get almost all health information we need to prevent health conditions from the regular media like tv and radio . We get to call in to ask questions and they answer us . And the good thing is that it’s in Fante .

Concerning improved health knowledge due to the COVID-19 pandemic, the participants argued that increased access to health information during this pandemic has resulted in better understanding of many health issues. Some also explained that they now understand how to prevent some health conditions like diabetes, hypertension and infectious diseases and how to boost the immune system. Chronic conditions like diabetes and hypertension were noted to dominate many health education programmes due to their increased risk of complications and deaths from COVID-19 with their preventive measures such as healthy diet and increased physical exercise highlighted. Explaining improvement in health knowledge due to COVID-19 pandemic, a 38-year-old woman said, “I now understand that I need to be careful of types of food I eat , do physical exercises , and not consume alcohol in order to reduce my chances of getting these conditions . ”

A male participant, 29-years old, also noted, “ Now , I know that too much alcohol consumption will likely lead to hypertension and other conditions for life . Initially , I didn’t understand why people make a fuss about others drinking alcohol . ” Again, a 47-year-old woman further added;

We just eat anything we have at home without regards to whether it improves or destroys our health , we just eat . But now , I know that food is like medicine and when we take lot of fruits and vegetables , we become stronger against diseases .

Impact of COVID-19 pandemic on health-related lifestyles

We explored the impact of COVID-19 on the health-related lifestyles among the participants. Three positive impacts of COVID-19 pandemic on lifestyle choices were observed, namely; stopped/reduced risky behaviours, started physical exercising, and started/increased consumption of fruits and vegetables. It was explained by the participants that their increased knowledge and perceived threat of the COVID-19 pandemic have made them assumed positive health-related lifestyles while others have quit risky behaviours such as alcohol intake, sharing of personal items, and consumption of junk foods. The participants explained that they had initiated or increased their consumption of fruits and vegetables and physical exercises as understanding their importance has dominated ongoing health education programmes. Thus, the perceived need to assume this positive health behaviours had improved leading to their decision to apply these health choices. A 40-year-old woman for instance, said; “Understanding that eating fruits and vegetables helps our body protect against disease in the midst of this Covid , now at least every two days we take banana , oranges and pineapples as part of our dinner .” A 28-year-old man also posited;

Oh , as for now , every weekend I and my ‘boys boys’ go for jogging and sometimes visit the gym to exercise because we understand exercising will keep us healthy and stronger . Our bodies will be strong to fight disease . Previously , aside some community football once a while , I hardly exercised .

Some of the participants also explained that the pandemic has impacted on their quitting risky behaviours such consumption of junk foods and alcohol. They argued they have stopped or reduced these behaviours due to their improved understanding of risks associated these behaviours and subsequent increased likelihood of complications and death should they be infected with the COVID-19 infection. Explaining this, a 25-year-old woman said;

I used not to cook regular meals at home because I mostly buy “indomie” from the fast-food joint in the evening . But I no longer buy that they said such food increases the risk of chronic conditions and subsequent vulnerability to severe complications should I unluckily get Covid . I eat healthier foods now .

Also, a 38-year-old man explained, “We’re all afraid of being in such conditions (severe COVID-19 illness) due to smoking and alcohol consumption . You know the Covid is everywhere . I have actually reduced my intake of alcohol now . ”

Impact of COVID-19 pandemic on healthcare seeking behaviour

COVID-19 pandemic positively impacted health seeking behaviour among some of the study participants. Positive effect on their healthcare seeking behaviour was explained to be due to the fear of contracting the complicated form of the disease and improved health knowledge. Two aspects of care seeking behaviour were identified to have improved, namely health consciousness and regular medical check-up. Some of the participants posited that they are now more conscious of their health due to improved health knowledge during this period and the need to avoid a health condition taking them by surprise. While some argued that anyone can contract the COVID-19 virus with the rising number of cases as such, they would not want to have the severe form of the disease due to some underlying health conditions, others attributed this to their improved knowledge of health conditions such as diabetes and hypertension. The following quotes summarise their views:

As for me , now every small thing (physical symptoms) then I feel I need to go to the clinic to check what is the problem . Who knows it could be Covid or some other condition that can worsen my survival should I contract the Covid . –Female, 39 years I come into contact with many different people while going to work so anything can happen . So , now even small headache or cough then I go to hospital to check what is going on . –Male, 43 years

Regarding assuming regular health check-ups as an impact of the COVID-19 pandemic, some participants explained that they now understand the risks of chronic diseases like diabetes and hypertension and that the conditions can be managed well when detected early. As such, they now go for regular blood pressure and blood glucose level checks to help diagnose or ascertain risk of hypertension and diabetes contrary to before the pandemic where these are done only when they were seriously ill. A 44-year-old woman for example noted, “I have started going for the nurse at the facility to check my BP at least once a month . By that , if I am found to have pressure (hypertension) then they can help me . ”

Also, a 51-year-old man said;

I know I have pressure (hypertension) but normally unless I feel very sick or need to go for new drugs that I go to the hospital–they check me before giving me my monthly drugs . But now , I go to the small clinic here every two weeks to check and even check for diabetes too . –Male, 51 years

Furthermore, a significant number of the study participants had negative experiences leading to poor healthcare seeking behaviour as a result of the impact of COVID-19 in terms of negative reception at the facility and poor access to care. Negative reception is explained to mean health professionals applying high-level infection prevention protocols alerted by patients presenting with symptoms such as cough and flu, symptoms also associated with the COVID-19 infection. This the framework considers as health system-related factor to health behaviour. Some participants explained that for fear of being treated like someone infected with COVID-19, they do not go to the health facility with symptoms like cough, flu and fever. For instance, a 33-year-old woman said;

When I have symptoms like cough or flu , I am unable to go to the hospital because I feel I will be mistakenly treated like someone with the disease (COVID-19) . I would rather get some drugs from the drugstore and stay home .

For others, poor health seeking behaviour is as a result of the fear of coming into contact with COVID-19 infected person or health professional when they visit the health facility. This is due to limited space at the health facilities and sometimes non-adherence to infection prevention protocols such as sanitizing of hands and equipment between patients, increasing risk of direct or indirect contact with the COVID-19 virus. Limited space and risk of nosocomial infection are health system barriers to positive healthcare seeking behaviour as argued in the framework. A 41-year-old man noted;

What if the person sitting by me at the OPD–sometimes it gets very crowded–has the disease (COVID-19) or the nurse has touched someone who have the disease (COVID-19) ? I can get infected so for me unless my condition is serious needing to visit the hospital , I will not go .

Again, inability to adhere to COVID-19 protocol of facemask wearing was cited to have resulted in poor healthcare seeking behaviour. Some participants argued that one may sometimes forget the face mask at home in the quest of rushing to seek care or may not be able to buy the mask but without the mask, they will not be allowed to enter the health facility to seek care. These barriers, negative health attitude and poor socio-economic status, are considered predisposing factors in the framework. Explaining this, a 38-year-old woman stated;

Sometimes the only money you have is what to take a car to the hospital and something small to add up for drugs because you are lucky to have (health) insurance . How do you use same money to buy nose mask ? But without it you will not be allowed to enter the hospital .

Also, a 47-year-old woman noted, “…sometimes due to how you’re feeling because of the sickness , you may be in a rush to go to the clinic . But should you forget the (face) mask , you will be denied entry to the place . ”

Additionally, male partner involvement in antenatal care (ANC) was found to be poor due to the impact of the COVID-19 pandemic. A participant explained that male partner involvement at ANC has reduced because of the COVID-19 pandemic citing restriction of male partners by nurses and midwives due to limited space at the facility. Limited space at ANC is a common constrain to male partner involvement in Ghana [ 37 ] even before the COVID-19 pandemic. He, 37-year-old, said;

Now , they don’t allow us (men) to be with our wives at ANC–we have to wait for them outside or stay in our cars till they are done . The workers say the place is small so due to social distancing , we should stay outside . What then is the use of coming with my partner ? Most of us (men) have stopped going with our wives now . It’s not good .

This qualitative study explored the impact of COVID-19 on health knowledge, health-related lifestyles and health seeking behaviour among adults in the Cape Coast Metropolis. We found that the pandemic has resulted in improved health knowledge and health behaviours. Similarly, healthcare seeking behaviour has improved although many people have been negatively affected especially due to the restrictions put in place to control the spread of the COVID-19 infection.

Our study found that the pandemic has resulted in improved health knowledge among the population. This is consistent with the intensive public health education including preventive behavioural change messages being disseminated through various media (television, radio, print media, and social media) across Ghana [ 38 , 39 ]. This could have resulted from the use of creative arts in translating COVID-19 information in ways that people are able to connect emotionally to create social awareness thereby, strengthening COVID-19 public health communication through improved public understanding [ 40 ]. The measures to controlling the COVID-19 pandemic in Ghana have used health education and literacy to improve access to health information [ 41 ] using mass media to establish local information networks and adapting educational messages to community beliefs and concerns [ 42 ]. In relation to the conceptual framework, health knowledge is argued to be predisposing factor which influences an individual’s health behaviour [ 18 ] while its access is considered an enabling factor to behaviour change [ 23 ]. Hence, the increases access to health knowledge due to numerous health education campaigns during the pandemic has improved individual’s predisposition to positive health behaviour, understanding of health issues.

Regarding the finding that health-related lifestyles had improved among the participants, Brauer [ 43 ] posits that during pandemic including COVID-19, people change their behaviours. Assumption of positive behaviours has been argued to result from increased access to and magnitude of health informational campaigns which leads to effective and fast behavioural modifications [ 44 , 45 ]. Thus, this finding supports the argument that adaptive and protective behaviour change in response to pandemic should be encourage [ 46 ] and agrees with the study by Min et al. [ 39 ] where significant improvement in food safety knowledge was observed in communities with existence of COVID-19 cases. Health education aims to provide health information and knowledge to individuals and populations and equip them with skills to be able to voluntarily adopt healthy behaviours [ 47 ]. Also, the increase in positive health behaviours and ceasing or reduction in negative health-related lifestyles could have resulted from self-preservation, a common psychological response in COVID-19 [ 48 ], resulting from improved health knowledge and risk perception. Again, the framework posits that improved health knowledge which influences attitude and perception increases the chances of individuals adopting appropriate health behaviour [ 18 , 24 ] including physical exercising, healthier diet choices and ceasing of risky behaviours like alcohol consumption and smoking. Thus, the adoption of healthy behaviours and avoiding of risky behaviours is consistent with the improved health knowledge as a result of increased access to health information in this pandemic period.

Again, we observed improved healthcare seeking behaviour among some of the residents which may have resulted from improved perception of risk of exposure and perceived severity of selected health conditions such as chronic diseases, food borne diseases, and COVID-19 as well as perceived efficiency of coping or preventive strategy [ 49 ] resulting from gained information. Hence, the type and amount of information communicated to individuals and the focus on specific health information could have heightened perceived risk [ 50 ]. Their positive health seeking behaviour change, thus, results from improved understanding of health conditions and risky health behaviours. This finding is consistent with the framework that supportive predisposing factors like improved health knowledge, need for care factors such as adequate perception of health risk and severity together with enabling factors like access to health information lead to better health seeking behaviour [ 18 , 22 ].

More so, our finding that some residents experienced poor healthcare seeking behaviour due to COVID-19 restrictions and protocols is in congruence to the position by Balhara et al. [ 51 ] and Yau et al. [ 48 ] that health-seeking behaviour continues to be significantly disrupted by the COVID-19 pandemic. This comes at the backdrop that outpatient and preventive care have changed significantly due to the COVID-19 pandemic with deferring of elective and preventive care visits, patients avoiding visits to reduce risk of exposure from leaving home [ 52 , 53 ]. The pandemic has also resulted in untold economic and social hardship on individuals making it difficult to access health service. This finding also supports the conceptual framework which Andersen and Newman [ 24 ] posit that the presence of negative factors such as limited access to care and health resources, poor understanding of policies and poor socio-economic status hinders the decision to use health service leading to poor care seeking behaviour.

Poor health seeking behaviour has negative implications for achieving the Sustainable Development Goal (SDG) 3 of ensuring health for all at all ages through promotion of health and provision of quality healthcare services [ 54 ]. Should the poor health seeking behaviour persist, the strides made towards achieving this goal would most likely be lost.

Strengths and limitations

The study is a novel inquiry into the significance of management of a pandemic on healthcare seeking behaviour and the general health system. The study relied on verbal reports by the participants which has the potential of resulting in recall bias and overreporting or underreporting of socially acceptable and unacceptable behaviours respectively. However, participants were encouraged to be honest in their reports and guaranteed on their privacy and confidentiality of their responses while probes were used as mechanism to verify participants’ views.

There has been a positive impact of COVID-19 and its associated management and control measures as well as reforms on health knowledge, health-related lifestyles, and healthcare seeking behaviour among adult residents in the resource-limited setting we studied. The implication of this finding is that although increasing cases of COVID-19 will overburden the health system, efforts put in place are likely to improve health outcomes such as chronic diseases, for majority of the population. COVID-19 associated conscious and unconscious reforms could be a window of opportunity to harness, in order to improve health systems, healthcare seeking behaviour and overall health outcomes even after the pandemic wades off. Thus, health promotion and education interventions put in place should be sustained as part of the regular healthcare structure and financing. It is also important to understand the impact of reduced utilization of healthcare services, as persons with chronic diseases might succumb, not only to COVID-19 if they become infected, but also to the development of complications from pre-existing conditions.

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Public Health Theses and Dissertations

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Analyzing the Relationship Between Preeclamptic Severity and Placental Methylation , Mackenzie C. Maggio

A Differentially Methylated Region Analysis Between Three Disease States of Major Depressive Disorder in Primarily African-American Cohorts , Lanie KateLynn Mullins

Preliminary investigation of differences in host mitochondria membrane potential during Toxoplasma gondii infection , Bryan L. Ortega

Theses/Dissertations from 2023 2023

Needs Assessment for a Web-Based Support Resource for Patients with a Pathogenic Variant in LMNA , Dylan M. Allen

Evaluation of a Story-telling Approach to Educate Minority Populations About Inherited Cancer , Celestyn B. Angot

Using the Genetic Counseling Skills Checklist to Characterize Prenatal Genetic Counseling , David A. Cline

Reframing Resistance, Resilience, and Racial Equity in Maternal Health: A Mixed Methods Exploration of Paternal Involvement and the Racial Disparity in Severe Maternal Morbidity , Marshara G. Fross

Student Perceptions of the Nonmedical Use of Prescription Stimulants and Preferences for Health Education , Ana Gutierrez

Relationships between Leading and Trailing Indicators at Construction Sites in Yanbu Industrial City, Saudi Arabia , Anas H. Halloul

Variability of Air Sampling Results Using Air-O-Cell Cassettes , Christina M. Haworth

Use of Silica Dust and Lunar Simulants for Assessing Lunar Regolith Exposure , Layzamarie Irizarry-Colon

The Aging Workforce: How it Relates to Incident Rates within a Distribution Warehouse and a Chemical Manufacturing Building , Elisabeth V. Jones

Fuzzy KC Clustering Imputation for Missing Not At Random Data , Markku A. Malmi Jr.

Piloting a Spanish-language Web-based Tool for Hereditary Cancer Genetic Testing , Gretter Manso

Development of a ddPCR Multiplex to Measure the Immune Response to Borrelia burgdorferi. , Kailey Marie McCain

A Healthcare Claims Investigation of Parasomnia Epidemiology, Associations with Attention Deficit/Hyperactivity Disorder, and REM Sleep Behavior Disorder Correlates , Anh Thy Ha Nguyen

Diet and Salivary Microbiome on Cardiovascular Risk and Glycemic Control in Participants with and without Type 1 Diabetes: The CACTI Study , Tiantian Pang

Evaluation of Two Methods to Estimate Wet Bulb Globe Temperature from Heat Index , Stephi Pofanl

Intimate Conversations: A Mixed-Methods Study of African American Father-Adolescent Sexual Risk Communication , Shanda A. Vereen

Assessment of ISO Heart Rate Method to Estimate Metabolic Rate , Karl Williams

Theses/Dissertations from 2022 2022

Outcomes of a Periodic Exposure Assessment of Workers at a University Campus , Logan M. Armagast

Evaluating the Effect of Public Health Governance Structure and Public Opinion on COVID-19 Disease Control Interventions , Daniel Chacreton

Alpha Synuclein: A therapeutic target and biomarker for Parkinson’s Disease , Max Chase

A Study of Noise Exposures for Amusement Park Employees by Positions and Ride Categories , Danielle M. Dao

Bayesian Network-based Diagnostic Support Tool with Limited Point-of-Care Ultrasound for Work-related Elbow Injuries , Cristina Maria Franceschini Sánchez

Understanding Food Insecurity as a Multidimensional Construct: A Mixed Methods Approach to Assess Changes in Food Insecurity Status among People Seeking Emergency Food Assistance , Whitney M. Fung Uy

Host-Pathogen Coevolution Between Tasmanian Devils (Sarcophilus harrisii) and Devil Facial Tumor Disease , Dylan Garret Gallinson

Joint Models for Repeated Measured, Non-Normally Distributed Multilevel Data , Weiwei He

Crosswalking Wet Bulb Globe Temperature and Heat Index , Paul Irvin

Impact of Perinatal Exposure Counseling on Patient Reported Emotional Outcomes and Decisional Empowerment , Madison J. Lake

Measurements of Generalizability and Adjustment for Bias in Clinical Trials , Yuanyuan Lu

Examining the Relationship between Racial Respect among Black Early Childhood Professionals and their Perceptions of Black Children , Kayla Nembhard

Etiology of sterile intra-amniotic inflammation: An exploratory study , Zoe M. Taylor

Evaluating and Improving a Novel Toolkit for Implementation and Optimization of Lynch Syndrome Universal Tumor Screening , Tara M. Wolfinger

Assessing Reported Use of Clinical Genetic Counseling Skills , Nicole M. Wright

Theses/Dissertations from 2021 2021

Exploring Adult Attachment in Intimate Relationships among Women who Were Exposed to Intimate Partner Violence in Childhood: A Convergent Mixed Methods Approach , Ngozichukwuka C. Agu

Comparison of the Effectiveness of Disinfectant-Impregnated Wipes Versus Detergent Wipes for Surface Decontamination , Jacob Amadin

Limited Point of Care Ultrasound Clinical Decision Support Model for Work-related Injuries of the Shoulder Utilizing Bayesian Network , Gwen Marie Ayers

Synthesis of a Multimodal Ecological Model for Scalable, High-Resolution Arboviral Risk Prediction in Florida , Sean P. Beeman

Feasibility of a Virtual Group Nutrition Intervention for Adolescents with Autism Spectrum Disorder , Acadia W. Buro

Defining Codes Based on the Consolidated Framework for Implementation Research in the Context of the Implementing Universal Lynch Syndrome Screening , Jasmine A. Burton-Akright

Americans’ Familiarity, Interest, and Actions with Direct-to-Consumer Genetic Testing , Riley L. Carroll

Does Better A1C Control Worsen Osteoarthritis? An Electronic Health Record Cross-Sectional Study , Sarah C. Cattaneo

Analysis of Post-traumatic Stress Disorder Gene Expression Profiles in a Prospective, Community-based Cohort , Jan Dahrendorff

Differential Privacy for Regression Modeling in Health: An Evaluation of Algorithms , Joseph Ficek

Does Time-Weighted Averaging for WBGT and Metabolic Rate Work for Work-Recovery Cycles? , John W. Flach

Screening of Pregnant Women with Opioid Use Disorder: Identifying Factors Impacting Implementation of Screening Recommendations Using the Theoretical Domains Framework , Tara R. Foti

Epigenetic Potential in an Introduced Passerine , Haley E. Hanson

Face Mask Use to Protect Against COVID-19; Importance of Substrate, Fit, and User Tendencies , Evelyn Kassel

Novel Educational Material for Patients with a Variant of Uncertain Significance (VUS) in a Cancer Risk Gene , Meghan E. Kelley

Mechanisms and Mitigation: Effects of Light Pollution on West Nile Virus Dynamics , Meredith E. Kernbach

Seasonality in Competence to Transmit West Nile Virus for a Widespread Reservoir , Kyle L. Koller

Mealtimes in Early Childhood Education Centers During COVID-19: A Mixed-Methods Assessment of Responsibilities, Interactions, and Best Practices , Joanna Mackie

Development and Validation of an Isothermal Amplification Assay for Eastern Equine Encephalitis Virus , Mikayla D. Maddison

Evaluating the Development and Implementation of Campus-based Sexual and Interpersonal Violence Prevention Programming , Robyn Manning-Samuels

Bait-and-Kill: Targeting a Novel Heme Biochemical Pathway in Hundreds of Cancers , Christopher G. Marinescu

Acclimatization Protocols and Their Outcomes , Ayub M. Odera

Promoting HPV vaccination with vaccine-hesitant parents using social media: a formative research mixed-method study , Silvia Sommariva

Sleep Diagnoses and Low Back Pain in U.S. Military Veterans , Kenneth A. Taylor

Theses/Dissertations from 2020 2020

Journey Mapping the Minority Student’s Path Toward Genetic Counseling: A Holistic Picture , Tatiana E. Alvarado-Wing

Using Observations from the UAW-Ford Ergonomic Assessment Tool to Predict Distal Upper Extremity Musculoskeletal Disorders , Zachariah T. Brandes-Powell

Do Similar Exposure Groups (SEG) differ from Air Force base to Air Force base? A Combat Arms Training and Maintenance (CATM) noise exposure comparison of Moody AFB and MacDill AFB. , Miriam F. Escobar

Predictors of Premature Discontinuation from Behavioral Health Services: A Mixed Methods Study Guided by the Andersen & Newman Model of Health Care Utilization , Shawna M. Green

Non-invasive Sex Determination and Genotyping of Transgenic Brugia malayi Larvae , Santiago E. Hernandez Bojorge

Does Gestational Diabetes Mellitus Increases the Risk of Preeclampsia Among Primigravid Women? , Astha Kakkad

Evaluating Effects of Cancer Genetic Counseling on Several Brief Patient Impact Measures , Alyson Kneusel

Impact of Heat-Related Illness and Natural Environments on Behavioral Health Related Emergency and Hospital Utilization in Florida , Natasha Kurji

The Quantification of Heavy Metals in Infant Formulas Offered by the Florida WIC Program , Naya Martin

Differences in Knowledge Acquisition, Perceived Engagement and Self-Efficacy in Latino Promotores Delivering the Heart Disease Prevention Program Su Corazόn, Su Vida , Samuel Matos-Bastidas

Spatial and Temporal Determinants Associated with Eastern Equine Encephalitis Virus Activity in Florida , Kristi M. Miley

Using Observations from the UAW-Ford Ergonomic Assessment Tool to Predict Low Back Musculoskeletal Disorders , Colins Nwafor

On the Importance of Context: Examining the Applicability of Infertility Insurance Mandates in the United States Using a Mixed-Methods Study Design , Nathanael B. Stanley

Exploration of Factors Associated with Perceptions of Community Safety among Youth in Hillsborough County, Florida: A Convergent Parallel Mixed-Methods Approach , Yingwei Yang

Theses/Dissertations from 2019 2019

The Ability of the U.S. Military’s WBGT-based Flag System to Recommend Safe Heat Stress Exposures , David R. Almario

The Relationship between Continuous Glucose Monitor (CGM) Derived Metrics and Indices of Glycemic Control , Ryan Bailey

“Man plans but ultimately, God decides”: A Phenomenological Investigation of the Contextual Family Planning Beliefs of Recently Resettled Congolese Refugee Women in West Central Florida. , Linda Bomboka Wilson

‘If He Hits Me, Is That Love? I Don’t Think So’: An Ethnographic Investigation of the Multi-Level Influences Shaping Indigenous Women’s Decision-Making Around Intimate Partner Violence in the Rural Peruvian Andes , Isabella Li Chan

An Assessment of the Role of Florida Pharmacists in the Administration of Inactivated Influenza Vaccine to Pregnant Women , Oluyemisi O. Falope

Epidemiological Analysis of Malaria Decrease in El Salvador from 1955 until 2017 , Tatiana I. Gardellini Guevara

Self-Collected Sampling Methods for Chlamydia and Gonorrhea Screening Among College Women: Exploring Patient-Centered Intervention Characteristics , Stacey B. Griner

The Relationship Between Hand and Wrist Musculoskeletal Disorders and Hand Activity and Posture , Warren M. Henry

Speeding Diagnosis and Saving Money Using Point of Care Ultrasound Rather Than MRI for Work-related MSK Injuries , Jared A. Jeffries

Mitigating Barriers to Chronic Disease Risk Factor Prevention and Management in Disadvantaged Communities , Krys M. Johnson

Comparing Family Sharing Behaviors in BRCA Carriers with PALB2 Carriers , Joy E. Kechik

Investigating Air Pollution and Equity Impacts of a Proposed Transportation Improvement Program for Tampa , Talha Kemal Kocak

Exploring Young Women’s Choice to Initiate Use of Long-acting Reversible Contraception: A Mixed Methods Approach , Helen Mahony

Evaluation of Clinical Practices and Needs about Variants of Uncertain Significance Results in Inherited Cardiac Arrhythmia and Inherited Cardiomyopathy Genes , Reka D. Muller

Effects of Medications with Anticholinergic Properties and Opioids on Cognitive Function and Neural Volumetric Changes in Elderly Australians , Malinee Neelamegam

Sundaas Story: A Mixed-Methods Study of Household Sanitation Provisioning in Urban Informal Housing in India , Sarita Vijay Panchang

A Retrospective Study of the Opioid Epidemic and Fentanyl Related Overdose Fatality Cases in a Florida West Coast Medical Examiner District Population , Anne Terese Powell

Using Predicted Heat Strain to Evaluate Sustainable Exposures , Samantha L. Thacker

Isokinetic Sampling Efficiency Differences for Blunt Edge vs Sharp Edge Sampling Probes , Cory A. Treloar

Using the Consolidated Framework for Implementation Research to Investigate Daily Pre-exposure Prophylaxis (emtricitabine/tenofovir DF) Implementation via Community-based HIV Testing Sites in Florida , Deanne E. Turner

“We can learn some things from them, but they can learn some things from us too”: Intergenerational Perceptions of Shared Infant Feeding Information , Alexis L. Woods Barr

Theses/Dissertations from 2018 2018

Comparison of Modeled and Measured Pesticide Concentrations in Air , Trenell Davis Boggans

Effectiveness of Biocide Substitution and Management Plan Implementation for the Control of , Adelmarie Bones

Design, Construction, and Characterization of the University of South Florida Wind Tunnel , Jason S. Garcia

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What is the thesis statement for "Stress Effects on Health and Behavior" and its three major points?

Quick answer:

The thesis statement for "Stress Effects on Health and Behavior" could be "Although stress is a normal body response to various situations, constant stress can have detrimental impacts on a person's overall health and wellness." The three major points supporting this thesis could be the effects of stress on physical health, mental health, and a person's behavior. Physical health effects may include headaches, increased blood pressure, and fatigue. Mental health effects could involve mood disorders like anxiety. Behavioral effects may include changes in social interactions and bursts of anger.

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6,806 answers

I have been in education for 16 years and have taught 20 different subjects.

There have been plenty of studies on the link between stress and its effects on overall health and wellness, so you should be able to find plenty of solid information that supports the effects of stress on a person's health. You may certainly come up with an argumentative thesis statement that claims the link between stress and poorer health is false or exaggerated; however, I think that you will find that argument difficult to support.

My recommendation for the initial thesis is to stay somewhat broad. For example, a broad thesis may read "Although stress is a normal body response to various situations, constant stress can have detrimental impacts on a person's overall health and wellness."

This particular thesis gives you the opportunity to explore what stress is and explain that stress is a normal biological response to certain environmental conditions. Constant and pervading stress is the problem. Your paper should explore that difference.

The thesis provided also stays broad in that it says that stress is bad for overall health and wellness rather than providing specific health problems. This gives your paper room to explore a variety of health complications related to stress. I would spend time explaining that a person's overall health is a combination of physical health, mental or emotional health, and social health. Stress can impact all three aspects of that health triangle, which is your link to how stress can affect behavior.

Definitely explore how stress can contribute to headaches, increased blood pressure, muscle tension and pain, fatigue, and other physical ailments. Discuss how many of these things are also psychosomatic symptoms. The doctor can treat the muscle pain but if the root cause is stress the treatment isn't targeting the problem.

You can explore how stress could lead to mood disorders like anxiety, and those kinds of mental and emotional changes generally impact a person's social health. If the stress leads to frequent bursts of anger, a person might find that their friends are less willing to be social with that person.

Before bringing the paper to a close, I recommend offering your reader some solutions regarding stress and stress management. Explore how something as simple as changes to diet and exercise can lower stress levels.

Further Reading

• https://www.mayoclinic.org/healthy-lifestyle/stress-manag...

Cite this page as follows:

Beutlich, Jonathan. "What is the thesis statement for "Stress Effects on Health and Behavior" and its three major points?" edited by eNotes Editorial, 20 Feb. 2020, https://www.enotes.com/topics/essay/questions/thesis-statement-stress-effects-health-behavior-185443.

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B.A. from University of Oxford M.A. from University of Oxford Ph.D. from University of Leicester

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2,557 answers

Oxford graduate with a doctorate in medieval literature and linguistics.

The previous answer gives a great starting point for how to write any essay of this kind. It is always better to do your research first, and then come up with your thesis statement from what you have found. Trying to summon a thesis statement before you have found your three major points is very difficult and means you risk trying to make the evidence fit the statement, rather than the other way around.

Let's consider some examples of topics you might cover:

The question asks about the effects of stress on your health and behavior, so a good starting point is to recognize that health and behavior are two separate things. We may even be able to break that down further: health could mean physical health and mental health. As such, our three topics might be . . .

1. The effects of stress on physical health

2. The effects of stress on mental health

3. The effects of stress on a person's behavior

So, effects on physical health might include headaches, difficulty sleeping, tiredness, and so on. Effects on mental health could include depression or anxiety, difficulty focusing, and lack of motivation. However, remember that everyone is different—for some people, stress can lead to increased drive. You should always consider alternative viewpoints in any essay. This element could fall under the effects of stress on a person's behavior. Negative behavioral effects might include substance abuse or irritable behavior.

Your thesis, then, should be drawn from what you have written under your three headings. Based on what I have brainstormed above, my thesis might be: "Stress has generally negative effects upon the physical and mental health of most people, resulting in negative behavioral changes." However, your own thesis might be different, depending upon the conclusions you draw and evidence you find.

Gilbert, Jay. "What is the thesis statement for "Stress Effects on Health and Behavior" and its three major points?" edited by eNotes Editorial, 30 Jan. 2018, https://www.enotes.com/topics/essay/questions/thesis-statement-stress-effects-health-behavior-185443.

Educator since 2010

2,323 answers

I am a former high school English teacher and writing specialist.

Someone could certainly give you a thesis statement and 3 topics for this paper - but then the paper wouldn't really be YOURS.  You need to own it.  The best way to do this is to draw these things from what you already know.

An easy way to come up with a thesis statement (and material for an entire paper, really) is to follow these steps first:

• State the topic in the form of a question.  What are the effects of stress on health and behavior?
• Brainstorm a list of 15 - 20 answers for the topic question.  Be as general or specific here as possible - remember it is just brainstorming so no ideas should be ruled out.  Also, keep in mind both negative and positive effects of stress.
• Categorize answers into three logical groups.  Do not make two of your categories the "negative" effects and the "positive" effects.  Instead, focus on one or the other.  Otherwise your final paper risks a lack of cohesiveness.
• Write thesis statement by giving a general and complete sentence answer to the topic sentence.  While stress has both positive and negative effects on health and behavior, the negative tend to outweigh the positive.

Then, your next sentence is blends naturally into identifying your three categories (major points).  Hope this helps.

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Wait, Claire. "What is the thesis statement for "Stress Effects on Health and Behavior" and its three major points?" edited by eNotes Editorial, 23 July 2010, https://www.enotes.com/topics/essay/questions/thesis-statement-stress-effects-health-behavior-185443.

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General Description of the Job Class

This job classification is used for the Behavioral Health Technician Float Pool managed by ISRP.

Perform a variety of routine activities to provide physical and psychological care to patients with psychiatric disorders.

Duties and Responsibilities of this Level

Observe patients and assesses progress on daily basis; report significant changes in patients' condition and/or behavior to supervising RN.

Interact with patients on a one to one basis providing recreational or social activities and reinforce patient teaching.

Assist patients in activities of daily living including making beds, bathing, personal hygiene, feeding and dressing.

Assist patients with position changes, range of motion exercises, transfers and walking.

Provide care and monitoring of patients in seclusion and/or restraint.

Provide protection and control for patients as required to ensure patient safety in the facility.

Participate in restraining combative patients as necessary.

Ensure compliance with safety and infection control guidelines including universal precautions for self and patients.

Participate in staff discussions to assess, coordinate and execute patient care.

Maintain a clean, neat and safe work environment; activities may include but not be limited to tidying room, cleaning equipment, changing bed linens, restocking work areas, keeping rooms and hallways clear of debris, etc.

Practice proper safety techniques in accordance with hospital and departmental policies and procedures: immediately reports any mechanical or electrical equipment malfunctions, unsafe conditions, or employee/patient/visitor injuries to manager.

Participate in review of activities and processes for work area; assist in implementing changes to effect continual improvement in services provided; comply with regulatory and legal requirements.

Assist in organizing and conducting recreational activities.

Interact with patients on a one to one as well as small group basis; assist patients in planning how the treatment plan can be optimally utilized for their benefit.

Perform other related duties incidental to the work described herein.

Required Qualifications at this Level

Graduation from high school or GED.

1 year of experience working with patients with substance abuse, mental health, dementia diagnosis, intellectually or disabled preferred.

Degrees, Licensure, and/or Certification

Listing on the Nurse Aid Registry of North Carolina

Certification as a Substance Abuse Counselor in North Carolina

Certification as an Emergency Medical Technician in North Carolina

Certification as a Behavioral Health Technician by The Academy of Addiction Professionals or American Medical Certification Association

If a hire does not meet 1 of the 4 requirements, the BHT must start the process to complete one of the requirements within 1 year of employment and complete within 2 years.

BCLS certification must be maintained/completed by the end of new hire orientation, which typically takes place during the first week of employment.

CPI certification strongly preferred.

Meet DUHS credential to perform analysis of blood glucose from finger sticks and report findings to nurse. Complete quality control measures for this equipment. Participate in specimen collection according to test requested. Is responsible for patient identification, specimen labeling, and collection verification. Instruct patients in collection and preservation of urine, sputum and stool samples for analysis. Obtain and record vital signs, intake and output amounts or other measures as delegated within 90 days of employment.

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Knowledge of special procedures that are applicable to work performed.

Knowledge of procedures and techniques involved in administering routine treatments to patients.

Knowledge of sanitation, personal hygiene, infection control, and basic health and safety precautions applicable to work in a health care environment.

Knowledge of specimen collection, storage and transport.

Knowledge of behavioral principles and individual responses to stressors.

Ability to establish and maintain effective working relationships with patients and hospital staff.

Ability to work with, express sensitivity and understanding, and secure the cooperation of patients, including maintaining sympathetic attitude towards patients.

Ability to keep calm in stressful situations.

Ability to maintain routine records and prepare reports.

Ability to recognize patients in emergency states and seek appropriate assistance.

Ability to maintain confidentiality and other patient rights.

Ability to understand, follow and communicate/relate oral and written instructions and pertinent information accurately.

Ability to apply proper body mechanics and safety. individuals in didactic or recreational groups.

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What Factors Affect Health Seeking Behavior?

Health seeking behavior has been defined as any action undertaken by individuals who perceive themselves to have a health problem or to be ill for the purpose of finding an appropriate remedy ( 1 ).

Attaining good health seeking behavior is an important element of prevention, early diagnosis and management of disease conditions. It helps in reducing cost, disability and death from diseases ( 2 ). However, good health seeking behavior cannot be achieved easily as it is guided by a decision-making process that is further governed by individuals and/or household behavior, community norms, and expectations as well as provider-related characteristics and behavior ( 3 ).

To understand the complex nature of health seeking behavior, it is imperative to note the two health behavior theories:

• The Health Belief Model where the concept is the ‘perceived susceptibility’, which refers to the perceived chance of acquiring a condition. The ‘perceived susceptibility’ and the ‘perceived severity’ leads to the formation of ‘perceived threat’ of a certain condition. The likelihood of performing a certain health behavior is directly linked to the perceived threat, the perceived benefits, barriers of the suggested behavior change and the self-efficacy and the cues to action ( 4 , 5 ).
• The Theory of Planned Behavior relates the attitude towards behavior, subjective norms and perceived behavioral control to behavioral intentions and actions ( 6 ).

In general, it is essential to note that health-seeking behavior is complex, has no solo method to justify or create any pattern. Health seeking behavior is a reflection of the prevailing conditions, which positively interact to produce a form of care seeking but which remain fluid and therefore amenable to change. Immediate health-seeking is critical for appropriate management, and for this reason, understanding the determinants of health seeking behavior becomes critical in the bid to provide client oriented services.

The current issue, the second regular issue for the year 2018, contains an editorial, fourteen original articles and a case report focusing on various topics. One of the article in this issue deals with health seeking behavior among cervical cancer patients.

I invite readers to read through these articles and appreciate or utilize the contents. I also encourage readers to forward comments and suggestions to the editor or the corresponding authors.

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Fargo Veterans Affairs to break ground on new $21M mental wellness and recovery center

The new facility will allow expansion of outpatient services in the areas of post traumatic stress disorder, behavioral health and substance use disorder..

FARGO — The Veterans Affairs Health Care System in Fargo will embark on a new chapter this week to improve mental health care options for its patients.

The Fargo VA is holding a groundbreaking ceremony on Friday, Sept. 6, for a new outpatient mental wellness and recovery facility at 2101 Elm St. N.

Jason Petti, interim medical center director, said the facility will bring “one-stop shopping” for veterans seeking care.

“If a primary care provider sees you, provides you with medications, things like that, your mental health provider has access to that. They can do any adjustments,” he said.

The two-story building, with approximately 8,000 square feet of space for offices, patient care and group therapy, will go up near the north entrance of the VA campus.

A one-story building currently in that spot, vacated by general administrative employees this week, will be torn down with those workers relocating to a downtown Fargo space leased by the VA.

Federal funds appropriated by Congress and totaling approximately $21.5 million will cover the cost of construction, Petti said.

The facility will help improve mental wellness and recovery to potentially more than 34,000 veterans in the area of the Fargo VA and at 10 community-based outpatient clinics.

Those clinic locations are in Grand Forks, Grafton, Devils Lake, Jamestown, Bismarck, Dickinson, Williston and Minot in North Dakota, along with Bemidji and Fergus Falls in northwest Minnesota.

Teresa Imholte, associate chief of staff for mental health, said the behavioral health interdisciplinary program teams will move into the new mental wellness facility, as will an outpatient mental health team, which includes a psychiatrist, therapists, nurses and pharmacy.

Currently, teams are spread out in the main VA building.

“That’ll be nice for the teams … their offices will physically be together,” Imholte said.

The post traumatic stress disorder, or PTSD clinical team, will also be housed in the new facility.

Imholte said the U.S. Department of Veterans Affairs is at the forefront of research determining the effectiveness of psychotherapies and practices used, including treatment for PTSD.

Patient rooms in the new facility will be designed with a therapeutic environment in mind, she said.

Certain group therapy sessions will be offered in person, some are hybrid, and others are strictly virtual.

In fact, many of the VA’s mental health services can be done virtually, and the VA will offer use of iPads for veterans who don’t have access to one, Imholte said.

Other mental health programs for the Fargo VA include suicide prevention, homeless assistance and substance use disorder treatment.

Imholte said one stigma that prevents some people, including veterans, from seeking mental health treatment is that they’ll be in it for the rest of their lives.

“That is definitely not the case,” she said.

The community is invited to the groundbreaking ceremony, which takes place at 10:30 a.m. Friday, just north of the former general administrative building.

Afterward, construction crews will set up fencing and begin demolition sometime shortly after.

Construction is expected to be finished in late 2025, Petti said.