Scholarly Journals--Published

  • Malcolm, O., Nelson, A., Modeste, N., Gavaza, P. (2021). Factors Influencing Implementation of Personalized Prevention Plans among Annual Wellness Visit Patients Using the Theory of Planned Behavior: A Quantitative Study. Research in Social and Administrative Pharmacy. (03/2021)
  • Nelson, A., Moses, O., Rea, B., Morton, K., Shih, W., Alramadhan, F., & Singh, P. N. (2021). Pilot Feasibility Study of Incorporating Whole Person Care Health Coaching Into an Employee Wellness Program. Frontiers in Public Health, 558. (03/2021) (link)
  • Ayer Miller, V., Radovich, P., Medina, E. (2021). The Healing Hearts at Home© Mobile Application Usability and Influence on Parental Perceived Stress: A Pilot StudyUsing Tablets to Collect Breast Cancer Risk Information in an Underserved Population. International Journal of E-Health and Medical Communications (IJEHMC), 12(3) (03/2021)
  • Alghmdi, E. M., Beeson, W. L., Medina, E., Nelson, A., & Dos Santos, H. (2020). Exergaming and Body Mass Index among Female Adolescents in Riyadh, Saudi Arabia. Health Education and Public Health. 3(2) (10/2020)
  • Singh, P., Steinbach, J., Nelson, A., Shih, W., D'Avila, M., Castilla, S., ... & Flores, H. (2020). Incorporating an Increase in Plant-Based Food Choices into a model of Culturally Responsive Care for Obesity in Hispanic/Latino Adults and Children, International Journal of Environmental Research, 17(13) (10/2020)
  • Alghmdi, E., Beeson, L., Medina, E., Nelson, A., & Dos Santos, H. (2020). Exergaming And Body Mass Index Among Female Adolescent In Riyadh Saudi Arabia: 1108 Board# 234 May 27 2: 30 PM-4: 00 PM. Medicine & Science in Sports & Exercise52(7). The purpose of this study was to examine the association between exergaming and body mass index among female adolescents in Riyadh, Saudi Arabia. A sample of 200 female students age 10-14 years completed a self-administered questionnaire after obtaining parental consent. Anthropometric measurements took place at schools after the completion of the enrollment questionnaire. The survey instrument included scales adopted from the validated Adolescent Sedentary Activity Questionnaire (ASAQ) and modified to include questions for exergaming. A multiple linear regression model was conducted to examine the association of exergaming with BMI. The results showed a significant negative association between exergaming and BMI among Saudi female adolescents after adjusting for several covariates (p<0.001). This is the first study to examine the association between exergaming and BMI among Saudi girls and to explore exergaming as an alternative solution for being more active in a population with limited physical activity due to cultural norms. (03/2020)
  • Malcolm, O, Nelson, A., Modeste, N., Gavaza, P. (2019). Assessing Medicare Patients' Salient Beliefs to Improve Annual Wellness Visit Health Outcomes, The Senior Care Pharmacist, 35(2), 93-106  OBJECTIVE: To identify key beliefs that influence behavior, regarding Medicare's Annual Wellness Visit (AWV) and older patients' willingness to implement personalized prevention plans.DESIGN: Cross-sectional. In-depth semi-structured focus group sessions with Medicare patients in July 2018.SETTING: Two primary care physician-based practices.INTERVENTION: A trained moderator facilitated two focus group sessions, and used open-ended questions based on the theory of planned behavior to elicit behavioral, normative, and control beliefs associated with implementing personalized prevention plans.MAIN OUTCOME MEASURE: Content analysis of the focus groups' transcribed data was used to identify modal salient beliefs. Transcribed focus group sessions were analyzed utilizing grounded-theory methods for emergent themes.RESULTS: A total of 13 older patients participated in the focus group sessions. Prevalent behavioral beliefs among participants influenced by patient-centered care outcomes included improvement in physical activity, adopting a healthy balanced diet, and weight loss.Interpersonal and environmental disparities influenced commonly reported control factors such as lack of support at home and affordable fitness facilities. Macro-level influences such as physicians and social marketing by insurance providers, and health partners and spousal support were identified as important normative factors.CONCLUSION: Identified salient beliefs were congruent to social determinants of health in Medicare patients. Results of the study demonstrate perceived enablers and barriers of elderly patients regarding implementing health-promoting advice. AWV pharmacists should address perceived barriers to improve attitudes and self-efficacy; and incorporate enabling beliefs into adherence strategies to improve adoption of health recommendations. (10/2019)
  • Malcolm, O, Nelson, A., Modeste, N., Gavaza, P. (2019). Assessing Medicare Patients' Salient Beliefs to Improve Annual Wellness Visit Health Outcomes, The Senior Care Pharmacist, 35(2), 93-106 (10/2019)
  • Alghmdi, Eiman & Beeson, Larry & Medina, Ernesto & Nelson, Anna & dos santos, Hildemar. (2019). The Association of Exergaming and other Activities with the WHO Physical Activity Recommendations among Female Adolescents in Saudi Arabia. International Journal of Advanced Nutritional and Health Science. 7. 325-333. 10.23953/cloud.ijanhs.423.  This cross-sectional study examined the association of the number of hours of exergaming along with other activities and body mass index (BMI) among Saudi female adolescents and explored the possibility of exergaming as an alternative to meet the World Health Organization (WHO) physical activity recommendations. A sample of 200 female students age 10-14 years completed a self- administered lifestyle questionnaire with their parents’ assistance after obtaining parental consent letter. The survey instrument included scales adopted from the validated Adolescent Sedentary Activity Questionnaire (ASAQ) and modified to include questions for exergaming. Anthropometric measurements of height and weight were conducted at school after the completion of the survey. A multiple linear regression model was conducted to examine the association of exergaming with other sedentary activities and BMI. There was a significant association between thenumber of hours of exergaming and lower BMI (p<0.001). Moreover, there was a significant difference between both groups with 98% of the exergamers accumulating ≥60 minutes of physical activity daily vs. 0% among non-exergamers (p<0.001). Exergaming may contribute to reducing sedentary behaviors and increasing physical activity levels and could be an alternative solution to aid in meeting the WHO daily recommendation of physical activities for Saudi girls. (08/2019) (link)
  • Lee, L., Montgomery, S., Gamboa-Maldonado, T., Nelson, A., & Belliard, J. C. (2019). Perceptions of organizational readiness for training and implementation of clinic-based community health workers. Journal of Health Organization and Management. Purpose The purpose of this paper is to assess perceptions of organizational readiness to integrate clinic-based community health workers (cCHWs) between traditional CHWs and potential cCHW employers and their staff in order to inform training and implementation models. Design/methodology/approach A cross-sectional mixed-methods approach evaluated readiness to change perceptions of traditional CHWs and potential employers and their staff. Quantitative methods included a printed survey for CHWs and online surveys in Qualtrics for employers/staff. Data were analyzed using SPSS software. Qualitative data were collected via focus groups and key informant interviews. Data were analyzed with NVIVO 11 Plus software. Findings CHWs and employers and staff were statistically different in their perceptions on appropriateness, management support and change efficacy (p<0.0001, 0.0134 and 0.0020, respectively). Yet, their differences lay within the general range of agreement for cCHW integration (4=somewhat agree to 6=strongly agree). Three themes emerged from the interviews which provided greater insight into their differences and commonalities: perspectives on patient-centered care, organizational systems and scope of practice, and training, experiences and expectations. Originality/value Community health workers serve to fill the gaps in the social and health care systems. They are an innovation as an emerging workforce in health care settings. Health care organizations need to learn how to integrate paraprofessionals such as cCHWs. Understanding readiness to adopt the integration of cCHWs into clinical settings will help prepare systems through trainings and adapting organizational processes that help build capacity for successful and sustainable integration. (05/2019)
  • Lewis, C. M., Gamboa-Maldonado, T., Belliard, J. C., Nelson, A., & Montgomery, S. (2019). Preparing for Community Health Worker Integration Into Clinical Care Teams Through an Understanding of Patient and Community Health Worker Readiness and Intent. The Journal of ambulatory care management42(1), 37-46. There is a rising demand to expand the successful roles community health workers (CHWs) offer into clinical settings (clinic-based community health worker [cCHW]) to support patient services. Using survey data, we evaluated patient and CHW readiness and intent to adopt cCHW clinical care integration. We found CHW and patient readiness to become or utilize a cCHW significantly predicted CHW and patient intent to become or utilize a cCHW; however, in our study, CHWs experienced greater readiness to serve as cCHWs than did patients to utilize cCHWs.COMMUNITY HEALTH WORKERS (CHWs) function as liaisons between health care systems, social services, and the community to facility health care access and care delivery (American Public Health Association, 2016Health Resources and Services Administration Bureau of Health Professions, 2007). There are 3 primary models for utilization of CHWs: (1) CHWs managed through community-based, nonprofit organizations; (2) CHWs managed by organizations that function at the intersection between health systems and communities; and (3) CHWs as extensions of hospital systems. The first 2 approaches reflect traditional CHW roles. The third approach blends these roles to expand the health care system's reach (Singh & Chokshi, 2013). As financing and delivery in public health continue to evolve, there is an opportunity to broaden the clinical care team, allowing expansion of the traditional CHW role into health care settings as clinic-based CHWs (cCHWs) (Balcazar et al., 2011Volkmann & Castanares, 2011). The cCHW, hired by and based out of hospitals or clinic centers, can provide relevant patient connection to inform the development and implementation of an effective patient care plan (Martinez et al., 2011). Initial cCHW studies demonstrate that cCHWs can provide valuable assistance in integrated behavioral health, team-based care, panel management, barrier-free access, and customer-driven care (Volkmann & Castanares, 2011), with positive effects on patient health outcomes, such as improved chronic care management, increased access to health care, and increased compliance with preventive care recommendations (Findley et al., 2014Hostetter & Klein, 2015Kenya et al., 2013Martinez et al., 2011). Despite these successes, many hospitals and clinics struggle to successfully incorporate cCHWs into their care teams. This is due, in part, to professional team members' fear of cCHW preparedness to correctly act within the boundaries of their role. Because of the growing interest in cCHWs, and in response to these concerns, efforts are underway to implement cCHW training programs and to investigate best practices for cCHW integration into clinical care teams (Community Clinic Inc, 2015Kapheim & Campbell, 2014Zahn et al., 2012). (01/2019) (link)
  • Lewis, C. M., Gamboa-Maldonado, T., Belliard, J. C., Nelson, A., & Montgomery, S. (2019). Patient and Community Health Worker Perceptions of Community Health Worker Clinical Integration. Journal of community health44(1), 159-168. Traditional community health workers (CHWs) are expanding their role into clinical settings (cCHW) to support patients with care coordination and advocacy services. We investigated the potential to integrate cCHWs, via evaluation of patients' and CHWs' key demographics, needs, and abilities. This mixed-methods study, including adult patients and CHWs, was conducted in the Inland Valley of Southern California, between 2016 and 2017. Survey data, key informant interviews, and focus group discussions were evaluated to compare patient/CHW core demographics, and contrast patient-identified healthcare needs against CHW-identified cCHW service capabilities. Quantitative data were evaluated descriptively and bi-variably using two-sample independent t tests and Pearson's Chi square tests. Qualitative data were coded for emerging themes using a priori and standard grounded theory methods. Patients and CHWs were significantly similar in age, education, and income, but significantly differed in gender, race, United States generation, and marital status. For all healthcare-related services in which patients and CHWs exhibited significant differences, the odds CHWs perceived themselves capable of performing services were greater than patients' stated need of services. Patients and CHWs overlapped regarding their expectations of cCHWs. Although patients and CHWs differed somewhat, they shared many of the same expectations for cCHW integration. This information is critical to further contextualize cCHW training programs and emphasizes the need to education patients about this exciting new form of healthcare delivery. The active role of cCHWs in the clinical care team and the community may expand patient access to preventive healthcare, improve care quality, and minimize health inequities. (01/2019)
  • Nelson, A, de Leon, A, Modeste, N, Marshak, H.H., Banta, J., Shah, H. (2018), Association of Covered California and healthcare access and utilization among Latino population. Californian Journal of Health Promotion, 16(2), 32-43. Background and Purpose: The Patient Protection and Affordable Care Act resulted in establishment of Covered California (Covered CA), a marketplace providing federally subsidized health insurance in California. This study explored whether obtaining Covered CA coverage improves healthcare access and utilization among Latinos, and whether acculturation plays a role in utilization of healthcare. Methods: 270 Latino adults in San Diego community completed a self-report survey. Results: Those with Covered CA were significantly more likely to have a main provider (p<.0005), to select doctor’s office as location for services (p<.05), and significantly less likely (p<.0005) to report cost as an obstacle to care compared to uninsured participants. The more acculturated group was more likely to report receiving care at a doctor’s office (p<.05). Those who were less acculturated were more likely to report cost as an obstacle to care (p<.05). However, no significant associations were found between acculturation or insurance type and utilization of healthcare. Conclusion: Although health insurance and higher levels of acculturation do improve access, the study did not find their significant association with utilization of provider visits. Our results suggest that healthcare providers might want to consider additional factors to improve utilization of services instead of mainly emphasizing insurance. (12/2018) (link)
  • Nelson, A., Modeste, N., Hopp Marshak, H., & Hopp, J. W. (2015). Saudi women's beliefs on the use of car infant restraints: a qualitative study. Traffic injury prevention16(3), 240-245. OBJECTIVE. The focus of this study was to identify the salient beliefs of pregnant women in Saudi Arabia, which may influence their intentions to use infant restraints for their children. These beliefs were later used to inform a subsequent quantitative study.METHODS. This qualitative study employed Ajzen's theory of planned behavior to elicit the salient behavioral, normative and control beliefs of Saudi pregnant women regarding the use of infant restraints for their future children. Twenty-five pregnant women participated in two focus groups conducted in June, 2013 in Dallah Hospital in Riyadh. RESULTS. Lack of health education and law enforcement, pressure of culture and traditions, counsel from family, specifically from husbands and mothers, desire to stay close to the child, family size or car size were key factors in deciding whether or not to use car seats; high cost of car seats was not. CONCLUSIONS. Aside from providing awareness to future mothers and the general public, health interventions should target the specific beliefs identified in this study. Since participants identified husbands as significant referents, further studies are needed to examine the husbands' attitudes and beliefs. (08/2015) (link)
  • Nelson Anna, Modeste Naomi N, Marshak Helen H, & Hopp Joyce W. (2014). Using the theory of planned behavior to predict infant restraint use in Saudi Arabia. Saudi Medical Journal, 35(9), 959-966. Objectives: To determine whether the theory of planned behavior (TPB) predicted intent of child restraint system (CRS) use among pregnant women in the Kingdom of Saudi Arabia (KSA). Methods: In this cross-sectional study conducted in Dallah Hospital, Riyadh, KSA during June-July 2013, 196 pregnant women completed surveys assessing their beliefs regarding CRS. Simultaneous observations were conducted among a different sample of 150 women to determine CRS usage at hospital discharge following maternity stay. Results: Logistic regression model with TPB constructs and covariates as predictors of CRS usage intent was significant (chi(2)=64.986, p<0.0001) and predicted 38% of intent. There was an increase in odds of intent for attitudes (31.5%, p<0.05), subjective norm (55.3%, p<0.001), and perceived behavioral control (76.9%, p<0.001). The 3 logistic regression models testing the association of the relevant set of composite belief scores were also significant for attitudes (chi(2)=16.803, p<0.05), subjective norm (chi(2)=29.681, p<0.0001), and perceived behavioral control (chi(2)=20.516, p<0.05). The behavioral observation showed that none of the 150 women observed used CRS for their newborn at discharge. Conclusion: The TPB constructs were significantly and independently associated with higher intent for CRS usage. While TPB appears to be a useful tool to identify beliefs related to CRS usage intentions in KSA, the results of the separate behavioral observation indicate that intentions may not be related to the actual usage of CRS in the Kingdom. Further studies are recommended to examine this association. (09/2014)

Books and Chapters

  • Hopkins, G.L., McBride, D.C., Duffy, J., Gleason, P.C., Nelson, A. and Terry-McElrath, Y. (2018).  The Value of Community Service Engagement in Lowering High-Risk Behaviors among Adolescents in Alaska.  In Y. Terry-McElrath, C.J. VanderWall, A.M. Baltazar, and D.J.B. Trim (Eds.), Promoting the Public Good:  Policy in the Public Square and the Church (pp. 279-288).  Corranbong New South Wales, Australia: Avondale Academic Press. (04/2019)


  • Nelson RD, Alhubaishi, F, Nelson, A. NBRC - Secure Self Assessment Tests: Saudi Arabia Experience. Respiratory Care. 2010;55(11):1539. Background: Respiratory Therapist (Specialist) programs in Saudi Arabia have no standardized external board requirement. The 1st generation of Saudi respiratory therapists was eligible for the National Board for Respiratory Care (NBRC) through the pioneering program of Loma Linda University (LLU). About 1/4th of Saudi respiratory therapists are credentialed by the NBRC and the rest not eligible. The current generation of Saudi respiratory therapists practice with a fee-based registration (no exam) through the Saudi Commission for Health Specialties (SCHS). LLU permits a Baccalaureate Certificate in Respiratory Care option for Saudi university respiratory care graduates integrated within LLU’s entry level BS degree. wRRT SAE data was extracted to see if Saudi respiratory care graduate applicants were already meeting the cut scores of the Commission on Accreditation for Respiratory Care (CoARC) and the NBRC. Material and methods: 2008-2009 accepted applicants were included in the study and were given the wRRT SAE. Data from traditional 4 year BS students was excluded. Successful certificate graduates took a different and subsequent year’s wRRT SAE. Format: proctored, secure, online.wRRT SAE Results: Scores from 2008 wRRT SAE Entry: 43% (n=12) > NBRC cut with 79% (n=22) > CoARC cut. Senior students on the 2009 wRRT SAE: 75% (n = 15) > NBRC cut with 100% (n= 20) > CoARC cut. Certificate seniors scoring < NBRC cut score were not allowed a Certificate of Completion but results were included in this study. Conclusion: This initial experience supports graduate success if an NBRC equivalent international board could be offered by the SCHS for outcomes assessment, to promote career protection and for patient safety. Further study is warranted with more wRRT SAE examinees and to study use of the Clinical Simulation SAE. Sponsored Research - None (12/2010)