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Associations Among Psychosocial Factors, Health-Related Quality Of Life, And Adherence In Pediatric Inflammatory Bowel Disease, Cecelia I. Nelson

Graduate Theses, Dissertations, and Problem Reports

Inflammatory Bowel Disease (IBD) is a prevalent disorder among youth in the United States. IBD is one of the leading causes of chronic pain in adolescence and symptoms can lead to reduced quality of life, social embarrassment, and lower self-esteem. Adherence to medical regimens for IBD is incredibly important to prevent morbidity, mortality, and impaired health-related quality of life (HRQOL). However, adolescents struggle generally with adherence and the regimen for IBD can be complicated and include aversive side effects. Psychological factors, such as depressive symptoms, are key factors associated with non-adherence. Nevertheless, gut-specific anxiety (GSA) is a psychological factor that …

Associations Among Executive Functioning, Family Functioning, Adolescent Responsibility, And Adherence In Pediatric Inflammatory Bowel Disease, Cecily Newel Conour

Graduate Theses, Dissertations, and Problem Reports

Background: Inflammatory Bowel Disease (IBD) is a common cause of chronic pain for adolescents in the United States. Adherence to the treatment regimen is a significant concern, particularly for adolescents. Barriers to adherence are varied, but include cognitive factors, such as forgetting. Parent involvement is associated with increased adherence in this population, though adolescent involvement is less studied. Family functioning is associated with adherence to medication regimen across pediatric chronic illnesses, including IBD treatment regimen. To better inform clinical care, this study aims to understand the relations among adolescent’s responsibility, executive functioning, family functioning, and adherence. Methods: The current study …

Using A Single Measure To Assess Adherence And Differentiation In Family Therapy For Adolescent Externalizing Problems, Stephanie Violante

Theses and Dissertations

Family therapy is considered a well-established treatment approach for adolescent externalizing problems; however, research examining its effectiveness when delivered in routine practice settings has produced mixed results. The accurate interpretation of these inconsistent results requires an understanding of what therapeutic techniques were delivered, including those that were prescribed (i.e., adherence) and those that were non-prescribed (i.e., differentiation), suggesting the need for a measure that can concurrently assess treatment adherence and differentiation. The current study examined the extent to which an observational measure of an array of therapeutic techniques for youth emotional and behavioral problems (the Therapy Process Observational Coding System …

Predicting Medication Adherence Patterns During The Maintenance Phase Of Treatment For Pediatric Leukemia And Lymphoma: A Model Of Individual- And Family-Level Factors, Stephanie M. Romo

Theses and Dissertations

Adherence during the maintenance phase of pediatric cancer treatment is critical to prevent relapse and ensure long-term, event-free survival. Yet, little research has been done to examine individual- and family-level factors that may relate to adherence during the maintenance phase of treatment, particularly among Latinx patients. This is surprising given findings demonstrating that children who miss more than 5% of their prescribed oral chemotherapy medicine, most commonly 6-mercaptopurine (6MP), are 2.5-2.7 times more likely to relapse than children who take 95% or more of their prescribed 6MP. Pediatric cancer patients face unique adherence challenges given the importance of family involvement …

Adherence To Dietary Recommendations For Adolescents With Cystic Fibrosis, Kristine M. Durkin

Graduate Theses, Dissertations, and Problem Reports

Background: Adhering to dietary recommendations and nutritional supplements to ensure adequate absorption of nutrients and malnutrition plays an important role in the health of patients with cystic fibrosis (CF). Non-adherence to the CF care regimen, including nutritional recommendations, is high in adolescents. Therefore, the overall goal of this study was to identify factors related to adherence to nutritional recommendations in adolescents with CF.

Method: A total of 42 adolescents (ages 12-18) were recruited from 5 CF centers across the US. Adolescents completed surveys measuring body image/satisfaction, health literacy, perceived barriers to enzyme use, and self-efficacy, as well as the quality …

Association Of Anxiety And Executive Function With Attendance And Fitness Improvement In Cardiac Rehabilitation, William A. Middleton

Graduate College Dissertations and Theses

Psychological factors such as anxiety and executive function (EF) may impact patient health outcomes from cardiac rehabilitation (CR). High anxiety and low executive function could reduce attendance or impede fitness improvements yielded from CR. Other research on exercise performance suggests, in certain circumstances, moderate levels of anxiety can be beneficial towards fitness gains. The current study evaluated the associations of anxiety and EF with attendance and fitness improvement in CR through retrospective analyses of two datasets from studies conducted at the University of Vermont Medical Center CR program. One sample contained a representative sample of CR patients, and the other, …

The Efficacy Of Brief Attitudinal Familism And Body Image Interventions On Diet And Exercise Self-Monitoring Adherence In Hispanic/Latinx Women, Kelsey Nicole Serier

Psychology ETDs

Addressing health disparities in overweight/obesity is a key public health issue. Research supports the efficacy of behavioral weight loss (BWL) interventions, however, adherence to these interventions is often low, which negatively impacts outcomes. The efficacy of BWL interventions is consistently lower among communities of color. Thus, there is a strong need to design and test interventions that are culturally sensitive and address predictors of BWL adherence in diverse groups. Previous research suggests that for Hispanic/Latinx women with overweight/obesity, attitudinal familism (“family comes first”) and body dissatisfaction were informative in predicting BWL adherence. The current study builds on this previous research …

Attitudes Toward Mindfulness And Adherence In Chronic Pain Management, Sarah Johnson

Global Honors Theses

Chronic pain is a global public health problem, affecting 10-25% of the population. Mindfulness is an effective treatment but requires consistency. Because of its benefit, it is important to examine obstacles to mindfulness practice. In order to determine if negative attitudes toward mindfulness are related to non-adherence, 748 adults with chronic pain were recruited to fill out a series of questionnaires assessing treatment adherence and attitudes toward mindfulness. We found that positive attitudes toward mindfulness predicted reduced adherence. However, those who had more positive feelings toward mindfulness made more attempts at the therapy. Upper and middle-class participants had more positive …

Adherence To A Mindfulness App For College Students With Depression: Patterns, Predictors, And Outcomes, Brynn Marie Huguenel

Dissertations

National trends indicate that mental health concerns, particularly rates of depression, continue to rise on college campuses; however, treatment utilization remains low. Technology-based mental health interventions, such as mental health apps (MHapps), are a promising means of overcoming treatment barriers. MHapps are effective in improving psychological outcomes, but low rates of adherence are a noted limitation. The current study explored patterns of adherence to a MHapp, investigated the bidirectional relation between adherence and depression, and identified motivational predictors of adherence rates. Undergraduate students (N= 66) reporting clinically-elevated depressive symptoms completed a three-month trial using Headspace, a mindfulness MHapp. Patterns of …

Exploring Motivation To Adhere Among Crossfit Exercise Participants, Lauren Elizabeth Falgout

Walden Dissertations and Doctoral Studies

Lack of exercise and obesity are prominent social problems in the U.S. population. Therefore, understanding the experiences that promote or hinder motivation and exercise adherence is important. A total of 15 adult participants who engaged in CrossFit for a minimum of 6 months were recruited for this generic qualitative study using purposeful sampling methods. They responded to an invitation on a social media page for CrossFit participants. They shared their exercise adherence experiences and motivation through semi-structured qualitative interviews. Trustworthiness procedures included reflexive journaling, and member checking. Data analysis proceeded from transcript reading to working with broad themes and phrases …

Changes In Patient Knowledge And Adherence To Glaucoma Treatment After Educational Intervention, Stella Stempel

Walden Dissertations and Doctoral Studies

Primary open-angle glaucoma is the most common form of glaucoma and the second-leading cause of preventable blindness worldwide. Although timely diagnosis and proper adherence to therapeutic regimen prevent blindness, patient nonadherence continues to be the greatest challenge to effective treatment. Preliminary research suggested that culturally interactive education delivery may increase patient adherence. However, this education intervention had not occurred with glaucoma treatment. The transtheoretical model of behavior change served as the framework for this study. The research questions addressed the effect that glaucoma education provided by a culturally competent patient navigator had on patient knowledge of glaucoma, adherence to medication …

Decision-Making Involvement, Social Support For Healthy Behaviors, And Nutritional Adherence In Adolescents With Cystic Fibrosis, Jennifer Kelleher

Graduate Theses, Dissertations, and Problem Reports

Background: Adolescents with cystic fibrosis (awCF) exhibit suboptimal adherence to dietary and enzyme recommendations despite the fact that eating a high calorie diet with enzymes significantly improves lung functioning. Furthermore, during adolescence teens and their caregivers begin to negotiate treatment responsibility, shifting treatment tasks to the youth. As such, it is important to understand which aspects of the complex decision-making process (e.g., expressing an opinion, asking for information from parents/adults, making joint decisions with parents) relate to better dietary adherence in adolescents with CF and how parents can best support these healthy behaviors. Thus, this study aimed to identify how …

Physical Therapists Perceptions Of Patient Adherence And Strategies For Facilitating Motivation, Teadora Markovski

Theses and Dissertations

Physical therapists (PTs) are professionally required to undertake a comprehensive examination of their patients and provide consultation within their expertise, yet also have the task to motivate patients to adhere to therapy. Self-determined motivation, as a positive predictor of treatment adherence, can be facilitated by promoting patient autonomy, competence and relatedness. However, a greater understanding is needed of the context specific strategies PT’s can use to facilitate motivation. The purpose of this study is to explore physical therapists’ (PT)s perceptions of the factors affecting patient motivation, strategies and methods to facilitate adherence, and strategies used to satisfy patients basic needs …

Problems With Adherence And Social Stigma In Adolescents With Type 1 Diabetes, Lauralee Davis

Master’s Theses

For adolescents with Type 1 Diabetes the clinical importance of both adherence to disease management and social support from family and friends is apparent. However, the role that family support or peer support plays on adherence to diabetes management or how stigma impacts adherence is still unclear. This study aims to determine differences between the type of support provided by family compared to peers, to examine how possible differences in the type of support impact adherence, to examine how social anxiety and stigma may be related to adherence, and to examine the types of barriers adolescents with Type 1 Diabetes …

Examining The Impact Of Treatment Fidelity On Client Outcomes In A Statewide Implementation Of Parent-Child Interaction Therapy, Mira D H Snider

Graduate Theses, Dissertations, and Problem Reports

Clinician treatment fidelity, consisting of treatment adherence and clinician competence, is commonly assessed during the implementation of evidence-based treatments to ensure that clinicians are delivering care according to an intended service model. Although resources are often expended in fidelity measurement, associations between fidelity and client outcomes has not been well established in the psychotherapy literature. The relationship between clinician fidelity and treatment outcomes was investigated in a longitudinal sample of clinicians (n = 17) and parent-child dyads (n = 32) following a statewide implementation of Parent-Child Interaction Therapy. Observer-rated measures of adherence and coaching competence collected from early …

Assessing Facilitator Adherence For The Delivery Of Cognitive Training Programs To Older Adults, Lydia Fry

All Graduate Theses, Dissertations, and Other Capstone Projects

The majority of psychological research has focused on outcomes of intervention, while there has been relatively little focus on measuring adherence to treatment protocol and how competently interventions are delivered. Issues of adherence and competence apply not only to psychotherapy research, but also in the field of cognitive training. The New England Cognitive Center (NECC) has disseminated manualized cognitive training programs for older adults who may be experiencing varying levels of cognitive decline. The purpose of the current study was to develop measures of adherence and competence for the Active Mind cognitive training program created by the NECC as well …

Does Sharing Information With Friends And Family Cause Men To Adhere More Strongly To Masculine Norms?, Clint E. Johnson

Electronic Theses and Dissertations

It is clear that social influence can elicit conformity to norms (e.g., Asch, 1956). It remains unclear, however, how various relationships elicit differential conformity to masculine norms in particular. In this pre-registered experiment, I tested the hypothesis that when men are asked to reveal their responses on the Conformity to Masculine Norms Inventory (CMNI; Mahalik et al., 2003), men conform more when sharing that identifiable information with others who know them (i.e., “public” conformity), namely friends and family, as compared to sharing that information anonymously with a random stranger (i.e., the anonymous “private” condition). My convenience sample consisted of participants …

The Effects Of Autonomous Motivation And Implementation Planning On Dietary Goal Adherence Among Personal Training Clients, Hannah Allen

All Master's Theses

Personal Fitness Trainers working within their scope of practice are in a unique position to encourage client adherence to dietary changes that are aligned with the Dietary Guidelines for Americans (DGA). Some research shows that the quality of an individual’s motivation may play a role in goal success, and that implementation planning may be an effective goal adherence promotion strategy for those with autonomous motivation. However, little is known regarding this relationship between type of motivation, implementation planning, and goal adherence among personal training clients interested in improving their dietary habits. This 6-week mixed methods study sought out female personal …

A Practice Elements-Based Approach To Adherence Measurement, Stephanie Violante

Theses and Dissertations

The measurement of treatment adherence (i.e., the frequency and thoroughness with which a therapist delivers a treatment as designed) is critical to the field of implementation science, as adherence is often considered an indicator of successful implementation. Most existing instruments of treatment adherence are treatment protocol specific; however, this approach is costly, inefficient, and disallows cross-treatment and cross-study comparisons. Thus, there is a need for adherence instruments that can be used across treatment protocols. It has been suggested that an instrument that captures adherence at the practice element level would meet this need, as it would have utility across protocols …

Cognitive Remediation Of Working Memory Deficits In Children With Chronic Health Conditions: Tailoring Cogmed Training To Address Barriers To Adherence, Kelsey Smith

Theses and Dissertations

Objective: Children with sickle cell disease (SCD) and cancer are at risk for working memory impairment due to the disease and treatment. However, inconsistency in adherence to cognitive training programs conducted with this population suggests that adaptations are necessary in order to improve the effectiveness of this intervention. In addition, it is unclear whether gains in working memory translate to improvement in classroom functioning.

Methods: Children engaged in cognitive training exclusively over the summer in order to improve adherence to Cogmed Working Memory Training. A total of 17 children ages 7- 17 with a diagnosis of SCD (n = 14) …

Sleep, Internalizing Symptoms, Executive Functioning, And Diabetes Outcomes In Adolescents With Type 1 Diabetes Mellitus, Ashley Charlene Moss

Dissertations (1934 -)

Insufficient sleep is a nearly universal problem during adolescence and is likely associated with various biopsychosocial and contextual factors present with this developmental period. Youth with type 1 diabetes mellitus (T1DM) may experience greater sleep difficulties, poorer sleep quality, and greater daytime sleepiness/fatigue compared to healthy youth. Also, sleep difficulties are associated with poorer diabetes outcomes (e.g., treatment adherence). Understanding how sleep may impact illness management during adolescence is critical given increasing rates of non-adherence during this developmental period. Although research suggests poor sleep is associated with decreased neurocognitive functioning and increased internalizing behavior among healthy youth, limited research has …

Psychosocial Mechanisms Of Outcome In Pediatric Psychiatry, Alessandro S. De Nadai

USF Tampa Graduate Theses and Dissertations

Nearly half of all youths experience a mental health disorder at some point during childhood (Merikangas et al., 2010). Pediatric psychopathology is associated with a substantial amount of impairment in the school, social, and home domains, and such symptoms can have adverse impacts on subsequent development (Beauchaine & Hinshaw, 2013; Patel, Flisher, Hetrick, & McGorry, 2007). Fortunately, a number of medications have demonstrated efficacy in treating a number of mental health conditions (Martin, Scahill, & Kratochvil, 2010). Despite these demonstrated effects, treatment response is often incomplete, and the mechanisms by which pharmacotherapy lead to behavior change are not well understood. …

Family Consultation To Reduce Early Hospital Readmissions Among Patients With End-Stage Renal Disease: A Randomized Clinical Trial, Matthew James Jasinski

Wayne State University Dissertations

Background: The U.S. Centers for Medicare and Medicaid Services have mandated reducing early hospital readmissions (i.e., within 30 days of discharge) to both improve patient care and reduce expenses. Patients with end-stage renal disease (ESRD) have relatively high early readmission rates, due in part to their complex medical regimens but also cognitive impairment, health literacy problems, and lack of social support. We developed a brief family consultation intervention to address these problems and tested its ability to reduce early readmissions among patients with ESRD.

Method: 120 hospitalized adults with ESRD (M age = 57.5 years; 50% male; 86% Black, 12% …

Sticking To The Recipe: How Do Adherence And Differentiation To A Cbt Protocol Affect Client Outcomes In Youths With Anxiety?, Ruben G. Martinez

Theses and Dissertations

Objective: Understanding the pathways through which treatments work to change symptom and diagnostic outcomes is important to the development and delivery of evidence-based treatments. This study assessed the extent to which adherence (therapist’s delivery of prescribed therapeutic interventions) and differentiation (therapist’s delivery of non-prescribed therapeutic interventions) to Coping Cat, a CBT program, affected client symptom and diagnostic outcomes. Method: The Therapy Process Observational Coding System for Child Psychotherapy – Revised Strategies Scale (McLeod et al., 2015) was used to characterize therapeutic interventions delivered within and outside of the Coping Cat program with youths aged 7-15 receiving treatment in one efficacy …

Acceptance And Commitment Therapy (Act) And Physical Therapy Adherence, Jennifer Ashley Battles

MSU Graduate Theses

Adherence to physical therapy rehabilitation is one of the most common issues physical therapists face with patients. Methods to improve physical therapy adherence have only been mildly successful, and many modalities fail to address psychological components that affect compliance. Acceptance and Commitment Therapy (ACT) is a third wave behavior analytic therapy that has recently been utilized to influence health behavior change through emphasizing mindfulness, values, and psychological. The current study evaluates the effectiveness of a brief ACT intervention on physical therapy adherence, including compliance with prescribed home exercises and attendance at sessions. Participants (n = 4) with a range of …

A Concurrent And Longitudinal Examination Of A Bio-Neuropsychosocial Model For Predicting Medical Adherence And Responsibility In Youth With Spina Bifida, Alexandra Psihogios

Dissertations

Objective: The purpose of this multi-source, multi-method study was to examine biological, neuropsychological, and social (i.e., family dynamics and social adjustment) predictors of medical adherence and responsibility in a pediatric spina bifida (SB) sample.

Methods: One hundred forty youth with SB (53.6% female; M age = 11.40 at Time 1) and their caregivers participated in two study time points (Time 2 occurred two years after Time 1). Youth and their caregivers completed several questionnaires regarding medical self-management, family functioning, child social adjustment, and child executive functioning. Teachers completed a parallel measure of child executive functioning. Children completed a brief battery …

Young Adults Adherence To Cancer Treatment As Compared To Older Adults, Laurie Ann Cox

Walden Dissertations and Doctoral Studies

As compared to pediatric and older adult cancer patients, young adults are the only oncology group that has not demonstrated an increase in survival rates. Low treatment adherence rates have been one explanation for this discrepancy, although this hypothesis has not been explored specifically. Guided by the biopsychosocial model of health and wellness, this study compared the treatment adherence rates of 46 young adult cancer patients (ages 18-39 years) to 46 older adult cancer patients (ages 40 years and older). Adherence was measured by a dichotomized variable, as yes/no, adhering to radiation treatment and follow-up appointments recommended by the physician, …

Medication Non-Adherence In Community Dwelling Older Adults With Dementia: An Educational Intervention For Family Caregivers, Nika Renee George

Dissertations

Older adults with neurocognitive disorders are at high risk for medication non-adherence, while being vulnerable to great injury from regimen deviations. Informal caregivers often aid in healthcare management for these individuals. The current study compared the efficacy of two online health education interventions designed to increase caregiver health related knowledge for use with care recipients. Women (N=35) assisting a cognitively impaired older person with medications were randomly assigned to one of two online health education conditions (1) written materials and narrative vignettes depicting actors encountering common medication challenges or (2) written materials and didactic video clips of information from medical …

Adherence To And Competence In Cognitive Behavioral Therapy For Youth Anxiety: Psychometric Evaluation, Cassidy C. Arnold

Theses and Dissertations

Treatment integrity—the extent to which a treatment is delivered as it was intended—has long been recognized as critically important in treatment evaluation research, but has garnered increased attention in recent years within the context of dissemination and implementation science. However, the field’s development has been hindered by inadequate measurement tools. This project is focused on developing and evaluating the psychometric strength of two measures of treatment integrity. To evaluate the psychometric strength of the Cognitive-Behavioral Therapy for Youth Anxiety Therapist Adherence Scale (CBAY-A)and the Cognitive-Behavioral Therapy for Youth Anxiety Therapist Competence Scale (CBAY-C), 954 psychotherapy sessions from two treatment evaluation …

The Contribution Of Parent Psychosocial Functioning To Parental Monitoring, Youth Adherence, And Glycemic Control During Adolescence, Elizabeth M. Robinson

Theses and Dissertations

Objective: Type 1 diabetes is one of the most common pediatric chronic illnesses. Adolescents are at risk for poorer adherence and in turn, poorer glycemic control; however, youth whose parents remain involved in diabetes care are in better control. A parent’s level of involvement is dependent in part upon his or her own social and emotional functioning. Much is known about the link between separate aspects of parent psychosocial functioning (e.g., depressive symptoms, parental stress) and parent involvement in diabetes care, adherence, and glycemic control. However, no study to our knowledge has examined these constructs simultaneously as they interrelate …