Richard M. Fairbanks School of Public Health Theses and Dissertations

Permanent URI for this collection

https://hdl.handle.net/1805/4859

Browse

Browsing Richard M. Fairbanks School of Public Health Theses and Dissertations by Author "Archer, Sarah E."

Now showing 1 - 3 of 3
  • Thumbnail Image
    Item
    Enabling Policy to Advance Black Maternal Health Equity Through the Use of Doulas in Indiana
    (2024-08) Brown, Jenell Nicole; Archer, Sarah E.; Jackson, Emily; Walter-McCabe, Heather
    Disproportionately high maternal mortality rates (MMR) among Black women continue to be a significant public health equity concern in the United States, particularly in the state of Indiana, where Black women experienced the highest MMR at 156.3 deaths per 100,000 live births in 2021. In comparison, White women experienced 90.7 deaths per 100,000 live births in the same year (Indiana Department of Health, 2024). Equity recognizes that high-risk populations have different needs and disadvantages and aims to address disparities by providing targeted opportunities, resources, and support to account for these differences. Health equity is achieved when everyone can attain their full potential for health and well-being (World Health Organization, n.d.). Equality refers to equal access for everyone, which in turn perpetuates inequities. While not the sole solution to Indiana’s Black maternal health equity crisis, Doulas are an evidence-based solution to reducing racial disparities in maternal health outcomes. Building on the current body of literature, this dissertation explores how Indiana can enable policy to expand access to Doula care and integrate Doula services into maternal healthcare systems. Through the employment of qualitative, semi-structured interviews with Doulas and other key stakeholders, findings identified that current barriers in Indiana include a lack of a supportive environment to legitimize the profession, lack of Medicaid reimbursement and inadequate private insurance coverage, processes that “medicalize” Doula care, and the need for collaborative efforts with Doulas when crafting Doula-related policies. By leveraging a policy and stakeholder analysis, an implementation plan was developed to provide recommendations on how Indiana policy can advance Black maternal health equity through the use of Doulas. This research's importance lies in its potential to inform policy and practice in Indiana and provide foundational information for other states that have yet to begin incorporating Doula care into policy to advance maternal health equity.
  • Thumbnail Image
    Item
    Examining Policy Solutions to Address Barriers Impeding the Adoption of Universal Adverse Childhood Experiences (ACE) Screening in Pediatric Primary Care Settings
    (2024-05) Ball, Tristyn Denyse; Archer, Sarah E.; Coburn, Kenneth; Jones-Kelley, Helen
    Over 93% of adults in Western Ohio have experienced at least one adverse childhood experience (ACE). This figure is significantly higher than the national average of 61% of adults who have experienced at least one ACE. Exposure to adversity in childhood increases levels of toxic stress, impacts brain development, and creates a predisposition for a variety of psychological and physiological ailments known as ACEassociated health conditions. While many pediatric healthcare professionals understand the implications associated with ACE exposure, the integration of ACE screening in pediatric healthcare facilities in the region is limited. The study aimed to determine the barriers to implementing ACE screening in pediatric primary care settings in Western Ohio and identify policy levers to increase the integration of ACE screening and care among pediatric healthcare professionals. The study used thematic analysis to identify themes in the results, as there is limited existing research in this area. Key informant interviews were conducted with local pediatric healthcare professionals to determine their views regarding the potential barriers and facilitators associated with implementing universal ACE screening in their organizations. The results concluded that barriers around workforce shortages, perceived diminished patient relationships, time, ethics, reimbursement, and overall discomfort lead to low screening integration in local pediatric healthcare organizations. Ohio’s current pediatric healthcare infrastructure can be leveraged to ease the implementation of the statewide initiative. ACE screening can be integrated into Ohio’s Early and Periodic Screening, Diagnosis, and Treatment program, which provides guidelines for developmental screening. Further, advocacy for the integration of ACE screening in the American Academy of Pediatrics Bright Future Guidelines will increase the utilization of the tool. The current state General Assembly has introduced legislation focusing on ACEs, and with new streams of state tax revenue, the policy window to advance this initiative is open.
  • Thumbnail Image
    Item
    Expanding Access to Novel Antibacterial Therapeutics in Low- and Middle-Income Countries: Leveraging Donor-Funded Pooled Procurement
    (2024-07) Swenson, Jessica Emily; Archer, Sarah E.; Coburn, Kenneth; Houchens, Christopher
    Antibiotics are one of the most significant advances of modern medicine, however, bacteria continue to evolve faster than new antibacterials are being developed. In 2019, 1.27 million deaths were directly attributable to bacterial antimicrobial resistance (AMR) globally—more than either HIV or malaria that year—with the highest death rates occurring in low- and middle-income countries (LMICs) (Murray et al., 2022). Because of limited returns on investment, multinational pharmaceutical companies have largely abandoned antibacterial development. This void has been filled by smaller product developers vastly located in the United States and Europe who have limited resources and experience in seeking licensure and commercialization in LMICs, where the need is greatest (WHO, 2021). When these smaller developers only seek regulatory approval in the high-income countries where they are located, they often cannot sell enough of their product to avoid bankruptcy because of the low volume of patients with susceptible infections there (Alm & Gallant, 2020). Building on the current body of literature, this study assessed the factors necessary to leverage an existing donor-funded pooled procurement strategy to expand its scope to include novel antibacterial therapeutics, with the goal of expanding access to these products in LMICs. Market access expansion would bring new products to patients where they are needed most while also ensuring financial viability for developers of novel antibacterials who struggle to retain financial solvency. A qualitative case study gathering expertise from individuals familiar with current procurement practices for novel antibacterials and donor-funded global procurement strategies for other infectious disease therapeutics elucidated that the Global Drug Facility (GDF) is the entity best positioned to expand scope to include novel antibacterials for AMR. An eight-stage action plan was developed to provide recommended actions, resource needs, measures of success, and an anticipated timeline over the next decade for GDF and a consortium of technical partners to implement the scope expansion. By pairing a market-driven access expansion initiative with a pragmatic approach to support financial sustainability of product developers, these critical medicines can be available for patients globally, and the AMR pipeline can support the demand for new antibacterials for decades to come.