Psychology Commons^™

Exploring The Role Of Motivational Interviewing In Adolescent Patient-Provider Communication About Type 1 Diabetes, Laura J. Caccavale

Theses and Dissertations

Type 1 diabetes (T1D) is one of the most common pediatric chronic illnesses. Glycemic control among patients with T1D often deteriorates during adolescence; yet little is known about the most effective way for providers to communicate with adolescents to prevent this decline. Given the importance of effective communication, examination of effective patient-provider communication strategies is needed. The current investigation used Motivational Interviewing (MI) as a framework to help characterize naturally-occurring adolescent patient-provider communication in medical encounters and examined the relations between provider communication and T1D self-management and control.

Participants were five pediatric endocrine providers and 55 adolescents with T1D (49% …

Effects Of Cumulative Risk On Asthma Outcomes In Urban Children And Adolescents, Samantha A. Miadich

Theses and Dissertations

Pediatric asthma disproportionately affects racial/ethnic minority children and children living in low-income, urban areas. Many families living in low-income, urban areas experience a number of stressors that can place children/adolescents at risk for worse asthma outcomes. This study examined the impact of a cumulative risk model of stressors (e.g., ED visits, quick-relief medication use, lung function, asthma control, QOL) in urban children (7-12 years) with persistent asthma. This study further aimed to examine both the original cumulative risk model and an adolescent-specific cumulative risk model as predictors of asthma outcomes in a sample of 60 adolescents (13-17 years). Asthma-related caregiver …

Mechanisms Of Motivational Interviewing In A Parent-Focused Pediatric Obesity Intervention, Nadia Islam

Theses and Dissertations

Pediatric obesity is a major public health epidemic with serious physical and psychological consequences. Difficulty engaging families in treatment is a significant obstacle in addressing pediatric obesity, especially among underserved populations. Motivational interviewing (MI) is a collaborative, person-centered communication style that has been shown to reduce attrition, increase attendance, and improve patient treatment adherence; however, little is known about the process of MI and how it improves treatment engagement. This study examined clinician and parent language in a pre-treatment MI session that increased initial engagement in a parent- focused pediatric obesity intervention (N= 81). Results showed that increased parent change …

Predictors Of Substance Use, Relationship Arrangements And Intimacy Expectancies Among Gay Couples And Associations To Erikson Intimacy Development, Jonathan Lopez Matos

Theses and Dissertations

This study explored relationship arrangements, intimacy expectancies of substance use and the potential role of Eriksonian intimacy development on drug use among gay and bisexual men. Data were collected from 339 partnered gay/bisexual men across the United States. Measures addressed arrangement type, intimacy expectancies, Eriksonian intimacy and drug use.

Rage And Social Media: The Effect Of Social Media On Perceptions Of Racism, Stress Appraisal, And Anger Expression Among Young African American Adults, Morgan Maxwell

Theses and Dissertations

Recently, social media has become a sociopolitical hotbed for discussions of racism. However, no extant studies have questioned if social media use increases how often African Americans vicariously and/or personally experience discrimination in America. The current study sought to answer this question. By examining the relationships between social media use, general stress, race-related stress, and anger expression, and the mediating role of perceived racism, this study explored if frequent social media use influences young African American adults’: a) perceptions of racism, b) experiences with general and race-related stress, and/or c) expressions of anger. The current study conducted an online survey …

An Examination Of The Technical And Relational Hypotheses Of Motivational Interviewing In A Sample Of African American Adolescent Girls Seeking Obesity Treatment, Rachel L. Boutte

Theses and Dissertations

Adolescent obesity has increased exponentially over the past three decades in the United States. In response, behavioral interventions have been developed and implemented to address this epidemic; however, treatment adherence is often suboptimal. Motivational interviewing (MI) is a directive, person centered approach to reducing patient ambivalence about change, which has been shown to increase engagement in obesity interventions. The current study investigated the underlying process of MI by exploring two different, but related pathways that explain how change happens (e.g., the technical and relational hypotheses) in the context of a multidisciplinary obesity intervention with African American adolescent girls (N …

Chronic Pain Causal Attributions In An Interdisciplinary Primary Care Clinic: Patient-Provider And Provider-Provider Discrepancies, Bryan Jensen

Theses and Dissertations

The purpose of the present study was to investigate the influence of pain causal attributions on patient pain-related functioning, treatment engagement, and clinical outcomes. Additionally, the impact of discordant pain causal attributions between patients and their providers as well as between interdisciplinary providers was examined. Patients rated their pain functioning and causal pain attributions during a regular clinic visit. Following the patient’s visit both the behavioral medicine provider and internal medicine resident provided ratings of similar pain-related functioning domains and causal attributions. Follow-up data were collected from the electronic medical record three months following that clinic visit. Overall, results revealed …

Non-Medical Use Of Prescription Stimulants For Weight Loss: Predictors, Consequences, And Implications For Intervention In A National Young Adult Sample, Amy J. Jeffers

Theses and Dissertations

The non-medical use of prescription drugs is an important public health concern. Non-medical use of prescription stimulants (NMUPS), specifically medications used to treat Attention Deficit Hyperactivity Disorder (ADHD), is particularly concerning. One timely concern regarding NMUPS, especially among young adults, is their role in appetite suppression/weight loss. Indeed, some individuals are motivated to misuse such drugs for the purpose of losing weight. Engaging in NMUPS for weight loss has been examined only minimally in the research literature. However, extant data demonstrate that this behavior is associated with other unhealthy behaviors and poor psychosocial health. Limitations of prior research include the …

Exploring The Role Of Intersectionality On Cardiovascular Disease Risk In Sexual Minorities, Leia Harper

Theses and Dissertations

Background: Previous research has shown that sexual minority individuals (SM) are twice as likely to smoke, twice as likely to be overweight or obese, and less likely to be physically active than heterosexual persons; all of which place SMs at an increased risk for cardiovascular disease (CVD). While information on CVD risk by race/ethnicity and socioeconomic status is well documented, there is scant literature examining race, gender, and the potential CVD risk in SMs. The purpose of this study was to examine CVD risk in sexual minorities.

Method: The current study used data from the National Longitudinal Study of Adolescent …

Pathways Linking Sleep Timing To Obesity In Midlife Women, Dana R. Schreiber

Theses and Dissertations

Midlife women are vulnerable to developing obesity. Both sleep timing and negative emotion are risk factors, yet limited research has explored their role on weight outcomes in this population. The current investigation explored the association of sleep timing (i.e., mean sleep time, sleep time variability) and obesity (i.e., BMI, waist circumference) in midlife women, considering emotional pathways (i.e., depressive symptoms, anger) that might mediate this association. PROCESS parallel mediation models assessed direct and indirect pathways. In follow-up analyses, sleep duration was explored as an indirect pathway linking sleep timing to obesity. Results demonstrated that sleep timing does not directly predict …

Urban Stressors And Child Asthma: An Examination Of Child And Caregiver Models, Gillian G. Leibach

Theses and Dissertations

The purpose of the present study was to examine how low-income, racial and ethnic minority, urban families experience and manage their child’s asthma. The rationale for this study stems from existing literature on asthma disparities and documented predictors of increased asthma morbidity and mortality. In particular, this study considered how specific types of stress may disproportionately impact low-income, racial and ethnic minority, urban families that have a child with asthma. This study aimed to determine associations between urban stressors (stressful life events, perceived discrimination, subjective socioeconomic status) and child asthma outcomes (emergency department visits, school days missed, asthma control), and …

Factors Predicting African American Renal Patients’ Completion Of The Medical Evaluation Process For Kidney Transplantation, Camilla W. Nonterah

Theses and Dissertations

African Americans (AA) are more susceptible to end-stage renal disease (ESRD) for several reasons. Treatment options for patients with ESRD include dialysis therapy and transplantation, with the latter typically producing better outcomes. AA are less likely to complete the medical evaluation process, which requires patients to consult with doctors and undergo a series of tests and examinations. This study sought to determine the factors that predict completion of the medical evaluation for AA ESRD patients using a mixed methods design. Participants consisted of transplant professionals (N=23) recruited from nine transplant centers in the Mid-Atlantic, Mid-Western and Southeastern parts …

Are You Covered? Examining How Knowledge Of The Patient Protection And Affordable Care Act Influences Use Of Preventive Reproductive Health Services, Ashlee Sawyer

Theses and Dissertations

The Patient Protection and Affordable Care Act (PPACA) expanded access to insurance coverage and health care services for many citizens, and has increased access for women in particular by including preventive reproductive health services as essential health benefits. The current national rates of sexually transmitted infections (STIs), reproductive cancer diagnoses, and unintended pregnancy serve as major areas of concern for women’s health and public health. The present study examined how knowledge of the PPACA influences receipt of preventive reproductive health services among women. Results indicate that higher levels of knowledge of the PPACA are associated with a greater likelihood of …

The Role Of N-Acetyl-L-Cysteine (Nac) As An Adjuvant To Opioid Treatment In Patients With Inadequately Controlled Chronic Neuropathic Pain, Thomas B. Moore

Theses and Dissertations

Introduction. While opioid medications are commonly prescribed for management of neuropathic pain (NP), long-term use has been associated with increased risk for overdose, drug interactions and addiction. New strategies are necessary to better manage chronic pain, thereby reducing need for opioid medications and their associated adverse consequences. N-acetyl-L-cysteine (NAC), an over-the-counter supplement, has shown promise in the treatment of psychiatric and addictive disorders. In addition, NAC has shown promise for reducing physiological signs of NP in laboratory rat models, prompting this study.

Purpose. The present study was an open-label clinical trial of NAC as an adjuvant to opioid treatment for …

Gender And Sexual Health: Applying Gender Role Theory To Men And Women’S Intention To Engage In Sexual Health Information Seeking Behaviors, Ariella R. Tabaac

Theses and Dissertations

The purpose of the present study is to examine the pathways between gender and behavioral intention to engage in sexual HISB through application of the Theory of Planned Behavior (TPB). It was found that feminine and masculine gender role stress differentially influence perceived behavioral control and behavioral attitudes, and that intention to engage in HISB was higher among women than men. Attitudes and PBC significantly predicted behavioral intention in this model. Further, women in the sample were more likely to search for sexual health information, with online sources being the most frequently reported resource. Additionally, past HISB was a significant …

Investigating The Effects Of Obesity Prevention Campaigns, Courtney C. Simpson

Theses and Dissertations

Public health campaigns might not be universally helpful and could have detrimental consequences. The current investigation explored the effects of obesity prevention campaigns. Their impact was assessed using an experiment in which participants were randomized to view either weight focused obesity prevention campaigns or obesity prevention campaigns that did not use weight related terms. Results demonstrated that compared with campaigns without weight related terminology, weight focused campaigns increased negative perceptions of obesity and decreased self-efficacy for health behavior change. No differences in body satisfaction, thin-ideal internalization, state anxiety, or frequency of positive health behaviors were found based on the type …

Use And Perspectives Of A Social Marketing Campaign To Improve Fruit And Vegetable Intake, Allison Palmberg

Theses and Dissertations

The current study evaluated the development and acceptability of a social marketing campaign to improve emerging adults’ fruit and vegetable (FV) intake. A social marketing campaign was developed through focus groups with 24 college students. Materials were implemented in two dining locations at Virginia Commonwealth University. Sales of carrots, apples, and chips were collected in three phases: baseline, implementation of the campaign, and washout. In addition, surveys were collected from 303 diners across all phases and locations. Results indicated an increase in carrot sales, decrease in sales of chips sold with a meal, and mixed findings regarding sales of apples …

An Exploration Of Factors Influencing Attrition From A Pediatric Weight Management Intervention, Melissa Ann Kwitowski

Theses and Dissertations

Childhood obesity is a serious health problem in the United States. Numerous weight management programs attempt to address this issue. However, attrition poses significant treatment efficacy challenges. Understanding attendance and attrition from childhood obesity programs is crucial for effective and appropriate resource utilization. NOURISH+ is a community-based treatment program for parents of overweight and obese children (age 5–11 years, BMI ≥ 85th percentile). The current study investigated attrition from NOURISH+ to enhance understanding of pediatric obesity treatment retention factors. NOURISH+ participants (n=70) completed a questionnaire assessing barriers to adherence and general program feedback. Data were analyzed using frequencies, …

Motivation, Mindfulness, And Metabolic Factors Predicting Adolescent Adherence And Attrition In A Multidisciplinary Weight Management Program, Stephen Trapp

Theses and Dissertations

Estimated rates of obesity are notably high in the United States and pose a significant public health concern. A number of deleterious physical and psychosocial conditions are associated with pediatric obesity and the cost of its treatment is considerable. Accordingly, the number of weight management treatments has increased to meet this growing public health challenge. Unfortunately, insufficient participation in weight management treatment, namely low adherence and high attrition, often impede the effectiveness of these programs. Although the barriers associated with inadequate adherence and elevated rates of attrition are documented, there is a dearth of research on the predictors of the …

Determinants Of Stress And Effects On Performance In Internal Medicine Residents, Sarah Braun

Theses and Dissertations

The purpose of the present study was to assess: a) perceived stress, burnout, depression, and empathy at three time points in internal medicine residents, b) the role of gender and trait mindfulness in stress response during residency and c) to evaluate the impact these variables have on performance evaluations. Additionally, specific tasks of the residency that may contribute to the experience of stress and burnout were evaluated to test a model of job strain. Stress predicted subsequent burnout and depression. Burnout predicted subsequent depression, and stress mediated this relationship. Women reported higher mean levels of empathy and burnout than men. …

The Heart Of Strength: The Strong Black Woman Schema And Cardiovascular Disease Risk, Jasmine A. Abrams

Theses and Dissertations

Black women are disproportionately affected by cardiovascular disease (CVD). While chronic stress has been identified as a key contributor to CVD risk, research has not identified the specific mechanisms through which stress influences CVD risk among Black women. Research suggests that in response to stress, Black women who internalize the SBW Schema engage in high effort coping, avoidant coping, postponement of self-care, and other maladaptive health behaviors and experience premature health deterioration. However, it is important to consider that internalization of the SBW Schema may exert differential effects on the physiological profiles of Black women due to varied interpretations of …

An Examination Of Weight, Weight Bias, And Health Care Utilization And Attitudes Among Emerging Adults, Jessica M. Mccauley

Theses and Dissertations

Individuals with overweight/obesity have been found to exhibit more negative attitudes toward health care and disproportionate rates of health care delay and avoidance, compared to their healthy weight peers. The present study sought to examine potential mechanisms through which weight status influences health care utilization and attitudes. Six hundred and thirty-three students completed a questionnaire measuring weight status, perceived weight bias, patient-provider relationship, and health care utilization and attitudes. Although the majority of the paths in the proposed theoretical mediation model were supported by the present findings, there was no support for the anticipated link between perceived weight bias and …

Heterosexism, Mental Health, And Suicide: Investigating The Moderating Role Of Coping In Sexual Minority Men, Michael A. Trujillo

Theses and Dissertations

This cross-sectional study examined if heterosexist experiences (harassment/rejection, workplace/school discrimination, other) were associated with suicidality (suicidal ideation, suicide attempts) and symptoms of anxiety/depression, and if symptoms of anxiety/depression were associated with suicidality in a national sample of sexual minority men (SMM; N = 89). The study also examined if depression mediated the relationship between heterosexist events and suicidal ideation and whether active and disengaged coping styles moderated this relationship. All associations were significant and positive, with harassment/rejection and symptoms of depression generally independently associated with outcome variables. Symptoms of depression were a significant mediator of the harassment/rejection-suicidal ideation relationship; however, …

The Role Of Psychology In Integrated Primary Care For Complex Patients: Effects On Mental Health, Utilization Of Medical Services, And Physiological Markers Of Health, Danielle C. Worthington

Theses and Dissertations

This study served as an initial evaluation of integrated psychology services within a clinic designed to serve uninsured patients with complex medical concerns and high utilization histories at the Medical College of Virginia in Richmond, Virginia. The current study evaluates patient outcomes, and more specifically, it further quantifies and describes the role that psychologists play in the primary care setting and their impact on utilization of medical care and in improved health outcomes. Additionally, the study evaluates psychologists’ success at treating mental and behavioral health conditions within the primary care model. The present study demonstrates that patients with complex medical …

Sexual Behavior And Hiv Risk In Black College Women: The Influence Of Gender, Peer, And Relationship Beliefs, Melanie P. Moore

Theses and Dissertations

Black women in the United States disproportionately represent 64% of women with an HIV infection (CDC, 2013). Research is needed to better understand gender and culturally-specific factors that contribute to Black women’s HIV risk. The Theory of Gender and Power and the Theory of Planned behavior were used as theoretical frameworks in examining the effect of attitudinal beliefs (gender related beliefs), subjective norm beliefs (peer norms), and perceived behavioral control beliefs (relationship power) on sexual behavior in Black college women. Condom use and assertiveness in sexual communication were the dependent variables. Participants included 136 Black college women recruited through the …

Family Needs, Caregiver Burden, And Mental Health: Caregivers Of Individuals With Various Neurological Conditions From Colombia And Mexico, Megan Elizabeth Sutter

Theses and Dissertations

This cross-sectional study examined differences in family needs (informational, social, financial, health, and household support), caregiver mental health (depression, satisfaction with life, vitality, social functioning, and emotional role limitations), and caregiver burden (personal life, guilt, and psychological) among caregivers of individuals with traumatic brain injury, spinal cord injury, multiple sclerosis, and dementia from cities in Colombia and Mexico (N = 343). The study also examined the connections among family needs, caregiver mental health, and caregiver burden in the combined sample of caregivers of individuals with neurological conditions. Many significant differences were identified among groups, and implications are discussed. Family …

Examining The Effect Of Race On The Relationship Between Posttraumatic Stress Disorder And Metabolic Syndrome In Women, Leia Harper

Theses and Dissertations

Posttraumatic stress disorder (PTSD) is a psychiatric condition affecting approximately 8% of the adult U.S. population with rates twice as high in women than men. Increasingly, evidence has suggested a close relationship between PTSD and increased risk of metabolic diseases. However, the literature on PTSD and metabolic disease risk factors has been limited by the lack of investigation of the potential influence of race on this relation. The current study examined the possible effect of race on the relation between PTSD and metabolic risk. Data for this study were provided from sample of that included 50 African American women and …

The Influence Of Dementia Caregiver Mental Health On Quality Of Care In Argentina, Alejandra Morlett Paredes

Theses and Dissertations

This study examined the connections between cognitive functioning in individuals with dementia and caregiver burden, burden and mental health, mental health and quality of care. One hundred two dementia caregivers from San Lucas, Argentina completed questionnaires assessing these constructs. Caregiver burden, depression, anxiety, and satisfaction with life explained 18.8% of the variance in quality of care – respect and 14.7% of the variance in quality of care – provide. An SEM with generally adequate fit indices uncovered that cognitive functioning in individuals with dementia was inversely associated with caregiver burden, caregiver burden was inversely associated with mental health, and mental …

Parent-Adolescent Communication About Sexual Topics, Cultural Factors, And Latino Adolescents’ Sexual Behavior And Condom Attitudes, Efren A. Velazquez

Theses and Dissertations

This study examined whether cultural values and gender moderate the association between mother-adolescent communication about sex and adolescents’ sexual behavior/intention to engage in sex and condom use attitudes. One hundred and fifty Latino adolescents completed an anonymous survey that measured sexual health outcomes, mother-child communication, and cultural factors. In bivariate analyses, adolescents with a higher sense of familismo had a more positive attitude towards using condoms and more acculturated Latino adolescents were less likely to speak to their mothers about pre-coital or coital sexual topics. Females spoke more about sex with their mother, compared to males. Traditional gender roles moderated …

Follow-Up Evaluation Of Treatment For Anxiety And Depression Provided In A University-Based Primary Care Clinic, Renée M. Grinnell

Theses and Dissertations

Although integrated primary care psychology services are becoming increasingly common, the literature lacks adequate research support for the longitudinal durability of treatment effects following the conclusion of brief primary care interventions. This study served as a follow-up program evaluation of psychological services for depression and anxiety provided at the Medical College of Virginia’s Ambulatory Care Center in Richmond, Virginia. Data were collected on 47 adult primary care patients who received treatment for depression and/or anxiety between six and 18 months prior to the follow-up telephone call. Data were collected on the trajectory of depression scores throughout and following treatment, treatment …